A Post-Census Mortality Survey to Capture HIV/AIDS Deaths and Other Causes of Death in Mozambique

A Post-Census Mortality Survey to Capture HIV/AIDS Deaths and Other Causes of Death in Mozambique Elisio Mazive – Mozambique National Institute of Statistics (INE), Maputo, Mozambique Stirling Cummings – MEASURE Evaluation, Chapel Hill, North Carolina, USA

Outline of Presentation

Background and Motivation

Design and Methods

Results

Policy Implications and Lessons Learned

Population: 20.9 million¹

11 Provinces, most urban in the south

Adult 15-49 prevalence rate: 12.5²-16%³

Adults 15+ living with HIV: 1.4 million²

Est. number Children 0-14 living with HIV: 100,000²

Est. number deaths due to AIDS: 81,000²

Est. number of children orphaned by AIDS: 400,000²

Background

Sources

US Census Bureau, 2009

UNAIDS/WHO, 2008

MZ National Survey, 2007

Motivation for a Post-Census Mortality Survey

Need for accurate and reliable mortality indicators (at the national and sub-national level)

The DHS and census do not provide data on cause-specific mortality.

Lack of fully-functioning vital registration system.

Opportunity for a post-census mortality survey following the 2007 census in Mozambique using SAVVY ¹ tools.

1. http://www.cpc.unc.edu/measure/tools/monitoring-evaluation-systems/savvy

HIV/AIDS Mortality Surveillance in Mozambique

A recent hospital-based mortality registration system provides some information on cause of death for Maputo Central Hospital.

Periodic surveys conducted in civil registries of 4 cities to assess cause of death.

Since above sources are inadequate to estimate national HIV/AIDS mortality in Mozambique, the SPECTRUM software has been used to model HIV/AIDS mortality.

Sample Design and Methods

Stratification by province x urban/rural.

Census enumeration areas (EAs) were randomly sampled - representative at the national, urban/rural, and provincial level.

All households in the sample EAs reporting a death in the last year for the census were interviewed with a verbal autopsy questionnaire.

A team of trained doctors reviewed the verbal autopsies and assigned and coded a cause of death following ICD-10 procedures.

Some Results from the Post-Census Mortality Survey

Distribution of Deaths by Age, by Sex n male deaths=5,315 n female deaths=4,753

Percent Distribution of Leading Causes of Death n male=5,315 n female=4,753

Percent Using Health Services Prior to Death n HIV/AIDS deaths=3,001 n all other deaths=7,075

Percent Distribution of Place of Death n HIV/AIDS deaths=2,985 n all other deaths=7,016

Percentage of All Deaths that are HIV/AIDS Deaths, by Province

What We Will Do in the Next Phase of Analysis

Survey deaths will be linked to the 2007 census; denominators from the census will allow us to determine mortality rates.

These mortality rates can then be compared by age, sex, across provinces, urban/rural, etc.

Challenges

A high quality census is essential. Errors in the census, in terms of cartography or data collection, make follow-up with verbal autopsy interviews difficult.

Post-census mortality surveys are highly dependent on census timetable for fieldwork and analysis.

Data management challenges.

Lessons Learned - Defining Deaths

Nearly 1 in 4 of census reported deaths (in the previous 12 months) were outside the reference period. This caused a significant decrease in sample size.

Stillbirths miscoded as infant deaths.

Policy Relevance of Survey Results

Provides national mortality burden estimates for Ministry of Health budgeting & planning.

Serves as a baseline for measuring the impact of scaled-up initiatives that aim to reduce mortality.

Identifies target populations and/or areas.

Provides indicators for: Millennium Development Goals; UNGASS; UNAIDS; PEPFAR, and the Global Fund to Fight AIDS, TB and Malaria; Poverty Reduction Strategies Indicators; The Safe Motherhood Initiative; Roll Back Malaria; Stop TB; The President’s Malaria Initiative.

Thank You