A new method to estimate mortality in crisis-affected and resource-poor settings: validation study.
BACKGROUND
Data on mortality rates are crucial to guide health interventions in crisis-affected and resource-poor settings. The methods currently available to collect mortality data in such settings feature important methodological limitations. We developed and validated a new method to provide near real-time mortality estimates in such settings.


METHODS
We selected four study sites: Kabul, Afghanistan; Mae La refugee camp, Thailand; Chiradzulu District, Malawi; and Lugufu and Mtabila refugee camps, Tanzania. We recorded information about all deaths in a 60-day period by asking key community informants and decedents' next of kin to refer interviewers to bereaved households. We used the total number of deaths and population estimates to calculate mortality rates for 60- and 30-day periods. For validation we compared these rates with a best estimate of mortality using capture-recapture analysis with two further independent lists of deaths.


RESULTS
The population covered by the new method was 76 ,476 persons in Kabul, 43,794 in Mae La camp, 54,418 in Chiradzulu District and 80,136 in the Tanzania camps. The informant method showed moderate sensitivity (55.0% in Kabul, 64.0% in Mae La, 72.5% in Chiradzulu and 67.7% in Tanzania), but performed better than the active surveillance system in the Tanzania refugee camps.


CONCLUSIONS
The informant method currently features moderate sensitivity for accurately assessing mortality, but warrants further development, particularly considering its advantages over current options (ease of implementation and analysis and near-real estimates of mortality rates). Strategies should be tested to improve the performance of the informant method.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Bayard
B
Roberts
Oliver W
OW
Morgan
Mohammed Ghaus
MG
Sultani
Peter
P
Nyasulu
Sunday
S
Rwebangila
Mark
M
Myatt
Egbert
E
Sondorp
Daniel
D
Chandramohan
Francesco
F
Checchi
D000293:Adolescent; D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods* / Q000592:standards*; D003906:Developing Countries; D005190:Family; D017144:Focus Groups; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011939:Mental Recall; D008875:Middle Aged; D009026:Mortality; D011159:Population Surveillance / Q000379:methods*; D012036:Refugees / Q000706:statistics & numerical data; D012042:Registries; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult