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COMPARISON OF GOVERNMENT STATISTICS AND DEMOGRAPHIC SURVEILLANCE TO MONITOR MORTALITY IN CHILDREN LESS THAN FIVE YEARS OLD IN RURAL WESTERN KENYA

Estimates of mortality in children less than five years old using government civil registration statistics (passive surveillance) were compared against statistics generated by active demographic surveillance during a randomized controlled trial of permethrin-treated bed nets (ITNs) in western Kenya. Mortality rates were two-fold lower when estimated through civil registration compared with active prospective surveillance (rate ratio [RR] = 0.51, 95% confidence interval [CI] = 0.44–0.59). While civil registration underestimated deaths, particularly in the neonatal period, the age distribution of deaths in children 1–59 months of age was the same as with active surveillance. Seasonal mortality trends were also similar. There was no agreement between cause of death recorded by active and passive surveillance. Verbal autopsy estimated that half of all deaths were associated with malaria and pneumonia, but civil registration markedly under-reported these illnesses; incidence RR (95% CI) = 0.18 (0.14–0.24), and 0.05 (0.03–0.08), respectively, while over-reporting deaths due to measles (RR = 15.5 [95% CI = 7.3–33.2]). Government statistics under-represent mortality, particularly neonatal mortality, in children less than five years of age in rural areas of Kenya. They can provide accurate information on the age-distribution of deaths among children 1–59 months old, and on seasonal trends, but not on disease-specific mortality.

Acknowledgments: We thank the bed net project field staff for their contribution to this study, and Polycarp Obel and James Kwach for their supervisory assistance. We are grateful to the residents of Asembo for their cooperation. Dr. Kevin DeCock is thanked for his comments on the manuscript. This paper is published with the permission of the Director of the Kenya Medical Research Institute.

Financial support: The ITN project was funded by the United States Agency for International Development.

Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by the U.S. Public Health Service or Department of Health and Human Services.

Authors’ addresses: John Arudo and Laurence Slutsker, Centre for Vector Biology Control Research, Kenya Medical Research Institute, Centers for Disease Control and Prevention, PO Box 1578, Kisumu, Kenya. John E. Gimnig, Feiko O. ter Kuile, S. Patrick Kachur, Margarette S. Kolczak, William A. Hawley, and Penelope A. Phillips-Howard, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. Alloys S. S. Orago, Zoology Department, Kenyatta University, PO Box 43844, Nairobi, Kenya. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.

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