Afghanistan Mortality Survey 2010 - Measure DHS

data was found in Afghanistan excluding the South zone. As reviewed in Appendix D, males appeared tohave been underreported, with the problem of underreporting concentrated in the North zone.The age pattern of deaths in infancy also can be examined for evidence of omission. This is basedon the assumption that omission occurs more often for children who died immediately after birthcompared with those who lived longer. Selective underreporting of early neonatal deaths would result inan abnormally low ratio of deaths within the first seven days of life for all neonatal deaths. There are nomodel mortality patterns for the neonatal period; however, one review of data from several developingcountries concluded that, at levels of neonatal mortality of 20 per 1,000 or higher, approximately 70percent of neonatal deaths occur within the first six days of life (Boerma, 1988). An abnormally lowproportion of neonatal to all infant deaths also provides evidence of selective omission of early infantdeaths. In countries with high levels of infant mortality due to high post-neonatal mortality, about half ofinfant deaths can occur in the neonatal period. As mortality falls in a society, the ratios of early neonatalto all neonatal and neonatal to postneonatal deaths are expected to increase as public health programsprevent and successfully treat the infectious diseases, which are the most common causes of death later ininfancy and early childhood. An examination of the ratios of early neonatal to all neonatal deaths and ofneonatal to all infant deaths for Afghanistan excluding the South (see Table C.6 and C.7) indicate that theratios fall within the expected range and generally have increased over time.The ratio of neonatal to postneonatal deaths provides perhaps a more sensitive indicator ofselective underreporting of deaths in the neonatal period. As can be seen in Figure D.5, which charts theratios for the periods 0-4 and 5-9 years before each of 209 DHS surveys, this ratio rises as the level ofunder-5 mortality falls. The neonatal-postneonatal (NN/PNN) ratios observed for other countries at levelsof under-5 mortality similar to that found in the AMS for Afghanistan excluding the South zone (83 per1,000) are generally higher than the ratio observed in the AMS excluding the South zone (0.8). Aregression curve fitted to the data for the 209 surveys can be used to derive a NN/PNN ratio forAfghanistan excluding the South zone which takes into account the global pattern. 4 The predictedNN/PNN ratio is 1.09. Applying this ratio to the postneonatal rate yields an adjusted neonatal rate of 39,which implies that neonatal deaths were underreported by around one-third.Finally, another area of concern in estimating mortality levels from birth history data ismisreporting of the dates of birth. Errors in birth date reporting affect period mortality estimates if theyshift children who died above or below the boundaries of the reference periods used for calculating thoseestimates. Such problems are of particular concern since experience in other surveys has indicated thatthey may result at least partially from deliberate interviewer transference of births out of the period priorto the survey for which detailed health questions about births are asked as is the case in the AMS. Anexamination of the distribution of births and deaths by the calendar year prior to the survey in Table C.5shows no evidence of serious displacement.5.3.2 Effect of Data Quality Issues on AMS Child Mortality EstimatesAdditional analysis of the AMS 2010 results as well as comparisons with other data sources arenecessary in order to finalize estimates of current child mortality levels in Afghanistan. However, it ispossible in this report to assess the potential effect of the data quality issues described above on the AMSmortality results and to provide some insight into the range within which the AMS results suggest childmortality levels in Afghanistan may lie.4 For more detail, see Appendix D.Infant and Child Mortality | 95