session 4a - mozambique

14
Mozambique Achievements in creating the Intra- hospital Mortality Register and multi- sectorial coordination mechanism Global Summit on Civil Registration and Vital Statistics Bangkok, Thailand, 18 April 2013 Dr Roberta Pastore (on behalf of Dr Alessandro Campione Jembi Health Systems/MOASIS

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Page 1: Session 4A - Mozambique

CRVS in MozambiqueAchievements in creating the

Intra-hospital Mortality Register and multi-sectorial

coordination mechanism

Global Summit on Civil Registration and Vital Statistics

Bangkok, Thailand, 18 April 2013

Dr Roberta Pastore (on behalf of Dr Alessandro CampioneJembi Health Systems/MOASIS

Page 2: Session 4A - Mozambique

MISAU - Mozambique

Mortality registration in Mozambique• Statistics on COD were available through surveys/ad hoc studies• In 2007 MoH started the process to revise the mortality system

within the health sector• Supporting partners: MOASIS , Jembi Health Systems, WHO, HMN,

CDC, SA WHO-FIC CC

New death certificate

- Analysis of death certification - New national regulation

ICD-10 adopted as national standard

• Set up of Intra-hospital mortality register (SIS-ROH)

• Training on ICD-10 and death registration

First national mortality

analysis based on routinely

collected data

2007 - 2008 2008 - 2011 2012

Expansion to 18 sites nationwide (35% of all hospitals)

Page 3: Session 4A - Mozambique

MISAU - Mozambique

Coordination mechanism for CRVS in Mozambique

The process in the health sector trigged broader inter-sectorial efforts in order to:- Expand registration and elaboration of statistics to all deaths- Review the whole national CRVS

Achievements to date:– High level Inter-institutional Vital Statistics Working Group (IVS WG)

created. MOU signed and work plan defined– Members: MOH, MOJ, MIT, UEM/MOASIS, INE +/- others– Main focus: revision/strengthening of overall death and birth

registration systems– Easier sharing of information, avoiding duplication of initiatives,

integrate ongoing efforts in a comprehensive framework– Planned in-depth assessment of CRVS to elaborate plan of action for

strengthening CRVS

Page 4: Session 4A - Mozambique

MISAU - Mozambique

Page 5: Session 4A - Mozambique

MISAU - Mozambique

Additional slides

Page 6: Session 4A - Mozambique

MISAU - Mozambique

Success factors• Bottom-up approach – Start little, be pragmatic– Obtain concrete results and grow based on success

• Local ownership and political commitment• Informatics solutions suitable to the country

setting• Data used locally and in real time

Page 7: Session 4A - Mozambique

MISAU - Mozambique

Copy 2: SIS-ROH (NEP)

Copy 3: Hospital

patient file / archive

Copy 1: Family of deceased

Death of inpatient

Extra-hospital death due to

external cause

Death certificate filled by

admission ward MD

DC filled by MD of

Forensic Medicine or Anatomo-pathology

Extra-hosp death due to natural cause

(family to request DC)

Health facility in proximity

No health facility in proximity

Auto de obito

District/provincial

directorate of Health (SIS-ROH)

DC filled by MD (or TM?)

DC with support of VA?

Civil Registration site

Currently in place

Piloted – under expansion

Drafted - To be defined by IVS WG

Page 8: Session 4A - Mozambique

MISAU - Mozambique

Intra-hospital mortality register Data management

Page 9: Session 4A - Mozambique

MISAU - Mozambique

2008 2009 2010 2011 2012*0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

~ 53,000 records

11

1

1

2

1

1 2

12

6

Implementation of SIS-ROH to dateScaled up at national level in 3 YEARS

Rapidly increasing coverage

*data from some hospitals are awaited

Page 10: Session 4A - Mozambique

MISAU - Mozambique

Mortality by cause of death – Broad CategoryMozambique 2009-2011

Infectious and

parasitic dis.37%

Disorders of perinatal period19%

Cardio-vascular dis.

8%

External causes

6%

Respiratory dis.5%

Neoplasms5%

Endocrine and metabolic dis.

4%

Nervous system dis.

3%

Hematological dis.2%

Digestive dis.2%

Pregnancy, delivery, puerp.

2% Other causes7%

Page 11: Session 4A - Mozambique

MISAU - Mozambique

Mortality by cause of death – Details per each category (ex. Infectious diseases)

HIV/AIDS73%

Malaria10%Infectious

diarrea5%

TB6%

Other infec-tious diseases

6%

Page 12: Session 4A - Mozambique

MISAU - Mozambique

Mortality by cause of death – Details per each disease (ex. HIV/AIDS)

71.9%

11.2%

5.0%

4.2%2.9%2.5%0.4%0.2%0.3%1.1%0.4%

HIV not specified

HIV + TB

HIV + multiple infections

HIV + encephalopathy

HIV + bacterial infections

HIV + Kaposi sarcoma

HIV + mycotic infections

HIV + Burkitt lynphoma

HIV + other malignant neoplasm

HIV + pneumonia (pneu-mocystis)

HIV + wasting syndrome

Page 13: Session 4A - Mozambique

MISAU - Mozambique

Distribution of the causes of death by age group and other demographic variables

Page 14: Session 4A - Mozambique

MISAU - Mozambique

Distribution of the deaths by type of admission

Birth in Hosp. Emergency Transfer from other HF

Transfer from outpatient service

0

500

1000

1500

2000

2500

3000

3500

200920102011

Information important for:• Improvement of hospital management • Enhancement of referral system among different levels of health services