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
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)
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
MISAU - Mozambique
MISAU - Mozambique
Additional slides
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
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
MISAU - Mozambique
Intra-hospital mortality register Data management
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
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%
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%
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
MISAU - Mozambique
Distribution of the causes of death by age group and other demographic variables
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