Using Health Extension Workers for Monitoring XXXX Mortality in Real-Time: Validation against Household Survey Data in Rural Ethiopia.

@entity1 @entity283 @entity600 @entity1939 @entity204
BACKGROUND: Ethiopia has scaled up its community-based programs over the past decade by training and deploying @entity283 ( @entity283 ) in rural communities throughout the country. Consequently, @entity1 mortality has declined substantially, placing Ethiopia among the few countries that have achieved the United Nations' fourth Millennium Development Goal. As Ethiopia continues its efforts, results must be assessed regularly to provide timely feedback for improvement and to generate further support for programs. More specifically the expansion of @entity283 at the community level provides a unique opportunity to build a system for real-time monitoring of births and @entity204 , linked to a civil registration and vital statistics system that Ethiopia is also developing. We tested the accuracy and @entity600 and @entity204 reported by trained @entity283 for monitoring @entity1 mortality over 15 -month periods. METHODS AND FINDINGS: @entity283 were trained in 93 randomly selected rural kebeles in Jimma and West Hararghe zones of the Oromia region to report births and @entity204 over a 15-month period from January, 2012 to March, 2013. @entity1939 of births and @entity204 , age distribution of @entity204 , and accuracy of resulting under-five, @entity1 , and neonatal mortality rates were assessed against data from a large household survey with full birth history from @entity1 aged 15-49. Although, in general @entity283 , were able to accurately report events that they identified, the completeness of number of births and @entity204 reported over twelve-month periods was very low and variable across the two zones. Compared to household survey estimates, @entity283 reported only about 30% of births and 21% of under-five @entity204 occurring in their communities over a twelve-month period. The under-five mortality rate was under-estimated by around 30%, @entity1 mortality rate by 23% and neonatal mortality by 17%. @entity283 reported disproportionately higher number of @entity204 among the very young @entity1 than among the older @entity1 . CONCLUSION: Birth and @entity204 data reported by @entity283 are not complete enough to support the monitoring of changes in childhood mortality. @entity283 can significantly contribute to the success of a CRVS in Ethiopia, but cannot be relied upon as the sole source for identification of vital events. Further studies are needed to understand how to increase the level of completeness.
