Challenges and Innovations in Using Community-Based Workers to Improve Vital Events Registration in Sub-Saharan Africa: Validation against Full Pregnancy Histories in Four Countries

Romesh Silva, Johns Hopkins University
Agbessi Amouzou, United Nations Children's Fund (UNICEF)
Melinda Munos, Johns Hopkins University
Gareth Jones, Johns Hopkins University
Aklilu Kidanu, Miz-Hasab Research Center
Daniel Arhinful, Noguchi Memorial Medical Institute for Research
Hamadou Sangho, CREDOS, Mali
Olga Helena Joos, Johns Hopkins University
Alain K. Koffi, Johns Hopkins University
Jennifer Bryce, Johns Hopkins University

Evaluating the scale-up to the MDGs is high on the international development agenda. Hence, there are increasing demands for measurement of short-term changes in mortality among children below five years of age in low-income countries. We report findings from a five-year project in Ethiopia, Ghana, Malawi and Mali that developed and tested methods for the real-time monitoring of under-five mortality based on vital events reporting by community health workers. We validated these data and the resulting under-five mortality rate estimates against comparable full birth histories collected in household censuses and surveys. Our results showed variable completeness of annualized births and under-five deaths reporting ranging from 30%-96% and 22%-91%, respectively. Resulting under-five mortality rates were under-estimated by 9% in Mali and up to 59% in Ghana. In countries lacking complete vital registration, no one-size-fits-all approach will be successful in guaranteeing complete and accurate reporting of vital events by community-based health workers.