An innovative documentation of AIDS mortality: Demographic and mortality surveillance in Ethiopia- Butajira, 2008

Background: Mortality data in Ethiopia are scarce; in the Butajira district most deaths occur at home and are undocumented. The Butajira Demographic Surveillance System (DSS), initially established as a community-based vital events registration system for research purposes, has evolved into a public health surveillance system. In 2002, the DSS began estimating cause-specific mortality, including AIDS, using verbal autopsy, an indirect method for estimating cause-specific mortality.

Methods: The communities (10) under surveillance in the Butajira district were selected using a probability proportional to size approach method. A qualitative review was conducted to determine the feasibility of DSS as a mortality surveillance system. Data collection activities included semi-structured interviews with DSS staff, field observations, and analysis of DSS databases.

Results: In January 2007 the population under surveillance was 54,096. Among 198 deaths reported between September 2007–June 2008, 21 (10.6%) were attributed to AIDS, yielding an AIDS specific mortality rate of 0.39 per 1,000. The system has operated without interruption since its establishment; household visits are conducted quarterly on a continuous basis. The DSS has shown flexibility by including the surveillance of migration and vital events.

Recommendations: The DSS has built capacity in the Butajira district by documenting health events and now providing a platform for AIDS mortality surveillance. Although geographically restricted, the DSS has generated mortality data in an ongoing manner within a resource limited setting. Collectively, DSS placed throughout Ethiopia could improve the assessment of mortality patterns, help estimate life expectancy, and improve public health planning.