Cause of death data from hospitals in Mozambique Dra. Cidalia Baloi - PowerPoint PPT Presentation

Cause of death data from hospitals in Mozambique Dra. Cidalia Baloi MISAU Moçambique Dra Roberta Pastore and Dr Alessandro Campione Jembi Health Systems - Moasis Mocambique “Improving cause of death and AIDS mortality measurement in Africa” Meeting Cape Town, 15-16 Nov 2012 WHO in collaboration with Medical Research Centre, Cape Town, South Africa ALPHA Network & INDEPTH Network, UNECA

MoH - MOASIS – Jembi a new cooperation model  Moasis is a Living Lab program of UEM  Have a 5 years MoU with the MoH  Is supported by Jembi Health System SA ( South-South Cooperation) and the Oasis network of HIS expert in the world  Resources are coming from CDC CoAg, WHO, Twinning Centre, HMN  Is becoming the E-Health Institute of Mozambique, Aims to :  Strengthen local e-Health capabilities  involve public, private, research and academic sectors.  linking between in country and regional institutions. MISAU - Mozambique

MOASIS – Jembi in the world MISAU - Mozambique

MOASIS – Jembi in Mozambique Outputs 23 active national-level projects, prioritized according to the MoH strategic plan, main projects: – National HIS policies – Mortality system (SIS-ROH) and vital statistic – national M&E system – Hospital Informational System based on reduced ICD- 10 list – individual based electronic system – Supply chain System – Data analyses, dissemination and publication MISAU - Mozambique

Mortality registration in Mozambique MISAU - Mozambique

• In 2008 MoH started a revision of mortality system in the health sector • NHS has the mandate to certify the cause(s) of death, classified and coded using ICD-10 • Comprehensive study of death • > 400 health certification in professional the health sector trained on ICD-10 • Review of work • Basic training flow and course for institutional interactions mortality coders New national Old certificate New certificate regulation MISAU - Mozambique

• First phase = to set up intra-hospital mortality register (death and causes of death) • Second phase = to initiate a inter-institutional collaboration to review the whole national CRVS – Create Inter-institutional Vital Statistic Working Group – Main focus on revision of overall mortality registration system and birth registration MISAU - Mozambique

Key Partners for mortality system Development and implementation • MOH • MOASIS • Jembi Health Systems Technical and financial support • WHO and HMN • South African MRC and WHO-FIC CC • CDC MISAU - Mozambique

Intra-hospital mortality register Data source • Source of data = Revised death certificate – Introduced nationwide in 2009 (books, 3 carbon copies) – Comprising 9 sections I. Identification of the issuing entity * II. Identification of the dead person * III. Residency of the dead person * IV. Place of occurrence of death * V. Information for death <1 year of age VI. Information for maternal mortality VII. Causes of death (underlying, intermediate, direct) * VIII. Identification of signing doctor IX. Information on external causes of death * captured by SIS-ROH MISAU - Mozambique

Intra-hospital mortality register Data management Introduction of electronic tool for data management ( SIS-ROH ) – Individual based electronic register – Using all ICD-10 list – Co-developed by mOASIS and MOH using national expertise – Data quality through in-built data validations – Produces automatic reports – Restricted access to data – Basic hardware requirements for instalation MISAU - Mozambique

Intra-hospital mortality register Data Flow Future Pilot phase Actually in phase place Extra-hosp Extra-hospital Health facility death due to death due to Death of in proximity natural cause external inpatient (family to cause request DC) DC filled by MD (or TM?) DC filled by Death MD of No health certificate Forensic facility in filled by District/provincial Medicine or proximity admission directorate of Anatomo- ward MD Health pathology DC with Auto de Copy 1: Copy 3: support obito Family of Copy 2: SIS- Hospital of VA? deceased patient file / ROH (NEP) archive Civil Registration site MISAU - Mozambique

Intra-hospital mortality register User manuals and training materials At central and provincial level: – TOT on use of ICD-10 for classification and codification of COD – Training on SIS-ROH software for IT public and private service providers (long term maintenance) In each new implementation site: – Training on ICD-10 for: • Clinical staff  to fill death certificate • Statistical unit staff  to code COD – Training on use of SIS-ROH for data management, filing, backup, maintenance of software, helpdesk MISAU - Mozambique

Implementation of SIS-ROH to date • Scaled up at national level (2,5 YEARS) • Installed in 28 sites 2 1 – 18 Hospitals: 1 2 • 7 provincial (100%) • 3 central (100%) 1 • 4 general (66%) 1 1 • 4 rural (13%) 1 – 10 Provincial ~ 35,000 Directorates of Health records 1 2 6 MISAU - Mozambique

