Day 2 panel 1 community based cause of death et

1. Title of IMCHA Project:
Community Based Cause of Death Study Linked to Maternal and
Child Health Programs and Vital Statistics in Ethiopia
Title of Synergy Proposal
Statistical Alliance for Vital Events: Strengthening Reporting and
Program uses of Facility-based Child and Maternal Mortality in
Ethiopia and Mozambique
Names of Implementation Research Team:
Addis Ababa University and the Central Statistical Agency
(Ethiopia), Centre for Global Health Research at St. Michael’s
Hospital and University of Toronto (Canada), and Centro de
Investigacao em Saude de Manhiça (CISM) in Mozambique 1

2. Research questions/objectives
General Objective:
• Provide proof of concept that high quality, low-cost, community-based
cause of death (COD) data collection is feasible in Ethiopia, and can be used
to fill the large evidence gap on mortality in the national Civil Registration
and Vital Statistics system.
Specific Objectives
1. Generate a national open-source catalogue of COD data from 1990
onward.
2. Pilot an integrated "Global Resource to Accelerate Accurate Death
Estimation and Evaluation (GRADE)" platform to increase the quality and
feasibility of COD surveys.
3. Provide synthesized evidence to stakeholders, linking CODs to maternal,
newborn and child health outcomes.
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3. Methods
• Attended a south-south knowledge sharing meeting jointly hosted by the
Registrar General of India in New Delhi and Canadian partners (March 2016)
• Compiled a systematic review of Ethiopian maternal and childhood COD data
from 1990 to 2016
• Helped design the Ethiopian November 2017 census questionnaires in order to
compile sampling frame for the post census mortality survey
• Begun customisation of the e-platform for capture of verbal autopsy COD data
• Will train field workers on verbal autopsy data collection
• Will recruit and certify physicians on accurate coding of COD
• Will conduct the post census mortality survey
• Routine participation in capacity strengthening activities
• Routine engagement of governmental and non-governmental stakeholders
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4. IMCHA Project Implementation
Results to Date/Key Lessons Learned
• Main direct causes of maternal death in Ethiopia include obstetric complications such as
hemorrhage, unsafe abortion, pregnancy induced hypertension, obstructed labour, and
puerperal sepsis.
• Hemorrhage has been the leading cause of maternal mortality followed by hypertensive
disorder of pregnancy and sepsis in recent years while the contributions of obstructed
labour and abortions have been decreasing over the period.
• Indirect causes of maternal death included previously existing diseases or diseases that
developed during pregnancy which were aggravated by physiologic effects of pregnancy.
Challenges in Implementation and Mitigation Strategies
Challenges
•The facility based COD was not included in the original proposed work.
•We need to conduct a nationally representative COD study
Mitigation Strategies
• The IRT won the synergy grant to improve reporting and quality of facility based COD data
•We have to solicit more funding opportunities to allow for national scalability
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5. IMCHA Project Implementation
Implementation Research Team – Focus on Capacity Strengthening
•Engaged graduate students of public health (masters and PhD students) in AAU in the
systematic review of literature, and analysis and reporting of COD data
•Offer certified trainings on coding COD for physicians in Ethiopia
•Orienting CSA, VERA and EPHI/MOH staffs on the value of COD data for averting
preventable maternal and childhood illnesses in Ethiopia
Next Steps (Plan for 2017) and Areas for Collaboration
•Disseminate the findings from the systematic literature review on COD
•Ensure the inclusion of major identifiers of deceased mothers and children and
abridged form COD in the November 2017 census
•Design a post-census mortality survey sampling frame
•Prepare a pool of certified physicians on coding COD
•Customise the e-platform to capture of COD data via a post-census mortality survey5

6. Synergy Proposal Overview
Background
• WHO has recommended two complementary strategies to address large gap in evidence on
COD. These solutions should be integrated with CRVS systems.
i. expand community/home-based COD ascertainment via nationwide, representative COD surveys
ii. strengthen facility-based reporting of CODs
Research questions/objectives
• Research Question: Can facility-based maternal and child deaths with accurate COD
improve MNCH programs in two African countries?
• Objectives:
1. Build capacity within each country to sustain and expand facility-based COD reporting.
2. Ensure knowledge translation to MOH and key disease programs on uses of COD data
that are directly relevant to MNCH control programs.
3. Ensure knowledge translation to CRVS institutions to enable expansion of low-cost,
sustainable facility-based COD systems in other parts of each country (and to other
priority IMCHA countries, as relevant).

7. Focus of Work in Synergy
Areas for Strategic Consideration/Collaboration
1. Jointly develop an open-access, online course to teach about 200 health facility staff how
to accurately complete the WHO death certificate; “Advanced Course on Death
Certification” (ACDC).
2. Administer an ACDC pilot in 1 hospital and expand to the 4 other participating hospitals in
Ethiopia and Mozambique over 2.5 years.
3. Ethiopian and Mozambican partners will engage in a “south-south” technical exchange
with the Indian government, on methods for collecting and publishing annual reports on
the national medically certified deaths.
4. Collect data from the 5 participating hospitals in each country using custom-built online
data capture systems to report hospital child and maternal mortality statistics
(disaggregated by age, gender and socioeconomic status).
5. Conduct in-country Knowledge Translation workshops with a focus on:
a. Use of the data to improve MOH programs, such as immunization and nutrition programs
b. Possible scale up of facility-based COD data capture in other parts of the country in accordance with the
existing national CRVS strategy.