Afghanistan Mortality Survey 2010 - Measure DHS

The VA interview started by checking the date of death and subsequent questions were onlyasked if the death occurred since 21 March 2007 (1 Hammal 1386), three years before the start of theAMS interviewing. 1 The VA questionnaires include a wide range of questions on signs and symptomsduring the disease or injury preceding death. In addition, the forms also included an open narrative sectionallowing respondents to describe verbatim the illness and events that led to the death. There were alsoquestions about the health and status of mothers (in the case of perinatal, neonatal, and child deaths), andquestions that specifically relate to women age 12-49 years. Additional information was collected onpreviously diagnosed conditions, medications used, utilization of health services, place of death, andbehavioral and environmental risk factors.After a 2-week training conducted by a physician with expertise in verbal autopsies, a panel of 15Afghan physicians reviewed the verbal autopsy questionnaires. Each form was reviewed independentlyby two physicians to assign the underlying cause of death and in case of discordance, the questionnairewas reviewed by both physicians together and a final cause was accepted if both physicians agreed. If acause could not be ascertained or both physicians disagreed, the cause was considered as undetermined.The final cause was then coded using the 10 th revision of the WHO International Classification ofDiseases (ICD-10). There are alternative computer-algorithm based methods for assigning the mostprobable cause of death, but these were not used for the analysis presented in this report.Overall, 6,089 deaths were reported in 5,257 households, including 14 percent of householdsreporting two or more deaths. A verbal autopsy questionnaire was administered for 6,044 deaths (99percent). Of these deaths, 536 stillbirths were identified and 2,106 deaths occurred between 21 March2005 (1 Hammal 1384) and 20 March 2007 (30 Hut 1385). The full verbal autopsy questionnaire wasadministered to the remaining 3,402 deaths. As the analysis is restricted to deaths that occurred in thethree years prior to the survey date, a further 245 deaths occurring between 1 Hammal 1386 and the dateof interview that were more than three years were excluded; therefore, all analysis in this chapter is basedon the remaining 3,157 deaths.8.2 CAUSE OF DEATH BY AGE AND SEXThe percent distribution of deaths by cause according to sex and age group is presented in Table8.1. Causes are grouped according to broad categories of classification in the ICD-10. Only a smallproportion of deaths (3 percent) were unable to be classified by underlying cause.About 35 percent of all deaths in Afghanistan are due to non-communicable diseases likecardiovascular diseases and cancers, while about three in ten are due to communicable diseases andinfections. Among females, the leading causes of death are infectious and parasitic diseases (18 percent)and cardiovascular diseases (18 percent), followed by respiratory infections (15 percent) and perinatalconditions (12 percent). Respiratory infections, infectious/parasitic diseases, and perinatal conditions arethe leading causes of death among female children under five years, accounting for 77 percent of deaths,while cardiovascular diseases predominate at ages 15-59 years (23 percent) and 60 and over (45 percent).Maternal conditions are responsible for one in five deaths to women at ages 15-59 years, while injuriesaccount for 9 percent of deaths in this age group. Notable is the high proportion of female deaths due tounintentional injuries at ages 5-14 years when mortality rates tend to be low (29 percent).1 Filter questions to capture deaths at the household level were collected for all deaths in the five years (since 1Hammal 1384) before the survey. However, the detailed verbal autopsy questions were administered only for deathsin the three years (since 1 Hammal 1386) prior to the survey. This was done to discourage interviewers fromdeliberately aging the dates of death to avoid administering the VA in an effort to reduce their workload. By doingthis, even if deaths that occurred in the five years were deliberately recorded as having occurred six years prior tothe survey it is less likely to result in underreporting of deaths in the three years before the survey.136 | Cause of Death