Evaluation of the National Maternal and Child Health Surveillance system and Application of the Standard WHO Verbal Autopsy Questionnaires for Infant Mortality in Guizhou, China

Abstract

Background: Priorities of researches, policies and programmes to prevent and reduce diseases and injuries should be properly based on adequate information about the nature and extent of the health situation. National Maternal and Child Health Surveillance System (MCSS) as the best possible and sustainable resources to get the data of the infant mortality in China, its quality is not well known by world. Objective: To evaluate the National Maternal and Child Health Surveillance System for infant mortality in Guizhou, China. Method: In a retrospective study, records of 157 deceased infants registered in the MCSS study areas of Guizhou Province were reviewed and assessed for their completeness and accuracy. Causes of 99 deaths among them were validated using WHO recommended Verbal Autopsy (VA) procedure. In addition, a self-administered questionnaire was used to obtain the feedback about this Verbal Autopsy, and analyzed using qualitative methodology. Result: MCSS forms filled in the study area of Guizhou Province was satisfying completed, while duplication errors were tracked in Honghuagang District and the age at infant death was recorded imprecisely in Pingtang County. This might be the first study using WHO recommended Verbal Autopsy to evaluate the classification of Cause of Death (COD) in western China. The agreement (Kappa=0.554) between VA-based causes of death and registered causes of death for the included 99 cases was moderate, and was increased (Kappa=0.648) for those 54 cases with better Verbal Autopsy evidence. Validity and reliability of MCSS-based causes of death for the pneumonia, birth asphyxia, and diarrhoea in the study areas of Guizhou Province were reasonably good, but the preterm or low birth weight obtained low scores in terms of sensitivity (50.0%), PPV (20.0%) and Kappa (0.242). Conclusion: Although great effort has been spent in the completeness of required form in the MCSS of Guizhou, China, the quality of the recorded data and cause of death classification are also worthy to be paid great attention on, For those who died in home without medical certification, Verbal Autopsy can be used to assign the causes of death. But Verbal Autopsy questionnaires, procedures and death classification terminology should be adopted in an identical way across the country.