Citation

von Schreeb J, Rosling H, Garfield R. Lancet 2007; 369(9556): 101; author reply 103-4.

Comment On:

Lancet 2006; 368(9545): 1421-1428

Copyright

(Copyright © 2007, Elsevier Publishing)

DOI

10.1016/S0140-6736(07)60058-0

PMID

17223462

Abstract

The uncertainty of estimates from retrospective mortality surveys in humanitarian emergencies is composed of both sampling and reporting errors. Gilbert Burnham and colleagues, in their mortality study in Iraq (Lancet 2006; 368(9545): 1421-1428), quantify the sampling error, but the security situation did not allow for the supervision and repeat interviews needed to estimate reporting errors.

Over-reporting of deaths was regarded as limited because 92% of reported deaths were supported by death certificates, but Burnham and colleagues do not report who issued these certificates. Neither do they discuss why the availability of death certificates increased from 81% in 2004.

The existence of a substantial reporting error is supported by the finding of low child mortality. The study population only reported 54 non-violent deaths in those younger than 15 years, and 1474 births—ie, an under-15 mortality of 36 per 1000 births. This is a third of the estimated preinvasion under-5 mortality. Since nothing indicates that child mortality has decreased, the results suggest that fewer than half of child deaths were reported.

Without an explanation for the high availability of death certificates, one could assume that the reporting error is of the same size as the sampling error (±30%). This assumption still yields at least a five-fold higher number of violent deaths than the passive surveillance mortality numbers. If the death certificates are valid and the availability above 90%, it seems better to monitor mortality by compiling data from the local agencies that issue these certificates than by doing further dangerous household surveys.

Language: en