Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana
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Date
2018-01
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Background
Reducing 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 findings
This 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). Thediscrepancies between the CBV and FPH estimates of infant and neonatal mortality were
more limited, but varied significantly across districts.
Conclusions
In 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.
Description
Keywords
Child Mortality, Community-based volunteers, sustainable development goal (SDG), Monitoring system based
Citation
Helleringer S, Arhinful D, Abuaku B, Humes M, Wilson E, Marsh A, et al. (2018) Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana.