No excess mortality detected in rural Bangladesh in 2020 from repeated surveys of a population of 81,000

Abstract

Background Excess mortality has demonstrated under-counting of COVID-19 deaths in many countries but cannot be measured in low-income countries where civil registration is incomplete. Methods Enumerators conducted an in-person census of all 16,054 households in a sample of 135 villages within a 350 km2 region of Bangladesh followed by a census conducted again in May and November 2020 over the phone. The date and cause of any changes in household composition, as well as changes in income and food availability, were recorded. For analysis, we stratify the mortality data by month, age, gender, and household education. Mortality rates were modeled by Bayesian multilevel regression and the strata aggregated to the population by poststratification. Results A total of 276 deaths were reported between February and the end of October 2020 for the subset of the population that could be contacted twice over the phone, slightly below the 289 deaths reported for the same population over the same period in 2019. After adjustment for survey non-response and poststratification, 2020 mortality changed by -8% (95% CI, -21% to 7%) relative to an annualized mortality of 6.1 per thousand in 2019. However, salaried breadwinners reported a 40% decline in income and businesses a 60% decline in profits in May 2020. Discussion All-cause mortality in the surveyed portion of rural Bangladesh was if anything lower in 2020 compared to 2019. Our findings suggest various restrictions imposed by the government limited the scale of the pandemic, although they need to be accompanied by expanded welfare programs.

Collecting mortality data via mobile phone surveys: A non-inferiority randomized trial in Malawi

“…During the Ebola epidemic in west Africa, a survey in Monrovia (Liberia) asked randomly selected mobile phone users about recent deaths in their households [5]. Since the beginning of the COVID-19 pandemic, MPS surveys in India and Bangladesh have also monitored recent household deaths [23,24]. In particular, a question about recent COVID deaths was included in a large phone survey, which allowed estimating that the death toll related to the COVID-19 pandemic in India might be 6-7 times larger than officially reported [25].…”

Revisiting the Recommended Duration of Interviews Conducted by Mobile Phone in Low- and Middle-income Countries: A Randomized Trial in Malawi

“…In particular, worries that questions about deaths might be too sensitive to ask on the phone seem unfounded. MPS conducted in India and Bangladesh during the COVID-19 pandemic have asked mobile subscribers to report recent deaths in their households, without experiencing significant declines in cooperation (Barnwal et al, 2021;Jha et al, 2022). A recent randomized trial in Malawi has also assigned mobile subscribers to an interview about either deaths having recently occurred in their family, or about their economic activity (Chasukwa et al, 2022), i.e., a topic often investigated by MPS in LMICs (Egger et al, 2021).…”

Collecting mortality data via mobile phone surveys: a non-inferiority randomized trial in Malawi

“…During the Ebola epidemic in west Africa, a survey in Monrovia (Liberia) asked randomly selected phone owners about recent deaths in their households [6]. Since the beginning of the COVID-19 pandemic, surveys in India and Bangladesh have monitored recent household deaths [28,29]. In particular, a question about recent COVID deaths was included in a large phone survey, which allowed estimating that the death toll related to the COVID-19 pandemic in India might be 6-7 times larger than officially reported [30].…”