Afghanistan Mortality Survey 2010 - Measure DHS

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