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Undertaking cause-specific mortality measurement in an unregistered population: an example from Tigray Region, Ethiopia
Tigray Regional Health Bureau, Mekelle, Ethiopia.
Tigray Regional Health Bureau, Mekelle, Ethiopia.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (WHO Collaborating Centre for Verbal Autopsy)ORCID iD: 0000-0003-1332-4138
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (WHO Collaborating Centre for Verbal Autopsy)ORCID iD: 0000-0003-2478-9598
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2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25264Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The lack of adequate documentation of deaths, and particularly their cause, is often noted in African and Asian settings, but practical solutions for addressing the problem are not always clear. Verbal autopsy methods (interviewing witnesses after a death) have developed rapidly, but there remains a lack of clarity as to how these methods can be effectively applied to large unregistered populations. This paper sets out practical details for undertaking a representative survey of cause-specific mortality in a population of several million, taking Tigray Region in Ethiopia as a prototype.

SAMPLING: Sampling was designed around an expected level of maternal mortality ratio of 400 per 100,000 live births, which needed measuring within a 95% confidence interval of approximately ±100. Taking a stratified cluster sample within the region at the district level for logistic reasons, and allowing for a design effect of 2, this required a population of around 900,000 people, equating to six typical districts. Since the region is administered in six geographic zones, one district per zone was randomly selected.

IMPLEMENTATION: The survey was implemented as a two-stage process: first, to trace deaths that occurred in the sampled districts within the preceding year, and second to follow them up with verbal autopsy interviews. The field work for both stages was undertaken by health extension workers, working in their normally assigned areas. Most of the work was associated with tracing the deaths, rather than undertaking the verbal autopsy interviews.

DISCUSSION: This approach to measuring cause-specific mortality in an unregistered Ethiopian population proved to be feasible and effective. Although it falls short of the ideal situation of continuous civil registration and vital statistics, a survey-based strategy of this kind may prove to be a useful intermediate step on the road towards full civil registration and vital statistics implementation.

Place, publisher, year, edition, pages
Co-Action publishing , 2014. Vol. 7, article id 25264
Keywords [en]
Ethiopia, mortality, verbal autopsy, population survey, civil registration and vital statistics, evidence-based decision making
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Identifiers
URN: urn:nbn:se:umu:diva-93710DOI: 10.3402/gha.v7.25264ISI: 000341393000001PubMedID: 25217254Scopus ID: 2-s2.0-84929512801OAI: oai:DiVA.org:umu-93710DiVA, id: diva2:750891
Available from: 2014-09-30 Created: 2014-09-30 Last updated: 2024-07-02Bibliographically approved
In thesis
1. Bridging gaps in under-five child health: a comprehensive assessment of their social determinants and the health system performance in Tigray, Ethiopia
Open this publication in new window or tab >>Bridging gaps in under-five child health: a comprehensive assessment of their social determinants and the health system performance in Tigray, Ethiopia
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att överbrygga klyftor inom barnhälsa för barn under fem år : En omfattande bedömning av deras sociala determinanter och hälsosystemets prestanda i Tigray, Etiopien
Abstract [en]

Background: Achieving the Sustainable Development targets related to child health necessitates a deep understanding of the multifaceted factors influencing their health.

Aim: To comprehensively examine the social determinants of the access to, and quality of, child health services, and the performance of the health system in the region of Tigray.

Methods: The study was conducted in six randomly selected rural districts of Tigray. The study employed focus group discussions and interviews (sub-study I), a retrospective case-control study (sub-study-II), a capture recapture method (sub-study III), and a two-stage mortality survey (sub-study IV).

Results: Sub-study I: underscored a good knowledge on the causes and management of common childhood morbidity, and that the health posts were conveniently located and provided trusted services. However, several barriers to using health services were identified. These included cultural beliefs, seasonal mobility, economic constraints, limited decision-making power for women, and accessibility challenges.Sub-study II: Revealed that only 76% of eligible children born to HIV-positive mothers were tested, with 17% testing positive for HIV, and only 29% of them linked to anti-retroviral treatment.Sub-study III showed that the concordance correlation coefficient between the Family Folder data and the household survey for the total population, reproductive age women, and under-five year child population were all above 0.73, while they were close to zero for other child health parameters. Tracing and recording neonatal deaths, and the aggregation of data at various levels were the major operational challanges.Sub-study IV identified infectious diseases (52.9%), neonatal causes (35.6%), nutritional disorders (6.6%) and external causes (4.3%) as the major causes of child death. The cause for 76 (16.2%) children was indeterminate. Tracing neonatal deaths and logistical challenges, especially in remote areas were the major operational issues of conducting the mortality survey.

Conclusion: In spite of the improvements in health literacy, access to cost-free reproductive, maternal, neonatal and child health services and improved utilization, various interrelated social determinants, including cultural beliefs, financial barriers and health system-related factors continue to hinder the optimal utilization of essential child health services. Moreover, the health system’s performance in the prevention of mother-to-child transmission of HIV and its effect in reducing mortality among exposed children is generally poor. Policymakers in the region should focus on tackling those social determinants, including the health system, to improve children´s health. The community health information system showed promising potential. However, the operational issue of capturing neonatal deaths adequately and the process by which community data can be aggregated upwards through the health system has to be improved. The study underscored the viability of implementing a cause-specific mortality survey using health extension workers, and the need to standardize data collection tools and logistics before implementation on a larger scale.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. p. 94
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2307
Keywords
Under-five children, family folder, community, health information, verbal autopsy, health extension program, health system, Tigray, Ethiopia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-224584 (URN)978-91-8070-404-5 (ISBN)978-91-8070-403-8 (ISBN)
Public defence
2024-08-30, NUS By 5B. plan 3, Umeå universitetssjukhus Rum Alicante, 09:00 (English)
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Note

Paper III listed in thesis with title "Assessing the performance of the FF system for collecting community-based health information In Tigray Region, North Ethiopia: A capture-recapture study". Correct title of publication: Assessing the performance of the family folder system for collecting community-based health information in Tigray Region, North Ethiopia: a capture-recapture study".

Available from: 2024-05-24 Created: 2024-05-20 Last updated: 2024-05-22Bibliographically approved

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Abrha, AtakeltiKinsman, JohnMyléus, AnnaByass, Peter

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