Afghanistan Mortality Survey 2010 - Measure DHS

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Table 5.1.2 Early childhood mortality rates for Afghanistan excluding the South zoneNeonatal, postneonatal, infant, child, and under-5 mortality rates for five-year periods preceding the survey,Afghanistan excluding the South zone, Afghanistan 2010Years precedingthe surveyApproximatecalendar yearNeonatalmortality(NN)Postneonatalmortality(PNN) 1Infantmortality( 1 q 0 )Childmortality( 4 q 1 )Under-5mortality( 5 q 0 )0-4 2006-2010 29 36 64 20 835-9 2001-2005 32 38 70 28 9610-14 1996-2000 33 44 76 34 108Household data 20-4 2006-2010 76 23 97Note: The years 1996-2010 in the Gregorian calendar roughly corresponds to the years 1375-1389 in the Afghancalendar1Computed as the difference between the infant and neonatal mortality rates2Neonatal and postneonatal mortality rates are not calculated from the household data. This is becauseadequately detailed exposure time is available only for the dead neonates and not for the survivors since date ofbirth information was not collected in the Household Questionnaire. Data on the movement of young childreninto and out of the household during the five-year period prior to the survey was used to adjust the exposuretime used in calculating the infant and under-5 rates.Figure 5.1, which compares mortality estimates for Afghanistan excluding the South zone tothose of the South zone for three five-year periods before the survey illustrates both the magnitude of thedifferences in the infant and under-5 rates between the zones and also shows that the differences betweenthe zones increases further back in time. Rates for the South zone are considerably lower than those forthe rest of Afghanistan. While the rates for Afghanistan excluding the South zone decline over time, boththe infant and under-5 mortality rates for the South zone increase. Given the rural and isolated characterof the South zone, the pattern seems implausible and, as discussed further in the next section, reflectsserious problems with the quality of the mortality data for the South zone.Figure 5.1 Trend in Infant and Under-5 Mortality in AfghanistanExcluding South Zone and South Zone1201008060Deaths per 1,000 births767064108968349402016213621260AfghanistanexcludingSouth ZoneInfant MortalitySouth ZoneAfghanistanexcludingSouth ZoneSouth ZoneUnder-5 Mortality10-14 5-9 0-4AMS 201092 | Infant and Child Mortality
In considering the mortality trends and differentials, it is important to bear in mind that the sourceof the AMS data is derived from only one of many representative samples that could have potentiallybeen drawn from the Afghan population, using the AMS design and sample size. Each of these othersamples would yield results that differ somewhat from the AMS estimates. Sampling errors provide ameasure of the potential variability between all possible samples and allow an assessment of the rangewithin which it is possible to say with a specific degree of confidence that the actual mortality rates lie.For example, the upper and lower boundaries of the 95 percent confidence interval for the under-5mortality estimate of 83 deaths per 1,000 births derived from the birth history data for Afghanistanexcluding the South zone are 77 and 89 per 1,000. This indicates that, given the sample size of the AMS2010, the true mortality rate may lie anywhere between 77 and 89 deaths per 1,000 births. Additionalinformation on sampling errors for the mortality estimates from the AMS 2010 as well as other indicatorsis presented in Appendix B.5.3 ASSESSMENT OF THE AMS 2010 EARLY CHILDHOOD MORTALITY DATA5.3.1 Data Quality MeasuresSeveral factors are important to consider in assessing and evaluating the estimates of the level ofearly child mortality derived from the AMS 2010; they include the completeness of the reporting of birthsand child deaths, the accuracy of information on the dates when children were born and, if they died, theirage at death, as well as coverage of the AMS sample. Omission of births and deaths affects mortalityestimates, displacement of birth and death dates affects mortality trends, and misreporting of age at deathmay distort the age pattern of mortality. The following discussion summarizes evidence with regard tohow these various problems may affect AMS early childhood mortality rates. A more detailed technicalnote on issues in the estimation of infant and child mortality levels from the AMS 2010 data is included inAppendix D.Typically, the most serious source of error in a survey that collects retrospective information onbirths and deaths is omission, i.e., the underreporting of these events. Chapter 3, which presents the AMSfertility results, included an assessment of the extent to which there may have been underreporting ofbirths in the AMS. As shown in Table C.5, there appears to have been consistent underreporting of femalebirths as evidenced by the fact that the sex ratios at birth, i.e., the number of male births per 100 femalebirths, exceed the normal ratio (around 105 at birth) in all calendar periods. A fairly sharp drop in birthsin the period 0-2 years before the survey also indicates underreporting of surviving as well as deadchildren although it may also reflect falling fertility. 3 Both the abnormal sex ratios and the drop in recentbirths were much more evident in the South zone than in the North and Central zones.Omission of births would not represent a problem for mortality estimation if womenunderreported surviving and dead children at the same rate. However, dead children are typicallydisproportionately represented in any omitted births because mothers are reluctant to talk about their deadchildren due to sorrow or guilt associated with their deaths or because their culture discourages discussionof the deceased.3 The age distribution of living children in the household schedule also showed substantially smaller numbers ofchildren ages 0 and 1 compared to older children, reinforcing the conclusion that there was underreporting of livingchildren in the youngest age groups.Infant and Child Mortality | 93
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AfghanistanMortality Survey 2010
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CONTENTSTABLES AND FIGURES ........
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4.3 Postnatal Care.................
