Abstract
BackgroundReducing neonatal and child mortality is a key component of the health-related sustainable development goal (SDG), but most low and middle income countries lack data to monitor child mortality on an annual basis. We tested a mortality monitoring system based on the continuous recording of pregnancies, births and deaths by trained community-based volunteers (CBV).Methods and findingsThis project was implemented in 96 clusters located in three districts of the Northern Region of Ghana. Community-based volunteers (CBVs) were selected from these clusters and were trained in recording all pregnancies, births, and deaths among children under 5 in their catchment areas. Data collection lasted from January 2012 through September 2013. All CBVs transmitted tallies of recorded births and deaths to the Ghana Birth and deaths registry each month, except in one of the study districts (approximately 80% reporting). Some events were reported only several months after they had occurred. We assessed the completeness and accuracy of CBV data by comparing them to retrospective full pregnancy histories (FPH) collected during a census of the same clusters conducted in October-December 2013. We conducted all analyses separately by district, as well as for the combined sample of all districts. During the 21-month implementation period, the CBVs reported a total of 2,819 births and 137 under-five deaths. Among the latter, there were 84 infant deaths (55 neonatal deaths and 29 post-neonatal deaths). Comparison of the CBV data with FPH data suggested that CBVs significantly under-estimated child mortality: the estimated under-5 mortality rate according to CBV data was only 2/3 of the rate estimated from FPH data (95% Confidence Interval for the ratio of the two rates = 51.7 to 81.4). The discrepancies between the CBV and FPH estimates of infant and neonatal mortality were more limited, but varied significantly across districts.ConclusionsIn northern Ghana, a community-based data collection systems relying on volunteers did not yield accurate estimates of child mortality rates. Additional implementation research is needed to improve the timeliness, completeness and accuracy of such systems. Enhancing pregnancy monitoring, in particular, may be an essential step to improve the measurement of neonatal mortality.
Highlights
Countries worldwide must have accurate data on births and deaths to track progress towards the health-related Sustainable Development Goal (SDG) on an annual basis
Comparison of the community-based volunteers (CBV) data with full pregnancy histories (FPH) data suggested that CBVs significantly under-estimated child mortality: the estimated under-5 mortality rate according to CBV data was only 2/3 of the rate estimated from FPH data (95% Confidence Interval for the ratio of the two rates = 51.7 to 81.4)
We evaluated the ability of CBV data to produce accurate mortality estimates, through comparison with FPH data collected in the same communities
Summary
Countries worldwide must have accurate data on births and deaths to track progress towards the health-related Sustainable Development Goal (SDG) on an annual basis. Retrospective interviews, on the other hand, yield representative estimates of mortality rates for countries or sub-national regions when they are collected during representative surveys They do so by collecting full pregnancy histories (FPH) or full birth histories (FBH), i.e., a series of questions during which women aged 15–49 years old report on all pregnancies or all births they ever had and the associated dates of birth outcomes and date or age at death of each child who died. Mothers may not report some births/ deaths ( if they have occurred several years prior to the survey), may misreport the child’s age or age at death [10, 11], or may misclassify stillbirths as neonatal deaths and viceversa [12] Despite these potential issues, FPH and FBH constitute the current best practice in mortality measurement in LMICs with limited CRVS systems. We tested a mortality monitoring system based on the continuous recording of pregnancies, births and deaths by trained community-based volunteers (CBV)
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