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Vital Events Measurement in M&E

Vital Events Measurement in M&E



Presented by Bates Buckner, Kavita Singh and Robert Mswia at the MEASURE Evaluation End-of-Phase-III Event.

Presented by Bates Buckner, Kavita Singh and Robert Mswia at the MEASURE Evaluation End-of-Phase-III Event.



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    Vital Events Measurement in M&E Vital Events Measurement in M&E Presentation Transcript

    • Session XII: Vital Events Measurement in M&E Bates Buckner MEASURE Evaluation End-of-Phase-III Event, May 22, 2014
    • www.measureevaluation.org/eop
    • Births, Deaths, Causes of Death and Illness  Primal data elements, challenge to obtain
    • Long-term Goal – Strong Civil Registration/Vital Statistics Systems (CRVS)  Health & Demographic Surveillance Sites (HDSS), significant contribution, limitations
    • Interim and Mid-term Strategies MEASURE Evaluation Phase III  SAVVY – SAmple Vital Registration with Verbal AutopsY  Post-census enumeration surveys  Maternal mortality estimation – census and survey data
    • This Session  Experience with SAVVY  Robert Mswia  Estimating Maternal Mortality  Kavita Singh
    • www.measureevaluation.org/eop
    • Strengthening Health Information and Civil Registration/Vital Statistics Systems – SAVVY– A Promising Approach Robert Mswia MEASURE Evaluation End-of-Phase-III Event, May 22, 2014
    • Stepping Stones to a Vital Statistics System Source: WHO/Health Metrics Network DSS SAVVY
    • SAVVY Data Collection: Census Enumeration A census enumerator using a Tablet PC, and a pen-and-paper when needed (Source: SAVVY Tanzania)
    • SAVVY Data Collection: Verbal Autopsy Interview A SAVVY Coordinator conductingVA interview for a probable cause of death (Source: SAVVY Tanzania)
    • Active Reporting of SAVVY Vital Events A SAVVY Facilitator training Key Informants on using mobile phones for reporting birth and death events in their communities
    • Different Scenarios – Examples From 3 Countries Currently Implementing SAVVY  Zambia  Tanzania  Malawi
    • Case Study 1: Tanzania
    • Case Study 2 – Zambia  SAVVY seen as key strategy for:  Improving quality and coverage of vital events  Building national system of vital registration
    • 5.0 9.9 1.2 1.3 1.5 1.8 2.4 3.1 3.8 5.6 5.7 5.9 6.2 6.5 9.8 10.9 19.3 4.3 10.2 1.5 0.4 1.6 2.3 1.4 3.1 3.2 4.1 4.8 4.9 9.0 5.9 5.3 4.4 12.2 21.5 25 20 15 10 5 0 5 10 15 20 25 Ill-defined & undetermined causes All other remaining causes Maternal causes Disorders of the kidney Meningitis Senility/oldage Diabetes mellitus Neoplasms Stillbirth Diarrhoeal diseases Perinatal and neonatal conditions Pneumonia/ARI Disease of the circulatory system Tuberculosis Malnutrition Injuries & Accidents AFI / Malaria HIV-related diseases Females (N=1,282) Males (N=1,474) Example: Output from SAVVY Zambia – Leading Causes of Death
    • SAVVY and the Saving Mothers, Giving Life Initiative (SMGL) in Zambia  SAVVY approach adopted for M&E of SMGL initiative in 4 districts.  Document change in maternal deaths before and after implementation of program interventions
    • SMGL Zambia: Percent Distribution of Maternal Deaths by Main Causes (N = 91 maternal deaths)
    • SAVVY Implementation in Zambia and Tanzania – Achievements  Change in practice: Cause of death certification based on ICD  SAVVY data to complement HMIS data  SAVVY incorporated into national M&E strategic plans as key data source
    • Integration, Institutionalization, Sustainability  IntegratedinHMIS,M&Eandnationalregistration bureaus–governmentcommitment  Involvementofotherministriesandinstitutions  LinkingCRVS,SAVVYandHMIS  Capacitybuilding  Goodwill
    • Key Issues in Maternal Mortality-Estimation and Cause of Death Kavita Singh MEASURE Evaluation End-of-Phase-III Event, May 22, 2014
    • A Human Rights Issue  Motherhood and childhood are entitled to special care and assistance. UN General Assembly, 1948. Article 25 of The UN Declaration of Human Rights
    • Maternal Mortality Estimation  Challenges  Incomplete vital registration systems  Large sample sizes needed for surveys  Two key activities:  2010 Bangladesh Maternal Mortality Survey  2014 Workshop on Estimating Maternal Mortality from Census Data
    • 2010 Bangladesh Maternal Mortality Survey (2010 BMMS)  175,000 households surveyed  Precise estimate of maternal mortality  Rich data on socio- economic and biological/ health services factors
    • Ascertaining Cause of Death from the 2010 BMMS  Sisterhood Method  Married womenareaskedaboutsurvival status ofsisters  Questions on Household Deaths  Householdswere askedaboutdeaths since 2006  Verbal Autopsy follow-up  Householddeaths ofwomen13to49 were followed upwith a verbal autopsy
    • Estimation from Census Data  Largesamplesizesavailable  Questionscanbeincludedonrecent deathsandspecificallypregnancy- relateddeaths  Yields pregnancy-related mortality rather than maternal mortality estimates  Sub-national level estimation is possible
    • Estimation from Census Data  Need to carefully assess quality of census data first  Reporting of adult (female) deaths  Reporting of pregnancy-related deaths among all deaths of women of reproductive age  Reporting of births  Key Resource: WHO (2013). WHO Guidance for Measuring Maternal Mortality from a Census. WHO, Geneva
    • Cause of Maternal Death WHO (2010) A global overview of Maternal Mortality. http://www.childinfo.org/maternal_mortality.html Cause of Maternal Deaths Globally 1997-2007
    • Indirect Causes of Maternal Mortality: A Study of Mozambique  Post Census Verbal Autopsy Survey Data 2007-2008  Indirect Causes  18.2%: HIV; 23.1%: Malaria  Study also found  Provincial-level variation in cause of death.  Population-level data revealed more indirect deaths than facility-level data. Singh,K, Moran, A, Story, W, Bailey, P, Chavane, L. Acknowledging HIV and Malaria as Major Causes of Maternal Mortality in Sub-Saharan Africa: A Study of Mozambique (forthcoming) Curtis, S, Mswia, R, Weaver E. Application for Measuring Maternal Mortality: Three Case Studies using Verbal Autopsy. Presentation at the 2013 IUSSP International Population Conference. Busan, Republic of Korea.
    • Indirect Causes of Maternal Mortality: A Study of Mozambique
    • Summary  Survey Methods: Provide a rich source of information  Census Method: A promising method of pregnancy-related mortality estimation  From a program and policy perspective  Indirect causes of maternal mortality need attention in Africa  Cause of death and sub-national population-level data are crucial
    • www.measureevaluation.org/eop