Afghanistan Mortality Survey 2010 - Measure DHS

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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
The cause of death pattern among males is different as injury-associated mortality accounts for amuch greater proportion of deaths (21 percent for all ages—see Figure 8.1). The distributions of causes ofdeath among males aged 0-4, 5-14 and 60 and over are similar to those for females, but with higher levelsof injury-related deaths. At age group 15-59, half of the male deaths are due to injuries, roughly evenlydivided between unintentional and intentional injuries.Table 8.1 Cause of death—all agesPercent distribution of female and male deaths in the three years before the survey by underlying cause of death, according to broad agegroups, Afghanistan 2010FemaleUnderlying cause of death 0-4 5-14 15-59 60+ Total 0-4 5-14 15-59 60+ TotalCommunicable, maternal, perinatal,and nutritional conditions 82.8 43.0 38.2 19.3 52.8 78.1 33.4 9.9 18.7 42.6Infections and parasitic diseases 22.0 25.3 15.2 13.7 18.3 21.7 19.7 7.7 13.7 16.2Respiratory infections 28.1 17.7 0.8 5.5 14.7 19.7 11.7 1.7 4.9 10.9Maternal conditions 0.0 0.0 20.3 0.0 5.1 0.0 0.0 0.0 0.0 0.0Perinatal conditions 27.3 0.0 0.0 0.0 11.8 31.3 0.0 0.0 0.0 13.0Nutritional deficiencies 5.4 0.0 2.0 0.2 2.9 5.4 2.0 0.5 0.1 2.5Noncommunicable diseases 7.2 24.8 52.3 75.7 37.5 8.0 20.7 37.6 72.4 33.3Malignant neoplasms 0.8 13.0 16.0 12.6 8.4 0.7 4.9 11.4 14.6 7.3Other neoplasms 0.0 0.0 0.5 0.0 0.1 0.0 0.0 0.0 0.2 0.1Diabetes mellitus 0.1 0.0 4.7 5.8 2.7 0.1 0.0 3.1 10.6 3.7Endocrine disorders 0.3 0.0 0.0 0.2 0.2 0.5 0.0 0.1 0.2 0.3Neuropsychiatric conditions 0.5 1.8 2.5 0.6 1.1 1.2 4.9 2.1 0.5 1.5Sense organ diseases 0.0 0.0 0.0 0.2 0.1 0.0 0.0 0.0 0.0 0.0Cardiovascular diseases 0.4 1.2 23.2 45.2 17.9 0.4 1.5 14.2 38.4 14.0Respiratory diseases 0.2 1.7 1.9 6.4 2.3 0.2 1.9 1.9 4.7 1.9Digestive diseases 1.4 1.6 1.9 3.4 2.1 0.9 4.5 2.7 1.4 1.8Genitourinary diseases 0.3 1.7 1.4 1.3 0.9 0.2 1.4 1.9 1.5 1.0Skin diseases 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.2 0.4 0.3Congenital anomalies 3.2 3.8 0.2 0.1 1.6 3.4 1.7 0.0 0.0 1.6Injuries 6.0 31.0 8.8 0.9 6.7 10.7 41.4 50.3 5.0 20.8Unintentional injuries 5.8 29.3 7.6 0.6 6.1 10.3 32.9 23.4 3.0 13.2Intentional injuries 0.2 0.0 1.2 0.2 0.5 0.4 8.2 26.1 2.0 7.4Ill-defined injuries / accidents 0.0 1.7 0.0 0.0 0.1 0.1 0.4 0.8 0.0 0.2Unclassified 4.0 1.2 0.7 4.1 3.0 3.2 4.6 2.3 4.0 3.3Ill-defined diseases 0.7 0.0 0.3 2.4 1.0 1.0 3.0 0.9 3.7 1.9Incorrect ICD code 3.3 1.2 0.4 1.7 2.0 2.2 1.6 1.4 0.2 1.4Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0Number of deaths 574 70 337 348 1,329 754 151 414 493 1,813Note: Data are derived from the verbal autopsy questionnaires. There were no deaths reported in the categories “Musculoskeletal diseases”or “Oral conditions.”MaleCause of Death | 137
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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
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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
Page 113 and 114: first seven days of life, to estima
Page 115 and 116: In considering the mortality trends
Page 117 and 118: data was found in Afghanistan exclu
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
Page 125: problem for areas outside the South
Page 128 and 129: information was usually reported by
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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 156 and 157: ased on the sibling history (270).
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
Page 172 and 173: ased on sampling probabilities sepa
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
Page 206 and 207: 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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