TY - JOUR
T1 - Using community-based reporting of vital events to monitor child mortality
T2 - Lessons from rural Ghana
AU - Helleringer, Stephane
AU - Arhinful, Daniel
AU - Abuaku, Benjamin
AU - Humes, Michael
AU - Wilson, Emily
AU - Marsh, Andrew
AU - Clermont, Adrienne
AU - Black, Robert E.
AU - Bryce, Jennifer
AU - Amouzou, Agbessi
N1 - Funding Information:
This research was supported by the "Real-Time Results Tracking" grant (#7056791) from Global Affairs Canada (http://www. international.gc.ca/international/index.aspx?lang= eng), known as the Canadian International Development Agency at the time of the award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank Global Affairs Canada for financial support, the Noguchi Memorial Institute for Medical Research at the University of Ghana for local support, and the Ghana Births and Deaths Registry for its assistance in implementing various activities. In addition to authors on this paper, the RMM Ghana country team included Richard Akuffo and Sedzro Mensah, Data Editors; Dziedzom Awalime, Research Assistant; Bismark Ofosu, Research Assistant; and Zakaria Abdulai and Mohammed Yakubu, Field Research Assistants. We also posthumously acknowledge the late Sandra Serwaa Bredu, who was the administrative assistant of the project in Ghana. The RMM Ghana team at IIP-JHU also included Eoghan Brady, Ken Hill, and Romesh Silva. We are grateful for their contributions to the project. Special thanks are due to Ghana RMM team members involved in technical assistance, project development and data collection, management and analysis. In addition to the contributors from Noguchi, we would like to thank Kingsley Addo of the Birth and Death Registry Accra, as well as the Regional Director of the Ghana Health Service and his team at the Northern regional health directorate and the many other individuals who contributed to this work. Among JHU-IIP members, we would like to extend our particular thanks to Lois Park, as well as former JHU-IIP faculty Marjorie Opuni and Kate Gilroy. RMM senior technical advisors Gareth Jones and Cesar Victora provided steady guidance and technical inputs along the way. Finally, we are extremely grateful to the hard-working Community Based Volunteers, the district GBDR officers who were involved in the fieldwork over the course of the project, and the women and families who generously shared personal reproductive health information with CBVs and survey team members. We would not be able to carry out this project without their support and participation.
Publisher Copyright:
© 2018 Helleringer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/1
Y1 - 2018/1
N2 - 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). The discrepancies 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.
AB - 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). The discrepancies 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.
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U2 - 10.1371/journal.pone.0192034
DO - 10.1371/journal.pone.0192034
M3 - Article
C2 - 29381745
AN - SCOPUS:85041223237
SN - 1932-6203
VL - 13
JO - PloS one
JF - PloS one
IS - 1
M1 - e0192034
ER -