Despite the urgent need for timely mortality data in low-income and lower-middle-income countries, mobile phone surveys rarely include questions about recent deaths. Such questions might a) be too sensitive, b) take too long to ask and/or c) generate unreliable data. We assessed the feasibility of mortality data collection using mobile phone surveys in Malawi. We conducted a non-inferiority trial among a random sample of mobile phone users. Participants were allocated to an interview about their recent economic activity or recent deaths in their family. In the group that was asked mortality-related questions, half of the respondents completed an abridged questionnaire, focused on information necessary to calculate recent mortality rates, whereas the other half completed an extended questionnaire that also included questions about symptoms and healthcare. The primary trial outcome was the cooperation rate, i.e., the number of completed interviews divided by the number of mobile subscribers invited to participate. Secondary outcomes included self-reports of negative feelings and stated intentions to participate in future interviews. We called more than 7,000 unique numbers and reached 3,054 mobile subscribers. In total, 1,683 mobile users were invited to participate. The difference in cooperation rates between those asked to complete a mortality-related interview and those asked to answer questions about economic activity was 0.9 percentage points (95% CI = -2.3, 4.1), which satisfied the non-inferiority criterion. The mortality questionnaire was non-inferior to the economic questionnaire on all secondary outcomes. Collecting mortality data required 2 to 4 additional minutes per reported death, depending on the inclusion of questions about symptoms and healthcare. More than half of recent deaths elicited during mobile phone interviews had not been registered with the National Registration Bureau. Including mortality-related questions in mobile phone surveys is feasible. It might help strengthen the surveillance of mortality in countries with deficient civil registration systems. Registration: AEA RCT Registry, #0008065 (14 September 2021).

Introduction: Despite the urgent need for timely mortality data in low-income and lower-middle-income countries, mobile phone surveys rarely include questions about recent deaths. There are concerns that such questions might a) be too sensitive, b) prompt negative/adverse reactions among respondents, c) take too long to ask and/or d) generate unreliable data. We assessed the feasibility of mortality data collection during mobile phone surveys. Methods: We conducted a non-inferiority trial among a random sample of mobile phone users in Malawi. Participants were allocated 3:1 to an interview about recent deaths in their family (treatment group) or about their economic activity (control group). In the treatment group, half of the respondents completed a short mortality questionnaire, focused on information necessary to calculate recent mortality rates, whereas the other half completed an extended questionnaire that also included questions about symptoms and healthcare use. The primary trial outcome was the cooperation rate. Secondary outcomes included the completion rate, self-reports of negative feelings and stated intentions to participate in future interviews. We also documented the amount of time required to collect mortality data, and we explored the quality of death reports. Results: The difference in cooperation rates between treatment and control groups was 0.9 percentage points (95% CI = -2.3, 4.1), which satisfied the non-inferiority criterion. Similarly, the mortality questionnaire was non-inferior to the control questionnaire on all secondary outcomes. Collecting mortality data required approximately 2 to 4 additional minutes per reported death, depending on the inclusion of questions about symptoms and healthcare use. More than half of recent deaths elicited during mobile phone interviews had not been reported to the national civil registration system. Conclusion: Including mortality-related questions in mobile phone surveys appears acceptable and feasible. It might help strengthen the surveillance of mortality trends in low-income and lower-middle-income countries with limited civil registration systems.