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Mortality assessment

This session discusses the factors that result in missing data in emergency mortality assessments, including lack of civic records, low level of contacts with health institutions, and lack of basic data on demography. It also explores mortality rate definitions and when to assess mortality, as well as understanding mortality rates and data collection procedures.

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Mortality assessment

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  1. Mortality assessment SESSION 13

  2. Factors leading to missing data in emergency • Lack of civic records • Low level of contacts with health institutions • Lack of basic data on demography = reliable census • Lack of effective mortality surveillance as well other surveillance that would provide proxy indicators of the crisis • Reluctance to discussions on mortality/ death

  3. Mortality rates definitions • Crude mortality rate (CMR): an estimate of the rate at which members of a population die during a specified period • U5 mortality rate (U5MR): The total number of children who die between birth and their fifth birthday. U5MR is a useful indicator of the level of health devt in a community NB: main advantage of U5MR is early warning of a looming mortality crisis

  4. When to assess mortality • During nutrition surveys (done concurrently • Monitor the status of the crisis after some interventions • When analyzing a severe impact of a crisis and wish to have some baseline information before commencing some interventions

  5. Understanding mortality rates • Previous birth history: measures mortality among <5yrs & no info. on the death at Household level • Past HH census and current HH census: MR for all HH members of all age groups

  6. Data collection procedure • Two stage cluster sampling methodology: sample selection - 30 randomly selected clusters, 30 households/cluster). 20 HH in 30 clusters is the minimum. Selection is house-house. • Exhaustive methodology (if population of interest is small) NB: Two stage cluster sampling used due to lack of detailed list of HH and HH are haphazard distributed

  7. Key considerations • Recall period: 1 or 3 month. 3 months is ideal retrospectively • HHs irrespective of U5 child presence or not are included in the sampling frame. This reduces risk of underestimating the mortality rates. • Interview conducted to a responsible member of the HH • Tactful phrasing of questionnaires due to sensitivity of the questions on death • NB: Early warning indications do not always triggering response - hence need for advocacy

  8. Key variables • Total no. of HH visited • No. of <5 yr children at start of the recall period • No. of <5 yr children now/today • No. of <5 deaths in the period under consideration (recall period) • Causes of death/ symptoms for each death • No. of >=5 yr adult at start of the recall period • No. of >=5 yr adult now/today • No. of >=5 deaths in the period under consideration (recall period) • Causes of death/ symptoms for each death

  9. Mortality rate formula • U5MR= {[n/(n+N+N)/2]/p}*10,000 • Total the deaths for a given number of days (n) • Divide the total deaths (n) by the mid period population size [(n+N+N)/2] • Divide outcome with recall period in days (p) • Multiply by 10,000 for a daily under-five mortality rate • Same formula is applied in the calculation of CMR. n- total deaths, N- pop size in the start. • Alternative: [n/{(N1+N2)/2}/p]*10,000

  10. Cut offs • In emergency, CMR and U5MR are expressed as deaths/10,000/day and they refer to aggregate deaths from all the causes/10,000 people/day • Details of the causes of death should be collected and summarized

  11. Cut offs- U5MR and CMR • U5MR >=2 death/10,000/d-------Alert • U5MR>=4 death/10,000/d----Emergency • CMR>=1 death/10,000/d-------Alert • CMR>=2 death/10,000/d------Emergency

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