Strengthening Community Networks for Vital Event Reporting: Community-Based Reporting of Vital Events in Rural Mali

Abstract

BackgroundLike many developing countries, Mali has few sources of mortality data. High quality mortality estimates are available from household surveys, such as the demographic and health surveys (DHS), approximately every five years, making it difficult to track progress in reducing mortality. The Rapid Mortality Monitoring (RMM) project in Mali aimed to address this issue by testing a community-based approach to measuring under-five mortality on a yearly basis.Methods and FindingsSeventy-eight community-based workers (relais) were identified in 20 villages comprising approximately 5,300 households. The relais reported pregnancies, births, and under-five deaths from July, 2012 to November, 2013. Data were double-entered, reconciled, cleaned, and analyzed monthly. In November-December 2013, we administered a full pregnancy history (FPH) to women of reproductive age in a census of the households in the project villages. We assessed the completeness of the counts of births and deaths, and the validity of under-five, infant, and neonatal mortality rates from the community-based method against the retrospective FPH for two rolling twelve-month periods. Monthly reporting by relais was high, with reports on pregnancies, births, and deaths consistently provided from all 78 relais catchment areas. Relais reported 1,660 live births and 276 under-five deaths from July, 2012 to November, 2013. The under-five mortality rate calculated from the relais data was similar to that estimated using the validation survey, where the overall ratios of the community-based to FPH-based mortality rates for the reporting periods were 100.4 (95% CI: 80.4, 120.5) and 100.8 (95% CI: 79.5, 122.0).ConclusionsOn a small scale, the community-based method in Mali produced estimates of annualized under-five mortality rates that were consistent with those obtained from a FPH. The community-based method should be considered for scale-up in Mali, with appropriate measures to ensure community engagement, data quality, and cross-validation with comparable FPHs.

Monitoring Change in Child Mortality through Household Surveys

“…We obtained approval from the Johns Hopkins Bloomberg School of Public Health ethical review board for the studies that involved primary data collection (Ethiopia [ 13 ] and Mali [ 14 ] endline surveys, Ethiopia baseline survey [ 13 ], and Malawi midline survey [ 15 ]; survey methodology is described in the referenced papers). For those studies, participants provided oral consent.…”

A systematic review of vital events tracking by community health agents

“…The RMM initiative also measured timeliness of community health agents reporting of monthly data on pregnancies, births, and deaths. CHWs submitted monthly vital event reports for over 95% of catchment areas in Ethiopia and Malawi, and for 100% of catchment areas in Mali [16,24,34].…”

“…These geographic factors included low population density, large geographic catchment areas, increasing distance from a HEW station, and long distances between houses [16,24,30,31,33,38,39]. Migration of the community was also noted as a challenge in areas in which there is a nomadic population or in cases in which the effect of migration within the community is not clear [24,34]. Another administrative issue that emerged was training and developing CHW staff.…”

“…Some articles proposed solutions to the barriers of retention, including providing adequate materials [17,21,36] or providing remuneration [11,22,40]. Other articles mentioned difficulty in providing frequent and routine supervision of the health workers [24,34]. Many articles also recommended providing continuous training or frequent refresher training in order to ensure adequate capabilities of their CHWs [28,35,36,41].…”

“…Other articles mentioned that using a variety of sources, including home visitations but also written records or reports from existing community-based networks, was important for capturing events [18,48]. Several articles noted challenges in accurate reporting of deaths due to recall bias, limitations in lay-reporting, underrecognition of underlying causes of death such as malnutrition or abortion, and unclear classification of overlapping causes of death such as AIDS and tuberculosis [16,19,21,23,26,34,49,50]. Additionally, two articles noted that there may be underreporting due to conflict of interest when CHWs or TBAs who are tasked with reducing adverse events such as maternal or neonatal deaths are asked to report on those events [11,24].…”