Analysis of SIS-ROH data: 2009-2011 • Datasets of ≥12 months were included in the analysis • Totally 10 hospitals included − 6 excluded because SIS-ROH was implemented from late 2011 onwards − 2 excluded because dataset was lost for technical problems and theft of IT equipment MISAU - Mozambique

Data available for analysis of mortality (10 hospitals) Rapidly 15063 16000 6000 increasing 14000 12000 coverage 5000 8995 10000 8000 5259 4000 6000 4000 3000 2000 0 2000 2009 2010 2011 1000 0 2009 2010 2011 MISAU - Mozambique

Mortality by cause of death (chapter), Mozambique 2009-2011 Pregnancy, delivery, puerp. Hematological 2% dis. Digestive dis. Other causes 2% 2% 7% Nervous system dis. 3% Infectious and Endocrine and parasitic dis. metabolic dis. Neoplasms 37% 4% 5% Respiratory dis. 5% Disorders of External causes perinatal period 6% 19% Cardio-vascular dis. 8% MISAU - Mozambique

Mortality by infectious diseases, Mozambique 2009-2011 HIV/AIDS Other is 28% of infectious diseases all causes 6% of death TB HIV/AIDS 6% 73% Infectious Malaria diarrea 10% 5% MISAU - Mozambique

Deaths due to HIV/AIDS, Mozambique 2009- 2011 HIV disease resulting in …. No. % Unspecified HIV disease 5870 72% HIV + mycobacterial infections 916 11% HIV + multiple infections 410 5% HIV + encephalopathy (HIV dementia) 339 4% HIV + other bacterial infections 238 3% HIV + Kaposi sarcoma 202 2% HIV + Pneumocystis pneumonia 86 1% HIV + candidiasis and other mycoses 36 0.4% HIV + wasting syndrome 29 0.4% HIV + other malignant neoplasms 22 0.3% HIV + Burkitt lymphoma 15 0.2% Total 8163 MISAU - Mozambique

Deaths due to HIV/AIDS, Mozambique 2009- 2011 HIV disease resulting in …. No. % Unspecified HIV disease 5870 72% HIV + mycobacterial infections 916 11% HIV + multiple infections 410 5% Need to disseminate HIV + encephalopathy (HIV dementia) 339 4% mortality statistics and HIV + other bacterial infections 238 3% HIV + Kaposi sarcoma conduct further training 202 2% HIV + Pneumocystis pneumonia 86 1% on ICD-10 to increase HIV + candidiasis and other mycoses 36 0.4% accuracy of information HIV + wasting syndrome 29 0.4% HIV + other malignant neoplasms 22 0.3% HIV + Burkitt lymphoma 15 0.2% Total 8163 MISAU - Mozambique

Distribution of HIV/AIDS related deaths by sex and age, 2009-2011 1400 1.1 Among 15-24 years old M/F ratio the risk to die for 1.6 1200 HIV/AIDS is Overall = 1.3 significantly higher for 1000 women [RR = 1.6 (1.4-1.8)] 800 1.8 600 0.5 1.3 1.7 400 1.2 200 1.0 1.5 0 <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65+ Feminino Masculino MISAU - Mozambique

Distribution of deaths by age and cause of death, 2009-2011 Average age of death % of deaths due to for >1 year is HIV/AIDS per each 9000 significantly lower for 7% age group 8000 deaths due to HIV/AIDS (34.9) than to 7000 other diseases (39.1) 6000 50% 5000 37% 4000 19% 54% 8% 3000 22% 23% 36% 2000 1000 0 <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65+ HIV/AIDS Other causes MISAU - Mozambique

Deaths related to HIV/AIDS in each hospital, 2010-11 Prevalence of HIV infection in the province (F – 15-49 ys) – INSIDA 2009 18% 21% 5% 20% 16% 10% 3% 10% 15% 30% 13% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% HCB HCM HCN HGJM HPC HPI HPL HPP HPQ HPX Total HIV/AIDS Other causes MISAU - Mozambique

Distribution of the deaths by type of admission to hospital, 2009-2011 100% 80% 60% 71% 56% 40% 20% 0% Other causes Total HIV disease Transferred from another HF Emergency Outpatient visit or birth MISAU - Mozambique

Trends of mortality per HIV/AIDS over time in HCM, 2008-2011 4500 % of 4000 death Year due to 3500 HIV/AIDS 3000 2008 35% 2500 2009 29% 2010 23% 2000 2011 24% 1500 1000 500 2008 2009 2010 2011 HIV/AIDS Other causes MISAU - Mozambique