Afghanistan Mortality Survey 2010 - Measure DHS

The first step in the assessment process involves evaluating the potential effects of omission onthe mortality estimates for Afghanistan excluding the South zone. In this regard, the review of dataquality problems summarized above identified two major areas of concern with the mortality data forAfghanistan excluding the South zone: (1) an apparent omission of living children in the two yearsimmediately prior to the survey evident in both the household schedule and birth history data and (2)underreporting of neonatal deaths. In view of the possible omission of living children in the youngest ageranges, a better estimate of child mortality may be obtained by using the rates for the period 2-6 yearsprior to the survey (circa 2004-2008) instead of the traditional 0-4 years. A comparison of the results inTable 5.2 with the rates presented in Table 5.1.2 indicates that the mortality rates for Afghanistanexcluding the South zone during the period 2-6 years are only slightly higher than the rates for the period0-4 years (infant mortality of 67 versus 64 and an under-5 rate of 87 versus 83). The results are in linewith a slow downward trend in fertility and, notably, do not suggest that the omission of births in theperiod immediately prior to the AMS was substantially greater in the case of dead than living children.Table 5.2 Early childhood mortality rates for Afghanistan excluding the South zone for the period 2-6years prior to surveyUnadjusted and adjusted neonatal, postneonatal, infant, child, and under-5 mortality rates for thepreceding the survey, Afghanistan excluding the South zone, Afghanistan 2010Years precedingthe surveyNeonatalmortality(NN)Postneonatalmortality(PNN) 1Infantmortality( 1 q 0 )Childmortality( 4 q 1 )Under-5mortality( 5 q 0 )2-6 years (unadjusted) 30 37 67 22 872-6 years (adjusted 2 ) 40 37 77 22 97Note: The reference period corresponds to the years 2004-2008 in the Gregorian calendar, which is roughlyequivalent to the years 1383-1387 in the Afghan calendar.1Computed as the difference between the infant and neonatal mortality rates2For presumed underreporting of neonatal deathsThe data quality assessment above also found that the ratio of neonatal to postneonatal deaths inthe mortality results for Afghanistan excluding the South (0.8) was quite low in comparison to ratiosfound in DHS surveys at a similar mortality level, suggesting a substantial underreporting of neonataldeaths. Applying a more plausible NN/PNN ratio of 1.09 that was derived taking into account data from209 DHS surveys to results in Table 5.2 raises the estimates of neonatal mortality in Afghanistanexcluding the South zone to 40 deaths per 1,000, the infant mortality rate to 77 deaths per 1,000, and theunder-5 mortality rate to 97 deaths per 1,000. 5The results presented in Table 5.2 represent the child mortality situation for Afghanistanexcluding the South zone, an area that comprises roughly two-thirds of the population of Afghanistan. Toobtain a national estimate, information also is needed on the mortality situation among young children inthe South zone. Unfortunately, due to both coverage problems and data quality issues, the AMS childmortality results for the South zone cannot be used in estimating rates for Afghanistan as a whole. Thus, avariety of other factors that traditionally influence mortality levels will have to be evaluated for the Southzone and used to derive child mortality estimates for the zone. These range from socioeconomicmeasures, e.g., wealth and education, which are typically inversely related to early childhood mortality.With regard to wealth, households in the South zone that were surveyed in the AMS were generallywealthier than households in the Central or especially the North zones; e.g., 88 percent of the populationin the South zone fell within the three highest quintiles on the wealth index compared to 58 percent in the5 Indirect estimates based upon the questions on the number of children ever born and surviving yield roughlysimilar rates for Afghanistan excluding the South (an infant rate of 71 deaths per 1,000 and an under-5 rate of 98 per1,000). See Appendix D for a more complete discussion.96 | Infant and Child Mortality