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TABLES AND FIGURESCHAPTER 1INTRODUC
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Table 5.2 Early childhood mortality
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APPENDIX CDATA QUALITY TABLESTable
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AMS 2010 TECHNICAL ADVISORY GROUP M
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AMS 2010 CONTRIBUTORS TO THE REPORT
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INTRODUCTION 11.1 GEOGRAPHY, HISTOR
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After the fall of the communist reg
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Afghanistan, in cooperation with th
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workload of the BHC, up to two addi
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complete list of names of persons i
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1.7 QUESTIONNAIRESFour questionnair
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survey, a detailed review of the qu
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1.10 RESPONSE RATESTable 1.2 shows
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72 percent of the rural population
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Figure 2.1 Population Pyramid80 +75
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Table 2.3 Children’s orphanhood s
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Table 2.5 presents information on h
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Table 2.7 Household possessionsPerc
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emoteness, and the scores were summ
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The analysis also suggests that amo
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Central zone (56 percent) has the h
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The data also show that more than h
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2.10 CONCLUSIONThe AMS 2010 enumera
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3.1.2 Data Quality AssessmentThe pr
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more problematic for the estimates
Page 64 and 65: Table 3.2 Fertility by background c
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Page 68 and 69: 3.2.6 Birth IntervalsA birth interv
Page 70 and 71: 3.2.7 Age at First BirthThe onset o
Page 72 and 73: Table 3.9 Teenage pregnancy and mot
Page 74 and 75: Table 3.11 Age at first marriagePer
Page 76 and 77: the community level by utilizing al
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Page 82 and 83: Table 3.17 Total fertility rate and
Page 85 and 86: MATERNAL HEALTH 4Afghanistan is com
Page 87 and 88: Table 4.1 Antenatal carePercent dis
Page 89 and 90: Figure 4.2 Trends in Antenatal Care
Page 91 and 92: 4.1.3 Problems with Pregnancy at Fi
Page 93 and 94: 4.1.4 Number and Timing of Antenata
Page 95 and 96: About one-third (32 percent) of mot
Page 97 and 98: As with other maternal health indic
Page 99 and 100: Table 4.8 Reasons for not deliverin
Page 101 and 102: Table 4.9 Assistance during deliver
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Page 105 and 106: Figure 4.6 Reasons for Not Seeking
Page 107 and 108: Table 4.12 presents information on
Page 109 and 110: Table 4.13 Problems in accessing he
Page 111 and 112: INFANT AND CHILD MORTALITY 5Early c
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Page 121 and 122: Table 5.4 Early childhood mortality
Page 123 and 124: The patterns of perinatal mortality
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Page 132 and 133: Table 6.4 shows adult mortality rat
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Page 136 and 137: Table 6.6 Female and male life tabl
Page 138 and 139: Table 6.7 Mean sibship size and sex
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Page 142 and 143: The unexpectedly low crude death ra
Page 144 and 145: Figure 6.8.2 Estimates of Female Ad
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Page 150 and 151: other words, about two in five deat
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Page 160 and 161: Figure 8.1 Causes of Female and Mal
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Global Agricultural Information Net
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Streatfield, P.K., S.E. Arifeen, A.
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• The Cluster Level Questionnaire
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A.3 STRUCTURE OF THE SAMPLE AND THE
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ased on sampling probabilities sepa
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ESTIMATES OF SAMPLING ERRORSAppendi
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For the total sample, the value of
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Table B.3 Sampling errors for Urban
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Table B.5 Sampling errors for North
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Table B.7 Sampling errors for South
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Table B.9 Sampling errors for North
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Table B.11 Sampling errors for Cent
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Table B.13 Sampling errors for East
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Table B.15 Sampling errors for Sout
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Table C.2 Myers’ Blended IndexPre
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Table C.5 Births by calendar years
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Table C.6 Reporting of age at death
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Table C.9 Sex ratio of live birthsS
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mother and the household. The morta
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The estimated infant mortality rate
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D.3.1 Evidence of Underreporting of
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Given the apparent omission of livi
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totally consistent with the estimat
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Perhaps a more sensitive indicator
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Figure D.6 Neonatal and Postneonata
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PERSONS INVOLVED IN AMS 2010Appendi
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Office EditorsMaleMohammad NaseemFe
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AshiqullahAssadullah JavedAtiqullah
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QUESTIONNAIRESAppendix FAppendix F
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Introduction and ConsentHello. My n
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SECTION 2. MIGRATION FROM HOUSEHOLD
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SECTION 4. INPATIENT HEALTH EXPENDI
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SECTION 5. OUTPATIENT HEALTH EXPEND
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SECTION 6. HOUSEHOLD CHARACTERISTIC
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NO. QUESTIONS AND FILTERS CODING CA
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SECTION 2. MARITAL STATUSNO.201QUES
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Now I would like to record the name
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SECTION 4. ANTENATAL, DELIVERY AND
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SECTION 6. MATERNAL MORTALITYNO. QU
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COMMENTS ABOUT RESPONDENT:INTERVIEW
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DEATH OF A CHILD AGED 0-28 DAYSSECT
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SECTION 6. DELIVERY HISTORYNO. QUES
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AFGHANISTAN MORTALITY SURVEYVERBAL
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DEATH OF A CHILD AGED 29 DAYS TO 11
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401 Could you tell me about the ill
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DEATH OF A PERSON AGED 12 YEARS AND
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