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Monitoring child survival in ‘real time’ using routine health facility records: results from M alawi
Author(s) -
Amouzou Agbessi,
Kachaka Willie,
Banda Benjamin,
Chimzimu Martina,
Hill Kenneth,
Bryce Jennifer
Publication year - 2013
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12167
Subject(s) - health facility , medicine , environmental health , developing country , child mortality , demography , population , mortality rate , health services , economic growth , sociology , economics
Objectives Few developing countries have the accurate civil registration systems needed to track progress in child survival. However, the health information systems in most of these countries do record facility births and deaths, at least in principle. We used data from two districts of M alawi to test a method for monitoring child mortality based on adjusting health facility records for incomplete coverage. Methods Trained researchers collected reports of monthly births and deaths among children younger than 5 years from all health facilities in B alaka and S alima districts of M alawi in 2010–2011. We estimated the proportion of births and deaths occurring in health facilities, respectively, from the 2010 Demographic and Health Survey and a household mortality survey conducted between October 2011 and February 2012. We used these proportions to adjust the health facility data to estimate the actual numbers of births and deaths. The survey also provided ‘gold‐standard’ measures of under‐five mortality. Results Annual under‐five mortality rates generated by adjusting health facility data were between 35% and 65% of those estimated by the gold‐standard survey in B alaka, and 46% and 50% in S alima for four overlapping 12‐month periods in 2010–2011. The ratios of adjusted health facility rates to gold‐standard rates increased sharply over the four periods in B alaka, but remained relatively stable in S alima. Conclusions Even in M alawi, where high proportions of births and deaths occur in health facilities compared with other countries in sub‐ S aharan A frica, routine H ealth M anagement I nformation S ystems data on births and deaths cannot be used at present to estimate annual trends in under‐five mortality.