Availability and quality of vital registration mortality data in South Africa: a national and surveillance site perspective

Abstract

The importance of valid and reliable mortality data as a key input for public and population health planning and research, and development programmes, is globally acknowledged.However, few low-and middle-income countries have such data. Even fewer have assessed the quality of their mortality data. Despite the particular utility of periodic, independent evaluations of national mortality statistics by countries themselves, such an evaluation has not yet been conducted for South Africa. Neither has a review been conducted of the sources of mortality data in South Africa since 1995. Regarding causes of death, a few small-scale studies assessed data quality in urban settings, but no study yet in civil registration mortality data in a rural setting. In addition, notwithstanding district health managers' critical need to know the health care needs of their district population current district mortality profiles are accompanied by strong warnings of invalid data.These gaps in essential public-and population-health intelligence present important reasons for research on the availability and quality of mortality data in South Africa.The primary aim of this body of research was to assess the quality of mortality data in the national CRVS system of South Africa. As alternative mortality data sources can complement or evaluate the quality of CRVS data, a secondary aim was to identify and review alternative mortality data sources, and assess the availability, strengths, and limitations of their data. A further aim was to conduct a field study to link and compare CRVS and Agincourt HDSS mortality data for the same individuals with the purpose of quantifying the level of completeness of death registration into the CRVS system, and assess the level of agreement between CRVS and verbal autopsy cause-of-death data. Seven research questions have been addressed towards achieving these aims. Different approaches were followed, including: (a) a mortality data source review and appraisal of the availability, strengths and limitations of different sources; (b) a comprehensive evaluation of national CRVS mortality data based on demographic and epidemiological principles; (c) a detailed record-linkage study applying both deterministic and probabilistic approaches; and (d) an application of adjustment factors from the linkage study to improve district-level cause-of-death data quality.iii The data source review found a rich and varied list of mortality data sources. Recent transformation in South Africa has enhanced mortality data availability from CRVS. Detailed cause-of-death data are available from civil registration and demographic surveillance.Additionally, a range of mortality data items are available in three population censuses, three demographic surveillance systems, and various national surveys, mortality audits and disease-notification programmes. Employing nine criteria to evaluate the quality of national CRVS mortality data, the data were rated satisfactory for coverage and completeness of death registration, temporal c...