Abstract
Measuring rates and circumstances of population mortality (in particular crude and under-5 year mortality rates) is essential to evidence-based humanitarian relief interventions. Because prospective vital event registration is absent or deteriorates in nearly all crisis-affected populations, retrospective household surveys are often used to estimate and describe patterns of mortality. Originally designed for measuring vaccination coverage, the two-stage cluster survey methodology is frequently employed to measure mortality retrospectively due to limited time and resources during humanitarian emergencies. The method tends to be followed without considering alternatives, and there is a need for expert advice to guide health workers measuring mortality in the field.In a workshop in France in June 2006, we deliberated the problems inherent in this method when applied to measure outcomes other than vaccine coverage and acute malnutrition (specifically, mortality), and considered recommendations for improvement. Here we describe these recommendations and outline outstanding issues in three main problem areas in emergency mortality assessment discussed during the workshop: sampling, household data collection issues, and cause of death ascertainment. We urge greater research on these issues. As humanitarian emergencies become ever more complex, all agencies should benefit from the most recently tried and tested survey tools.
Highlights
Measuring rates and circumstances of population mortality is an essential component of evidence-based humanitarian relief interventions
Crude and under-5 mortality rates are used internationally to benchmark the severity of crises [1] and evaluate the effectiveness of humanitarian assistance
We focus here on one approach for household selection that has led to much discussion
Summary
Measuring rates and circumstances of population mortality is an essential component of evidence-based humanitarian relief interventions. Before any cluster survey, investigators perform a literature search for past reports providing Deff or ICC within the population to be studied, so as to inform sample size calculations. Accurate documentation of the reasons for each instance of non-response should be standard practice in every survey; this information will be key in interpreting findings, assessing the possibility of selection bias, considering the pros and cons of weighting, and could be important in performing sensitivity analyses which take likely mortality levels among nonresponders into account. Calculations of sample size should be based on the estimated proportion, the desired confidence level, the anticipated level of non-response and an estimate of either the ICC or Deff This information can be used to determine the number of households to select, in addition to an estimated proportion of the target group in the population (e.g. children < 5 years of age) and the average household size (if known). In some countries (e.g. Iraq) death certificates are available [3]; these aid greatly in identifying causes of death
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