Abstract
IntroductionMortality data provide essential evidence on the health status of populations in crisis-affected and resource-poor settings and to guide and assess relief operations. Retrospective surveys are commonly used to collect mortality data in such populations, but require substantial resources and have important methodological limitations. We evaluated the feasibility of an alternative method for rapidly quantifying mortality (the informant method). The study objective was to assess the economic feasibility of the informant method.MethodsThe informant method captures deaths through an exhaustive search for all deaths occurring in a population over a defined and recent recall period, using key community informants and next-of-kin of decedents. Between July and October 2008, we implemented and evaluated the informant method in: Kabul, Afghanistan; Mae La camp for Karen refugees, Thai-Burma border; Chiradzulu District, Malawi; and Lugufu and Mtabila refugee camps, Tanzania. We documented the time and cost inputs for the informant method in each site, and compared these with projections for hypothetical retrospective mortality surveys implemented in the same site with a 6 month recall period and with a 30 day recall period.FindingsThe informant method was estimated to require an average of 29% less time inputs and 33% less monetary inputs across all four study sites when compared with retrospective surveys with a 6 month recall period, and 88% less time inputs and 86% less monetary inputs when compared with retrospective surveys with a 1 month recall period. Verbal autopsy questionnaires were feasible and efficient, constituting only 4% of total person-time for the informant method's implementation in Chiradzulu District.ConclusionsThe informant method requires fewer resources and incurs less respondent burden. The method's generally impressive feasibility and the near real-time mortality data it provides warrant further work to develop the method given the importance of mortality measurement in such settings.
Highlights
Mortality data provide essential evidence on the health status of populations in crisis-affected and resourcepoor settings and to guide and assess relief operations
We reported findings of verbal autopsy questionnaires performed as part of the informant method in Malawi [9]
Study sites Between July and October 2008, we evaluated the informant method in four study sites: District 1 of Kabul, Afghanistan, a poor urban community; Mae La camp for Karen refugees, on the Thai-Burma border; Chiradzulu District in Malawi, a rural, scattered community impacted by the HIV pandemic; and Lugufu and Mtabila refugee camps in Tanzania, which hosted refugees mainly from the Democratic Republic of Congo and Burundi
Summary
Mortality data provide essential evidence on the health status of populations in crisis-affected and resourcepoor settings and to guide and assess relief operations. Relief agencies most commonly measure mortality through retrospective surveys, in which a representative sample of households is interviewed using a standardised questionnaire about demographic changes (births, deaths, in- and out-migrations) in the household over a specified period in the past (the recall period). Mortality surveys conducted in the humanitarian sector are not done frequently enough and often do not provide information useful for assessing programme performance They usually generate limited or unreliable data on causes of death, thereby reducing their usefulness for operational purposes [4,7]
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