School of Public Health
Countrywide Mortality Surveillance in Action (COMSA) - Mozambique
Mozambique is one of the few countries in sub-Sahara Africa that has met the Millennium Development Goal (MDG) four by reducing its -under-five mortality rates (U5MR) by over two-thirds that was estimated at 79 deaths per 1000 in 2015. Reaching the newly set target under the Sustainable Development Goals (SDG) of U5MR at least as low as 25 by 2030 will require greater efforts in health program strategies but also precise, accurate and timely measurement of mortality and cause of death to inform these programs. Similar to most low-income countries, Mozambique does not currently have a functioning civil registration and vital statistics (CRVS) system that is able to produce complete and high-quality mortality data for monitoring recent trends in mortality and cause of death. Mozambique currently relies on national household surveys such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS) to measure mortality but these sources are not able to generate recent and timely mortality data.
The project aims to establish a Countrywide Mortality Surveillance for Action (COMSA) in Mozambique consisting of a nationwide sample registration system to record pregnancies, pregnancy outcomes, and deaths; verbal and social autopsy of deaths identified; hospital surveillance of under-five deaths in a provinces, and analysis of project data including using of data collected through a separate project on Child Health and Mortality Prevention Surveillance (CHAMPS) that relies on minimally invasive tissue sampling (MITS). The CHAMPS project is implemented by Emory University and is independent of the COMSA project.
The COMSA investment, funded by the Bill & Melinda Gates Foundation, aims to address the measurement and monitoring challenges by supporting Mozambique to develop and implement an approach of sample registration system (SRS) of pregnancies, births, and deaths, with cause of death assessment in the total population, with particular emphasis on children under-five using verbal autopsy and an innovative approach that relies on minimally invasive tissue sampling (MITS). Over a period of three years, we aim to achieve four primary outcomes:
(a) A sustainable and country-owned sample registration system (SRS) for mortality and cause of death surveillance enabling national and subnational comparison leading to action,
(b) improvements in measurement of causes of death among children under-five by setting up a hospital under-five death surveillance to identify a sample of deaths linked to the CHAMPS project on MITS for accurate cause of death determination and its use to validate and improve verbal autopsy-based child cause of death,
(c) annual national and subnational mortality and cause-specific rates generated using directly the SRS data but also through sound statistical modeling, combining data from the SRS, CHAMPS and other available national surveys such as DHS and MICS leading to production of subnational distribution of mortality burden that is used for action,
(d) a sustainable system for mortality and cause of death data collection, analysis and use in place in Mozambique by the end of the three-year project, owned and run by the government, generating frequent national and subnational mortality and cause-specific rates that responds to government's and partners' needs for program, policy planning, and resource allocation.
PI Mentor: Agbessi Amouzou