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International Health

International Health faculty receive $7 million grant to develop a national mortality surveillance system in Mozambique

The system will track births, deaths, and identify causes of death at the national and provincial levels 

The Institute for International Programs in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health was awarded a 3-year, $7-million grant to develop a nationwide surveillance system capable of producing annual estimates of mortality rates and causes of death throughout Mozambique—information currently unavailable at the national and provincial levels.  

Funded by the Bill & Melinda Gates Foundation, the Comprehensive Mortality Surveillance for Action, or COMSA, project addresses a critical information gap faced by many low- and middle-income countries without a fully operational civil registration and vital statistic (CRVS) system. Without a complete CRVS system, most births and deaths in Mozambique go undocumented. Information about mortality and causes of death is estimated from data that can be up to 10 years old. As a result, changes in the distribution and levels of disease burden can go unrecorded. Policymakers and program managers rely on this type of demographic and epidemiologic information to help them make decisions about where and how to allocate public health resources. COMSA will build a surveillance system that continuously tracks pregnancies, births, and deaths, in representative communities from across the country, allowing national and provincial mortality estimates to be produced for the first time on an annual basis in the country.  

“The system we’re building will provide a better picture of what is happening on the ground as it’s happening,” says Agbessi Amouzou, COMSA’s principal investigator and a faculty member in the Department of International Health at the Bloomberg School.  “We’ll be able to tell, for instance, if pneumonia deaths are spiking in one part of the country and traffic deaths decreasing in another–information crucial for targeting interventions to where they are most needed—and just as important, when.”

Making Progress toward a Complete Civil Registration and Vital Statistics System

The project will train community representatives to identify all pregnancies, births and deaths in the sample communities. COMSA will also develop mobile applications for data collection with handheld devices such as cellphones. The data will systematically be reported to the country’s CRVS system. The new reporting infrastructure will dramatically increase the reach of Mozambique’s CRVS system and it will help provide birth and death certificates to populations who previously lacked access to any kind of government vital statistics documentation. 

 “COMSA will be first in an African country to establish such a national sample surveillance system,” says Robert Black, a professor in International Health at the Bloomberg School and a coinvestigator on the project. “It could be a model for similar countries to quickly improve the quality of information while simultaneously developing a complete CRVS system.”

Methodological Innovation

Conducting medical autopsies for every death is not feasible in Mozambique. Instead, COMSA will employ a widely recognized technique known as verbal autopsy to determine probable cause of death. To improve the accuracy of estimates derived from verbal autopsies, COMSA will collaborate with another Bill & Melinda Gates Foundation-funded project working in Mozambique—the Child Health and Mortality Prevention Surveillance (CHAMPS) project. CHAMPS conducts a type of medical autopsy called minimally invasive tissue sampling (MITS) in a district in the country. The procedure involves collecting a set of specimens that are analyzed with a number of laboratory tests. While MITS results can be used to attribute cause of death as accurately and specifically as possible, the procedure is too costly to implement universally. However, researchers can compare findings from MITS to those from verbal autopsy. This analysis will help make refinements to the methodological approaches used for cause-of-death estimation with verbal autopsy data.  

Other Bloomberg School faculty and staff working on COMSA include Scott Zeger, Henry Kalter, Malick Kante, Abhirup Datta, Alain Koffi, Tim Roberton, and Fred Van Dyk.