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


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

  1. 1. 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
  2. 2. Outline of Presentation <ul><li>Background and Motivation </li></ul><ul><li>Design and Methods </li></ul><ul><li>Results </li></ul><ul><li>Policy Implications and Lessons Learned </li></ul>
  3. 3. <ul><li>Population: 20.9 million¹ </li></ul><ul><li>11 Provinces, most urban in the south </li></ul><ul><li>Adult 15-49 prevalence rate: 12.5²-16%³ </li></ul><ul><li>Adults 15+ living with HIV: 1.4 million² </li></ul><ul><li>Est. number Children 0-14 living with HIV: 100,000² </li></ul><ul><li>Est. number deaths due to AIDS: 81,000² </li></ul><ul><li>Est. number of children orphaned by AIDS: 400,000² </li></ul>Background <ul><li>Sources </li></ul><ul><li>US Census Bureau, 2009 </li></ul><ul><li>UNAIDS/WHO, 2008 </li></ul><ul><li>MZ National Survey, 2007 </li></ul>
  4. 4. Motivation for a Post-Census Mortality Survey <ul><li>Need for accurate and reliable mortality indicators (at the national and sub-national level) </li></ul><ul><li>The DHS and census do not provide data on cause-specific mortality. </li></ul><ul><li>Lack of fully-functioning vital registration system. </li></ul><ul><li>Opportunity for a post-census mortality survey following the 2007 census in Mozambique using SAVVY ¹ tools. </li></ul>1. http://www.cpc.unc.edu/measure/tools/monitoring-evaluation-systems/savvy
  5. 5. HIV/AIDS Mortality Surveillance in Mozambique <ul><li>A recent hospital-based mortality registration system provides some information on cause of death for Maputo Central Hospital. </li></ul><ul><li>Periodic surveys conducted in civil registries of 4 cities to assess cause of death. </li></ul><ul><li>Since above sources are inadequate to estimate national HIV/AIDS mortality in Mozambique, the SPECTRUM software has been used to model HIV/AIDS mortality. </li></ul>
  6. 6. Sample Design and Methods <ul><li>Stratification by province x urban/rural. </li></ul><ul><li>Census enumeration areas (EAs) were randomly sampled - representative at the national, urban/rural, and provincial level. </li></ul><ul><li>All households in the sample EAs reporting a death in the last year for the census were interviewed with a verbal autopsy questionnaire. </li></ul><ul><li>A team of trained doctors reviewed the verbal autopsies and assigned and coded a cause of death following ICD-10 procedures. </li></ul>
  7. 7. Some Results from the Post-Census Mortality Survey
  8. 8. Distribution of Deaths by Age, by Sex n male deaths=5,315 n female deaths=4,753
  9. 9. Distribution of Deaths by Age, by Sex n male deaths=5,315 n female deaths=4,753
  10. 10. Percent Distribution of Leading Causes of Death n male=5,315 n female=4,753
  11. 11. Percent Using Health Services Prior to Death n HIV/AIDS deaths=3,001 n all other deaths=7,075
  12. 12. Percent Distribution of Place of Death n HIV/AIDS deaths=2,985 n all other deaths=7,016
  13. 13. Percentage of All Deaths that are HIV/AIDS Deaths, by Province
  14. 14. What We Will Do in the Next Phase of Analysis <ul><li>Survey deaths will be linked to the 2007 census; denominators from the census will allow us to determine mortality rates. </li></ul><ul><li>These mortality rates can then be compared by age, sex, across provinces, urban/rural, etc. </li></ul>
  15. 15. Challenges <ul><li>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. </li></ul><ul><li>Post-census mortality surveys are highly dependent on census timetable for fieldwork and analysis. </li></ul><ul><li>Data management challenges. </li></ul>
  16. 16. Lessons Learned - Defining Deaths <ul><li>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. </li></ul><ul><li>Stillbirths miscoded as infant deaths. </li></ul>
  17. 17. Policy Relevance of Survey Results <ul><li>Provides national mortality burden estimates for Ministry of Health budgeting & planning. </li></ul><ul><ul><li>Serves as a baseline for measuring the impact of scaled-up initiatives that aim to reduce mortality. </li></ul></ul><ul><ul><li>Identifies target populations and/or areas. </li></ul></ul><ul><li>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. </li></ul>
  18. 18. Thank You
  19. 19. <ul><li>MEASURE Evaluation is funded by the U.S. Agency for </li></ul><ul><li>International Development (USAID) through Cooperative </li></ul><ul><li>Agreement GHA-A-00-08-00003-00 and is </li></ul><ul><li>implemented by the Carolina Population Center at the </li></ul><ul><li>University of North Carolina at Chapel Hill, in partnership </li></ul><ul><li>With Futures Group International, John Snow, Inc., Macro </li></ul><ul><li>International Inc., Management Sciences for Health, and </li></ul><ul><li>Tulane University. The views expressed in this presentation </li></ul><ul><li>do not necessarily reflect the views of USAID or the United </li></ul><ul><li>States government. </li></ul>