Village registers for vital registration in rural Malawi

Abstract

Paper-based village registers were introduced 5 years ago in Malawi as a tool to measure vital statistics of births and deaths at the population level. However, usage, completeness and accuracy of their content have never been formally evaluated. In Traditional Authority Mwambo, Zomba district, Malawi, we assessed 280 of the 325 village registers with respect to (i) characteristics of village headmen who used village registers, (ii) use and content of village registers, and (iii) whether village registers provided accurate information on births and deaths. All village headpersons used registers. There were 185 (66%) registers that were regarded as 95% completed, and according to the registers, there were 115 840 people living in the villages in the catchment area. In 2011, there were 1753 births recorded in village registers, while 6397 births were recorded in health centre registers in the same catchment area. For the same year, 199 deaths were recorded in village registers, giving crude death rates per 100 000 population of 189 for males and 153 for females. These could not be compared with death rates in health centre registers due to poor and inconsistent recording in these registers, but they were compared with death rates obtained from the 2010 Malawi Demographic Health Survey that reported 880 and 840 per 100 000 for males and females, respectively. In conclusion, this study shows that village registers are a potential source for vital statistics. However, considerable inputs are needed to improve accuracy of births and deaths, and there are no functional systems for the collation and analysis of data at the traditional authority level. Innovative ways to address these challenges are discussed, including the use of solar-powered electronic village registers and mobile phones, connected with each other and the health facilities and the District Commissioner's office through the cellular network and wireless coverage.keywords operational research, vital statistics, village registers, Malawi

Community workers contribution for data quality improvement in routine health information system: Live births number estimation by capture recapture method

“…If we do not take into account the CWs in our study, the number of live births not reported by any source rises from 18.2% to 26.8% in group 1 and from 18.3% to 23.3% in group 2. These results bear out the positive benefit of the CWs in improving the vital statistics system, as reported by studies in Malawi, Indonesia and in DRC [17][18][19]. The estimates made in group 1 are questionable as the optimum model seems to be the saturated model [23,31].…”

“…To improve the exhaustiveness of information concerning vital events, various strategies have been proposed and implemented at national level in countries such as Ghana and India, with varying degrees of success [6,8,16]. On a more local level, in Malawi, Indonesia and DRC, studies have identified positive experiences with community-based organisations [4,[17][18][19]. According to these studies, the workers of community-based organisations or community workers (CW) could represent an opportunity to improve the performance of RHIS as regards the exhaustiveness of vital events.…”

Evaluation of approaches to strengthen civil registration and vital statistics systems: A systematic review and synthesis of policies in 25 countries

“…India [62], Malawi [52] Supply Integration of birth and/or death registration in existing services (e.g., health facilities or burial sites) was low cost, required minimal additional human or IT infrastructure, and reduced indirect costs for clients.…”

“…Albania [75], Botswana [72], Brazil [71], Ghana [64], India [59,73], Malawi [52], Peru [56] Incentive Requiring a national ID for government services (e.g., education, social protection, voting, etc.) and subsequently linking birth registration to national ID provision improved human resource availability, physical infrastructure accessibility, and client uptake of birth registration.…”

Who Counts? What Counts? Place and the Limits of Perinatal Mortality Measures

“…Infrastructure problems mean that neither paper death certificates nor computerized records are gathered reliably into a central vital registration system. By some estimates, three-quarters of Malawi's deaths are never officially reported [6]. Instead, maternal mortality is estimated from samples of Malawi residents who are surveyed about the lives and deaths of their adult siblings.…”