Monitoring Child Mortality through Community Health Worker Reporting of Births and Deaths in Malawi: Validation against a Household Mortality Survey
Monitoring Child Mortality through Community Health Worker Reporting of Births and Deaths in Malawi: Validation against a Household Mortality Survey
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DOI：
10.1371/journal.pone.0088939
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发表时间：
2014-02-18
期刊：
影响因子：
3.7
通讯作者：
Bryce, Jennifer
中科院分区：
文献类型：
--
作者：
Amouzou, Agbessi;Banda, Benjamin;Bryce, Jennifer
背景资料：在大多数非洲国家，儿童死亡率下降速度太慢，无法实现在1990年至2015年期间将五岁以下儿童死亡率降低三分之二的千年发展目标。在缺乏准确的生命登记数据的情况下，需要制定有效的战略来监测儿童死亡率，以帮助政府评估和报告儿童生存方面的进展情况。我们目前的结果从一个测试的基础上记录出生和死亡的死亡率监测方法由专门培训的社区卫生工作者（CHWs）在Malawi.Methods和调查结果：政府雇用的社区卫生工作者在马拉维负责维护一个村庄的健康登记册，在其中他们记录出生和死亡发生在他们的集水区。我们扩大了这一制度，以提供额外的培训、监督和激励。我们测试了两个地区的160名随机选择和培训的CHW在20个月内收集的出生和死亡数据与通过标准家庭死亡率调查计算的数据之间的等效性。CHW报告得出的5岁以下儿童死亡率为住户调查死亡率的84%（95% CI：[0.71，1.00]），在统计学上与住户调查死亡率相当。五岁以下儿童的死亡比出生更有可能被遗漏。新生儿和婴儿死亡更有可能被错过比老年人deaths.Conclusion：这第一次测试的准确性和完整性的人口动态事件的数据报告的CHWs在马拉维作为一项战略，用于监测儿童死亡率显示出可喜的成果，但低估了儿童死亡率，并不稳定，在四个时期的评估。鉴于马拉维政府致力于加强其生命登记系统，我们正在与卫生部合作，实施该方法的修订版，为社区卫生工作者提供更多支持。
Background: The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed where accurate vital registration data are lacking to help governments assess and report on progress in child survival. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially trained community health workers (CHWs) in Malawi.Methods and Findings: Government-employed community health workers in Malawi are responsible for maintaining a Village Health Register, in which they record births and deaths that occur in their catchment area. We expanded on this system to provide additional training, supervision and incentives. We tested the equivalence between child mortality rates obtained from data on births and deaths collected by 160 randomly-selected and trained CHWs over twenty months in two districts to those computed through a standard household mortality survey. CHW reports produced an under-five mortality rate that was 84% (95% CI: [0.71,1.00]) of the household survey mortality rate and statistically equivalent to it. However, CHW data consistently underestimated under-five mortality, with levels of under-estimation increasing over time. Under-five deaths were more likely to be missed than births. Neonatal and infant deaths were more likely to be missed than older deaths.Conclusion: This first test of the accuracy and completeness of vital events data reported by CHWs in Malawi as a strategy for monitoring child mortality shows promising results but underestimated child mortality and was not stable over the four periods assessed. Given the Malawi government's commitment to strengthen its vital registration system, we are working with the Ministry of Health to implement a revised version of the approach that provides increased support to CHWs.