1. Mortality assessment SESSION 13

2. Factors leading to missing data in emergency Lack of civic records Low level of contacts with health institutions Lack of basic data on demography = reliable census Lack of effective mortality surveillance as well other surveillance that would provide proxy indicators of the crisis Reluctance to discussions on mortality/ death

3. Mortality rates definitions Crude mortality rate (CMR): an estimate of the rate at which members of a population die during a specified period U5 mortality rate (U5MR): The total number of children who die between birth and their fifth birthday. U5MR is a useful indicator of the level of health devt in a community NB: main advantage of U5MR is early warning of a looming mortality crisis

4. When to assess mortality During nutrition surveys (done concurrently Monitor the status of the crisis after some interventions When analyzing a severe impact of a crisis and wish to have some baseline information before commencing some interventions

5. Understanding mortality rates Previous birth history: measures mortality among <5yrs & no info. on the death at Household level Past HH census and current HH census: MR for all HH members of all age groups

6. Data collection procedure Two stage cluster sampling methodology: sample selection - 30 randomly selected clusters, 30 households/cluster). 20 HH in 30 clusters is the minimum. Selection is house- house. Exhaustive methodology (if population of interest is small) NB: Two stage cluster sampling used due to lack of detailed list of HH and HH are haphazard distributed

7. Key considerations Recall period: 1 or 3 month. 3 months is ideal retrospectively HHs irrespective of U5 child presence or not are included in the sampling frame. This reduces risk of underestimating the mortality rates. Interview conducted to a responsible member of the HH Tactful phrasing of questionnaires due to sensitivity of the questions on death NB: Early warning indications do not always triggering response - hence need for advocacy

8. Key variables Total no. of HH visited No. of <5 yr children at start of the recall period No. of <5 yr children now/today No. of <5 deaths in the period under consideration (recall period) Causes of death/ symptoms for each death No. of >=5 yr adult at start of the recall period No. of >=5 yr adult now/today No. of >=5 deaths in the period under consideration (recall period) Causes of death/ symptoms for each death

9. Mortality rate formula U5MR= {[n/(n+N+N)/2]/p}*10,000 Total the deaths for a given number of days (n) Divide the total deaths (n) by the mid period population size [(n+N+N)/2] Divide outcome with recall period in days (p) Multiply by 10,000 for a daily under-five mortality rate Same formula is applied in the calculation of CMR. n- total deaths, N- pop size in the start. Alternative: [n/{(N1+N2)/2}/p]*10,000

10. Cut offs In emergency, CMR and U5MR are expressed as deaths/10,000/day and they refer to aggregate deaths from all the causes/10,000 people/day Details of the causes of death should be collected and summarized

11. Cut offs- U5MR and CMR U5MR >=2 death/10,000/d-------Alert U5MR>=4 death/10,000/d----Emergency CMR>=1 death/10,000/d-------Alert CMR>=2 death/10,000/d------Emergency