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Archived Comments for: Unreported births and deaths, a severe obstacle for improved neonatal survival in low-income countries; a population based study

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  1. Low mortality registration- client and system perspectives

    Rajesh Sood, National Institute of Epidemiology, Chennai, India

    7 May 2008

    Mortality registration should be viewed from the client perspectives. Adult deaths are notified and reported due to inheritance, and insurance benefits.

    In case of infant deaths, the matter often goes unreported as the family members perceive no direct benefit as outcome of death registration.

    From the system prespective there are a number of barriers.

    The local registrars do the registation only once a month, and ask the person to come in person to get "His Work done", which is another deterrent to access to registration. Expecting a person in grief to go through the trouble of waiting 30 minutes among a group of people who have come for their work to the village council and get a neonatal death registered is thus unreasonable and impractical from the client's perspective.

    In India, the health worker is to notify births and deaths to local registrar of village panchayat (local self government). The workers are reluctant or hesistant to do so dur to fear and apprehensisons that they will be puled up for poor care negligence, and subsequent enquiry and unwanted paperwork.

    In institutional deliveries, there is a tendency to report early neonatal deaths as stillbirths by health care providers, to avoid death enquiry was seen in areas where death enquiry was attempted (like Tamil Nadu).

    Institution based de facto reporting of deaths suffers from a major limitation of skewed disaggergated analysis. Places having medical colleges get high number of high risk cases, more deaths reported and thus higher IMR, NMR etc which is not actually true.

    The solution thus lies in strengthening community based reporting de jure. An incentive to grassroot level workers to register the vital events, sensitize registrars and validation of the zero reporting is suggested as a measure to strengthen vital registration.

    Competing interests