Afghanistan Mortality Survey 2010 - Measure DHS

There is evidence of substantial underreporting of deaths in the South zone. This can be seen inFigure 5.2 which shows the proportion of all births that were reported to have died by year of birthgrouped in five-year calendar periods. This proportion would be expected to decrease closer to the timeperiod before the survey due to a lower duration of exposure to mortality, the more recent the birth, anddue to an expected decline in mortality rates over time. The expected pattern is clearly seen in the Northand Central zones. The south zone, on the other hand, shows a generally rising pattern. Moreover, lookingat the calendar period immediately before the survey, the proportion dead among all reported births is 5percent compared to 7 percent in the North and Central zones. The lower proportion is surprising giventhe more isolated character of the South zone. Although the pattern may be in small part due to the urbanbias in the sample coverage in the South zone, it points to substantial underreporting of child deaths in theSouth zone, even in the period immediately before the survey.20Figure 5.2 Percentage of All Births Reported as Having DiedAccording to Year of BirthPercent1513105976111087 73350All Afghanistan North Central South1996-2000 2001-2005 2006-2010Note: The years 1996-2010 in the Gregorian calendar correspondroughly to the years 1375-1389 in the Afghan calendar.AMS 2010The observed increases in the percentage dead among all births for the North and Central regionsshown in Figure 5.1 are more plausible than the pattern observed for the South zone and suggest that themortality estimates for Afghanistan excluding the South zone are more robust. Nevertheless, a moredetailed review of the AMS mortality data is warranted to asssess the extent to which the mortalityestimates for Afghanistan excluding the South also may have been affected by omission and other dataquality issues.One approach to detecting omission is to look for evidence of sex selectivity in the reporting ofchildhood deaths. A simple measure of sex selectivity is the ratio of deaths among male births to thoseamong female births. Unlike the sex ratio of births, for which the range is assumed to be between 103 and107, the interpretation of the sex ratio of deaths is more complex. This is because, for biological reasons,boy deaths outnumber girl deaths, and no simple standard exists for assessing if a given sex ratio ofdeaths exceeds (or is lower than) what might naturally be expected, and, thus, indicates selective omissionof girl (or boy) deaths. To assess sex selective underreporting of deaths, it is, therefore, better to use thesex ratio of mortality, which can be calculated by dividing the sex ratio among child deaths by the sexratio of births. Model life tables are used to evaluate if the sex ratio of mortality exceeds the expectedratio for a given childhood mortality rate. Some evidence of sex selectivity in the AMS child mortality94 | Infant and Child Mortality