Monitoring Child Mortality through Community Health Worker Reporting of Births and Deaths: A Case Study of Community Health Surveillance Assistants in Malawi

The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed to help Governments assess and report on progress and to target their child survival programs. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially-trained community health workers (CHW) in Malawi. Mortality data collected by randomly-selected CHWs in two districts are compared to those of a “gold-standard” mortality survey. Results indicate that CHW reports under-estimated child mortality by 24% to 49%, and the level of under-estimation increased over time. The approach appears to hold some promise, however, because the vital events that were reported by the CHWs were accurate and reliable. We are now investigating further to determine patterns of errors so that CHW performance can be improved and sustained.