Academic journal article Demographic Research

Evaluation of a Village-Informant Driven Demographic Surveillance System in Karonga, Northern Malawi

Academic journal article Demographic Research

Evaluation of a Village-Informant Driven Demographic Surveillance System in Karonga, Northern Malawi

Article excerpt

Abstract

This paper describes and evaluates the first demographic surveillance system (DSS) in Malawi, covering a rural population of 30,000. Unlike others, the Karonga DSS relies on trained village informants using formatted registers for the primary notification of vital events and migrations. Seven project enumerators subsequently collect detailed data on events notified by the village informants, using stringent identification procedures for households and individuals. Internal movements are traced systematically to augment event registration and data quality. Continuous evaluation of data collection is built into the methods. A re-census conducted after 2 years indicated that the routine system had registered 97% of 1,588 births, 99% of 521 deaths and 92% of 13,168 movements.

1. Introduction

Demographic Surveillance Systems (DSSs) have been established in many developing countries to provide data on fertility and mortality and on determinants of trends in health (9, 18). These systems complement nationally representative surveys such as the Demographic and Health Surveys (DHS) which, along with decennial censuses, are the main source of demographic data in countries lacking universal vital registration systems. DHS has been designed to yield high quality data on fertility, family planning and child health but has been less successful at documenting levels, trends, age patterns and causes of adult mortality. DSS use 'verbal autopsies' (VAs), to ascertain the causes of death in broad categories in communities where many deaths occur at home (2, 3, 10, 25). This consists of a structured interview with an informant close to the deceased, with the reported signs interpreted by a physician to infer a diagnosis. If VAs are linked to Sample Vital Registration it may be possible to obtain nationally representative data on causes of death (24).

We initiated the first DSS in Malawi in 2002, in Karonga District in the north of the country. Various models were considered for the new surveillance system, including the widely used Household Registration System pioneered in Navrongo, Ghana (1). Most existing DSSs employ teams of professional enumerators to re-census every household two to four times a year, checking the actual composition against an expected listing of household members. In many DSSs, (e.g. Agincourt, Dar Es Salaam, Hai, Ifakara, Morogoro, Manhiça, Kisesa) the identification of individuals is linked to their relationship to the head of household (14, 19, 26) and this can make it difficult to trace individuals moving between households. The system in Karonga was developed with the specific capacity to identify individuals regardless of their current household and residence, to capture the links between parents and their biological children and to keep household visits by project staff to a minimum to facilitate field logistics and to prevent "interview fatigue" of the study population.

The Karonga DSS was established within the Karonga Prevention Study (KPS), a large epidemiological study of leprosy and tuberculosis which has been running since 1979. This has provided background data from total population surveys conducted in the 1980s, as well as established methods for identification of individuals encountered in health facilities and households and for tracking of individuals enrolled in longitudinal studies (7, 21). The new DSS is based on continuous recording of births and deaths ('vital events'), and changes of household membership and migrations by trained village informants, with follow-up visits by professional enumerators. The system was evaluated with a re-census after two years. We describe the methods and present the results of the evaluation.

The Karonga DSS, known as the "Continuous Registration System" (CRS) joined the 'International Network for the continuous Demographic Evaluation of Populations and Their Health in developing countries' (INDEPTH) in 2002. …

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