Comparison of government statistics and demographic surveillance to monitor mortality in children less than five years old in rural western Kenya.
Estimates of mortality in children less than five years old using government civil registration statistics (passive surveillance) were compared against statistics generated by active demographic surveillance during a randomized controlled trial of permethrin-treated bed nets (ITNs) in western Kenya. Mortality rates were two-fold lower when estimated through civil registration compared with active prospective surveillance (rate ratio [RR] = 0.51, 95% confidence interval [CI] = 0.44-0.59). While civil registration underestimated deaths, particularly in the neonatal period, the age distribution of deaths in children 1-59 months of age was the same as with active surveillance. Seasonal mortality trends were also similar. There was no agreement between cause of death recorded by active and passive surveillance. Verbal autopsy estimated that half of all deaths were associated with malaria and pneumonia, but civil registration markedly under-reported these illnesses; incidence RR (95% CI) = 0.18 (0.14-0.24), and 0.05 (0.03-0.08), respectively, while over-reporting deaths due to measles (RR = 15.5 [95% CI = 7.3-33.2]). Government statistics under-represent mortality, particularly neonatal mortality, in children less than five years of age in rural areas of Kenya. They can provide accurate information on the age-distribution of deaths among children 1-59 months old, and on seasonal trends, but not on disease-specific mortality.
Arudo
John
J
Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Centers for Disease Control and Prevention, Kisumu, Kenya.
Gimnig
John E
JE
ter Kuile
Feiko O
FO
Kachur
S Patrick
SP
Slutsker
Laurence
L
Kolczak
Margarette S
MS
Hawley
William A
WA
Orago
Alloys S S
AS
Nahlen
Bernard L
BL
Phillips-Howard
Penelope A
PA
D017677:Age Distribution; D002423:Cause of Death; D002675:Child, Preschool; D003710:Demography; D006077:Government Agencies; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D011159:Population Surveillance / Q000379:methods; D012042:Registries; D012424:Rural Population; D011795:Surveys and Questionnaires; D013997:Time Factors