A significant component of the under-5 child health and mortality statistics project is the collection of primary data in order to more fully understand weaknesses in the cause of death certification process and medical record keeping systems, as well as bottlenecks and delays in the search for care process. A variety of data collection methods are utilized. Below is an overview of the primary forms of data collection and the corresponding data collection instruments, where available.

Household survey

IHME, in collaboration with UADY, developed a household survey to be conducted in select communities in Yucatán, Mexico. The household survey contains questions on household composition and characteristics, recognition of alarm signs for common causes of mortality for children under the age of 5, and search for care practices for recent illnesses among children under the age of 5. The survey also contains questions about more general topics related to care for children under the age of 5, such as nutrition and breastfeeding practices and vaccination. The household survey is designed for households which contain one or more children under the age of 5, with the primary caretaker of the child as the key respondent.

The household survey was used to collect data in eight communities from January through March of 2020. All households in selected areas were censused to identify eligible households with children under the age of 5 and the complete household survey was conducted in all eligible households identified. Data collection was conducted on tablets using the SurveyCTO/ODK electronic data collection platform by a team of eight data enumerators based at UADY. Data collected in early 2020 will serve as a baseline measurement in order to evaluate the effectiveness of community-based interventions. Additional household survey data collection is scheduled for late 2020, however restrictions due to COVID-19 may result in the delay or cancellation of future household survey data collection.

Household survey data collection instruments, as well as data and corresponding codebooks for household surveys conducted in early 2020, can be found here on the Global Health Data Exchange.

Medical record review

Medical record review (MRR) consists of the systematic review and extraction of data from selected clinical medical records.

MRR data extraction forms developed specifically for the under-5 child health and mortality statistics project were designed and programmed into the SurveyCTO/ODK electronic data collection system at IHME in collaboration with UADY. The MRR forms focused on identifying causes of death based on information contained in the medical record and classifying the quality of records based on their contents. The MRR forms utilize the gold-standard criteria from the Population Health Metrics Research Consortium (PHMRC) study to identify cause of death based on requisite laboratory tests, imaging, and recorded clinical symptoms.

MRR forms were used to collect data for all deaths of children under the age of 5 which occurred in Yucatán, Mexico during the years 2015 and 2016. Eligible deaths were identified using the vital registration system and the corresponding electronic medical records were obtained from the relevant hospital. MRR extraction was conducted by a team of five doctors based at UADY who underwent extensive training on both sampling procedures and the data collection instrument.

Additional MRR extraction for deaths of children under the age of 5 in Yucatán, Mexico is planned for late 2020, however restrictions due to COVID-19 may result in the delay or cancellation of future MRR extraction.

Data collection instruments, as well as the corresponding datasets and codebooks, for the Medical Record Review tool are publicly available here on the Global Health Data Exchange.

Health facility survey

IHME, in collaboration with UADY, developed a health facility survey to be conducted in Agustín O’Horan Hospital. The health facility questionnaire covers a variety of general topics aimed at gaining a deeper overall understanding of the hospital, such as facility characteristics, services offered, and staffing practices. Additionally, the survey contains a more detailed battery of questions targeted at specific areas of interest for the under-5 child health and mortality statistics project, most notably pertaining to medical record-keeping practices and the process for certifying causes of death at the hospital. While the majority of the survey is comprised of structured questions, it also provides an opportunity for respondents to reflect and comment more broadly on topics of interest through open-ended discussion questions.

The health facility questionnaire is designed to be conducted by medical personnel trained specifically on the use of this data collection tool. A facility administrator will serve as the primary respondent for the survey, however other facility staff with more specialized knowledge of specific areas of interest, such as medical record specialists, may also respond directly or support the primary respondent. Data collection at Agustín O’Horan hospital using the health facility survey is expected to be conducted in late 2020, however the completion of the survey may be delayed or cancelled due to restrictions resulting from COVID-19.

The health facility survey data collection instrument continues to be refined and will be made publicly available in the coming months.

Verbal Autopsy

Verbal Autopsy (VA) is a method for determining cause of death, typically used in circumstances where more robust medical record and vital registration systems are not available. Verbal autopsies generally take the form of a structured interview using a standardized questionnaire conducted with a family member of the deceased.

Customized verbal autopsies were designed and conducted for all deaths of children under the age of 5 which occurred in Yucatán, Mexico during the years 2015 and 2016. Eligible deaths were identified through the vital registration system. Interviews were conducted with caretakers of the deceased child from March to November 2017 by a local field team based at UADY using the SurveyCTO/ODK electronic data collection software system.

The verbal autopsy utilized for the under-5 child health and mortality statistics project was designed and implemented by IHME and UADY and comprised of the neonatal and child modules from the PHMRC Shortened Questionnaire, supplemented with questions pertaining to health seeking behavior during the illness or injury leading up to the death and questions pertaining to general household characteristics.

Verbal autopsy data collection instruments used in the under-5 child health and mortality statistics project, as well as the corresponding datasets and codebooks, are publicly available here on the Global Health Data Exchange.

Additionally, more detailed information on the Verbal Autopsy tools and resources in general, including electronic and paper copies of PHMRC data collection instruments, can be found here.