Mortality assessment
SESSION 13
Factors leading to missing data
in emergency
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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
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
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When to assess mortality
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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
Understanding mortality rates
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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
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 househouse.
 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
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Key considerations
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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
Key variables
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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
Mortality rate formula
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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
Cut offs
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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
Cut offs- U5MR and CMR
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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