Afghanistan Mortality Survey 2010 - Measure DHS

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ased on the sibling history (270). If that same relative difference were to be applied to the pregnancyrelatedmortality ratio of 327 from the sibling history for the seven years before the survey, the resultingestimate of the pregnancy-related mortality ratio for the seven-year period would increase to 453. Theexpected age pattern of the risk of pregnancy-related mortality is seen in the household data, with aparticularly high risk for very young women (age 15-19) and for older women (age 35-49).There are several ways to assess the quality of the AMS data used for the estimates in thischapter. Response rates for the AMS 2010 are high at both the household and woman’s level. Siblingsthat are reported have almost complete information on survival status, the age of living siblings and theyears since death of deceased siblings. The distribution of the year of birth of siblings is similar to thedistribution of the respondents’ own years of birth, which would be expected if the data are of reasonablequality. However, there appears to be some omission in the reporting of siblings, particularly of olderwomen. In addition, the sex ratio at birth of siblings that women reported is outside the high end of thenormal biological range, indicating that some sisters were likely to be underreported. This suggests thatthe pregnancy-related mortality ratios are likely to be underestimated to some extent.As in any sample survey, the mortality rates may vary somewhat due to heterogeneity in thepopulation and clustering in the sample design. In the AMS 2010, the confidence interval around thepregnancy-related mortality ratio of 327 from the sibling history is 260-394. The confidence intervals ofthe estimates show the likely range within which the true value of the pregnancy-related mortality ratio islikely to fall. Based on the sampling errors, the pregnancy-related mortality ratio for the seven yearspreceding the AMS 2010 could be as high as 394. If an additional 14 percent is added on because of thehigher estimate using the Gakidou-King method, the pregnancy-related mortality ratio could be as high as449. If the pregnancy-related mortality ratio is taken from the verbal autopsy for the three years before thesurvey (374), the highest ratio would still be well below the 500 level even after the confidence intervalaround the estimate is considered.134 | Maternal Mortality
CAUSE OF DEATH 8One of the main objectives of the Afghanistan Mortality Survey (AMS) 2010 is to ascertain thecause of death. Information on cause of death is essential for policy makers to assess the needs of healthsystems and to set priorities for interventions. Ideally such data would be generated from a vital statisticssystem. However, this system is not functioning well in Afghanistan, as no death certificate is issued inmost cases and reliable data on cause of death are not available.To address this information gap, the AMS included collection of data on cause of death throughinterviews with the relatives of the deceased. These “verbal autopsies” are generally not as accurate asmedical certification of the cause of death but can be useful in identifying the probable cause of death inbroad groupings.The verbal autopsy (VA) questionnaire and manual used in the AMS 2010 were adapted fromSAmple Vital registration with Verbal autopsy (SAVVY). SAVVY is a library of best practice methodsfor improving the quality of vital statistics where high coverage of civil registration and good cause ofdeath data are not available. SAVVY is not a substitute for universal civil registration. Its componentscan, however, fill short- to medium-term needs for critical information on births, deaths, and cause ofdeath at the population level. The Verbal Autopsy instrument administered in the AMS 2010 usedinternational standards for verbal autopsy forms, death certification and ICD coding proceduresdeveloped in collaboration with WHO, the Health Metrics Network, and other stakeholders. The purposeof the VA was to describe the cause structure of mortality at the community or population level where nobetter alternative sources exist. VA is not intended to diagnose cause of death at the individual level.While VA has some limitations, the shortcomings of the tool are known and quantifiable.Interviewers visited households where deaths occurred and interviewed relatives or caregiversusing VA forms. Once completed, these forms were used to determine probable causes of death. Thisinformation can be used at many levels of the health system for planning, reporting, monitoring,evaluating, and priority setting.8.1 SOURCE OF DATADuring the household interview, questions were asked about deaths among usual residents of thehousehold since 21 March 2005 (1 Hammal 1384), a date that was five years before the start of the AMSdata collection. Probing questions were included to elicit early infant deaths and stillbirths. For eachdeath, the name, age at death and sex of the deceased were recorded. Following the household interview,the Verbal Autopsy (VA) questionnaire was administered to a caregiver or family member of thedeceased. One of three separate verbal autopsy questionnaires was used, depending on the age at death:1. Form 1 for deaths to children aged 0-28 days (neonatal)2. Form 2 for deaths to children aged 29 days-11 years (post neonatal and child)3. Form 3 for deaths to adults aged 12 years and above (adult).Key informants, that is, person(s) identified as present at the time of death, were interviewed toensure accurate information surrounding the circumstances that lead to the death of the deceased.Cause of Death | 135
