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Paper Abstract
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Introduction Despite the urgent need for timely mortality data in low-income and lower-middle-income countries, mobile phone surveys rarely include questions about recent deaths. There are concerns that such questions might a) be too sensitive, b) prompt negative/adverse reactions among respondents, c) take too long to ask and/or d) generate unreliable data. We assessed the feasibility of mortality data collection during mobile phone surveys.
Methods We conducted a non-inferiority trial among a random sample of mobile phone users in Malawi. Participants were allocated 3:1 to an interview about recent deaths in their family (treatment group) or about their economic activity (control group). In the treatment group, half of the respondents completed a short mortality questionnaire, focused on information necessary to calculate recent mortality rates, whereas the other half completed an extended questionnaire that also included questions about symptoms and healthcare use. The primary trial outcome was the cooperation rate. Secondary outcomes included the completion rate, self-reports of negative feelings and stated intentions to participate in future interviews. We also documented the amount of time required to collect mortality data, and we explored the quality of death reports.
Results The difference in cooperation rates between treatment and control groups was 0.9 percentage points (95% CI = -2.3, 4.1), which satisfied the non-inferiority criterion. Similarly, the mortality questionnaire was non-inferior to the control questionnaire on all secondary outcomes. Collecting mortality data required approximately 2 to 4 additional minutes per reported death, depending on the inclusion of questions about symptoms and healthcare use. More than half of recent deaths elicited during mobile phone interviews had not been reported to the national civil registration system.
Conclusion Including mortality-related questions in mobile phone surveys appears acceptable and feasible. It might help strengthen the surveillance of mortality trends in low-income and lower-middle-income countries with limited civil registration systems.
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