Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana

BackgroundReducing neonatal and child mortality is a key component of the health-related sustainable development goal (SDG), but most low and middle income countries lack data to monitor child mortality on an annual basis. We tested a mortality monitoring system based on the continuous recording of pregnancies, births and deaths by trained community-based volunteers (CBV).Methods and findingsThis project was implemented in 96 clusters located in three districts of the Northern Region of Ghana. Community-based volunteers (CBVs) were selected from these clusters and were trained in recording all pregnancies, births, and deaths among children under 5 in their catchment areas. Data collection lasted from January 2012 through September 2013. All CBVs transmitted tallies of recorded births and deaths to the Ghana Birth and deaths registry each month, except in one of the study districts (approximately 80% reporting). Some events were reported only several months after they had occurred. We assessed the completeness and accuracy of CBV data by comparing them to retrospective full pregnancy histories (FPH) collected during a census of the same clusters conducted in October-December 2013. We conducted all analyses separately by district, as well as for the combined sample of all districts. During the 21-month implementation period, the CBVs reported a total of 2,819 births and 137 under-five deaths. Among the latter, there were 84 infant deaths (55 neonatal deaths and 29 post-neonatal deaths). Comparison of the CBV data with FPH data suggested that CBVs significantly under-estimated child mortality: the estimated under-5 mortality rate according to CBV data was only 2/3 of the rate estimated from FPH data (95% Confidence Interval for the ratio of the two rates = 51.7 to 81.4). The discrepancies between the CBV and FPH estimates of infant and neonatal mortality were more limited, but varied significantly across districts.ConclusionsIn northern Ghana, a community-based data collection systems relying on volunteers did not yield accurate estimates of child mortality rates. Additional implementation research is needed to improve the timeliness, completeness and accuracy of such systems. Enhancing pregnancy monitoring, in particular, may be an essential step to improve the measurement of neonatal mortality.背景 降低新生儿与儿童死亡率是健康相关可持续发展目标（SDG）的核心组成部分，但绝大多数中低收入国家缺乏按年度监测儿童死亡率的相关数据。本研究针对由经培训的社区志愿者（Community-based volunteer, CBV）持续记录妊娠、分娩与死亡事件的死亡率监测系统开展了测试。 方法与结果 本项目在加纳北部地区3个行政区的96个集群中实施。研究人员从上述集群中招募社区志愿者（Community-based volunteer, CBV），并对其开展系统培训，使其能够记录服务覆盖区域内所有5岁以下儿童的妊娠、分娩与死亡事件。数据采集工作于2012年1月至2013年9月期间开展。所有CBV每月均向加纳出生与死亡登记系统上报其记录的分娩与死亡事件统计数据，仅其中一个研究行政区的上报率约为80%。部分事件会在发生数月后才被上报。本研究通过将CBV采集的数据与2013年10月至12月期间对同一集群开展的普查中收集的回顾性完整妊娠史（Full pregnancy history, FPH）进行比对，评估了CBV数据的完整性与准确性。所有分析均按行政区单独开展，同时也对所有行政区的合并样本进行了综合分析。在21个月的实施周期内，CBV共计上报2819例分娩事件与137例5岁以下儿童死亡事件。其中，婴儿死亡84例（含55例新生儿死亡与29例新生儿后期死亡）。将CBV数据与FPH数据进行比对后发现，CBV显著低估了儿童死亡率：根据CBV数据估算的5岁以下儿童死亡率仅为FPH数据估算结果的2/3（两率比值的95%置信区间为51.7至81.4）。CBV与FPH对婴儿死亡率及新生儿死亡率的估算差异相对有限，但在不同行政区间存在显著差异。 结论 在加纳北部地区，依托志愿者的社区数据采集系统无法得出准确的儿童死亡率估算结果。仍需开展额外的实施研究，以提升此类系统的时效性、完整性与准确性。其中，加强妊娠监测或为改善新生儿死亡率测量精度的关键步骤。