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

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.

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

by MEASURE Evaluation on Oct 19, 2009

Accessibility

Tags

Upload Details

Usage Rights

1 Embed 1

Statistics

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