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A Post-Census Mortality Survey to Capture HIV/AIDS Deaths
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A Post-Census Mortality Survey to Capture HIV/AIDS Deaths A Post-Census Mortality Survey to Capture HIV/AIDS Deaths Presentation Transcript

  • 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
    • 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
  • 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
    • MEASURE Evaluation is funded by the U.S. Agency for
    • International Development (USAID) through Cooperative
    • Agreement GHA-A-00-08-00003-00 and is
    • implemented by the Carolina Population Center at the
    • University of North Carolina at Chapel Hill, in partnership
    • With Futures Group International, John Snow, Inc., Macro
    • International Inc., Management Sciences for Health, and
    • Tulane University. The views expressed in this presentation
    • do not necessarily reflect the views of USAID or the United
    • States government.