Contribution of community health workers towards estimating the global mortality rate in rural Eastern DR Congo: a household-based survey.
Ndongozi B.F2, Nabugobe S.P2, Cikomola M.A1,2,3, Birembano M.F 2, Bahati M2, , Bashonja M2, Bwenge M1,2, Ntambwe M.A3,4, Bisimwa B1,2,3.
(1= Université Catholique de Bukavu, 2= Ecole Régionale de santé Publique de l’Université Catholique de Bukavu, 3=Renforcement Institutionnel pour des Politiques de Santé basées sur l’Evidence en République Démocratique du Congo, RIPSEC, 4= Ecole de Santé Publique de l’Université de Lubumbashi).
In developing countries, accurate global mortality estimates are hardly available due to the dysfunction of public record systems. This is likely the case of Mulungu (cris and instability) and Idjwi (stable and security), two eastern DR Congo health zones with respectively 0.5 and 0.6 doctors, 4 and 6 nurses; and 0.8 and 1.2 hospital beds per 1000 inhabitants.
This study aimed at evaluating the capacity of community health workers (CHW) to provide accurate estimates of deaths occurring in a community through a household survey in a post-war region.
This retrospective cross-sectional survey was conducted in two rural health zones in South-Kivu province (Mulungu and Idjwi) between 20th January and 15th February 2016. Community health workers primarily enrolled in a mosquito net distribution campaign were trained to collect global mortality data on the number of deaths occurring between January and December 2015, using a semi-structured questionnaire. We used stata 13 to generate prevalence estimates and odds ratios using the “cci” command.
Overall, 23810 (77.7%) households were surveyed in Mulungu (total population =139964) and 36058 (92.9%) in Idjwi (total population=197305). The CHW were able to identify up to 1800 deaths in Mulungu with a global mortality rate of 12,86 per 1000 inhabitants and 1743 deaths in Idjwi equivalent to a global mortality rate of 8.83 per 1000 inhabitants. Bivariable analysis showed that the odds of death were 45% higher in Mulungu than in Idjwi (OR=1.45, 95% CI: 1.36-1.55; p<0.001).
In instable Eastern DR Congo regions still recovering from war effects on the health systems, mortality rate remain higher compared to that in more stable areas. CHW involved in a number of public health interventions in the region can contribute substantially to collecting mortality data in their health zones.
Key words: Community health workers, health zone, global mortality, crisis.