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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
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Table 3.2 Fertility by background c
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Another frequently used approach to
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3.2.6 Birth IntervalsA birth interv
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3.2.7 Age at First BirthThe onset o
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Table 3.9 Teenage pregnancy and mot
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Table 3.11 Age at first marriagePer
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the community level by utilizing al
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difference may be due to difference
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There are substantial differences i
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Table 3.17 Total fertility rate and
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MATERNAL HEALTH 4Afghanistan is com
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Table 4.1 Antenatal carePercent dis
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Figure 4.2 Trends in Antenatal Care
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4.1.3 Problems with Pregnancy at Fi
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4.1.4 Number and Timing of Antenata
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About one-third (32 percent) of mot
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As with other maternal health indic
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Table 4.8 Reasons for not deliverin
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Table 4.9 Assistance during deliver
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4.2.4 Procedures Performed at Deliv
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 115 and 116: In considering the mortality trends
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Page 119 and 120: Central zone and 32 percent in the
Page 121 and 122: Table 5.4 Early childhood mortality
Page 123 and 124: The patterns of perinatal mortality
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Page 128 and 129: information was usually reported by
Page 130 and 131: fallen from 118 deaths to 71 deaths
Page 132 and 133: Table 6.4 shows adult mortality rat
Page 134 and 135: mortality levels. The procedures us
Page 136 and 137: Table 6.6 Female and male life tabl
Page 138 and 139: Table 6.7 Mean sibship size and sex
Page 140 and 141: 6.4.2 Household ReportingIn the Hou
Page 142 and 143: The unexpectedly low crude death ra
Page 144 and 145: Figure 6.8.2 Estimates of Female Ad
Page 146 and 147: The third panel estimates life expe
Page 148 and 149: Maternal mortality in Afghanistan i
Page 150 and 151: other words, about two in five deat
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Page 154 and 155: 50PercentFigure 7.1Timing of Pregna
Page 158 and 159: The VA interview started by checkin
Page 160 and 161: Figure 8.1 Causes of Female and Mal
Page 162 and 163: Table 8.4 Causes of deaths among ch
Page 164 and 165: Global Agricultural Information Net
Page 166 and 167: Streatfield, P.K., S.E. Arifeen, A.
Page 168 and 169: • The Cluster Level Questionnaire
Page 170 and 171: A.3 STRUCTURE OF THE SAMPLE AND THE
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Page 175 and 176: ESTIMATES OF SAMPLING ERRORSAppendi
Page 177 and 178: For the total sample, the value of
Page 179 and 180: Table B.3 Sampling errors for Urban
Page 181 and 182: Table B.5 Sampling errors for North
Page 183 and 184: Table B.7 Sampling errors for South
Page 185 and 186: Table B.9 Sampling errors for North
Page 187 and 188: Table B.11 Sampling errors for Cent
Page 189 and 190: Table B.13 Sampling errors for East
Page 191: Table B.15 Sampling errors for Sout
Page 194 and 195: Table C.2 Myers’ Blended IndexPre
Page 196 and 197: Table C.5 Births by calendar years
Page 198 and 199: Table C.6 Reporting of age at death
Page 200 and 201: Table C.9 Sex ratio of live birthsS
Page 202 and 203: mother and the household. The morta
Page 204 and 205: 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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