Countrywide Mortality Surveillance for Action in Mozambique: Results from a National Sample-Based Vital Statistics System for Mortality and Cause of Death

Sub-Saharan Africa lacks timely, reliable, and accurate national data on mortality and causes of death (CODs). In 2018 Mozambique launched a sample registration system (Countrywide Mortality Surveillance for Action [COMSA]-Mozambique), which collects continuous birth, death, and COD data from 700 randomly selected clusters, a nationally representative population of 828,663 persons. Verbal and social autopsy interviews are conducted for COD determination. We analyzed data collected in 2019–2020 to report mortality rates and cause-specific fractions. Cause-specific results were generated using computer-coded verbal autopsy (CCVA) algorithms for deaths among those age 5 years and older. For under-five deaths, the accuracy of CCVA results was increased through calibration with data from minimally invasive tissue sampling. Neonatal and under-five mortality rates were, respectively, 23 (95% CI: 18–28) and 80 (95% CI: 69–91) deaths per 1,000 live births. Mortality rates per 1,000 were 18 (95% CI: 14–21) among age 5–14 years, 26 (95% CI: 20–31) among age 15–24 years, 258 (95% CI: 230–287) among age 25–59 years, and 531 (95% CI: 490–572) among age 60+ years. Urban areas had lower mortality rates than rural areas among children under 15 but not among adults. Deaths due to infections were substantial across all ages. Other predominant causes by age group were prematurity and intrapartum-related events among neonates; diarrhea, malaria, and lower respiratory infections among children 1–59 months; injury, malaria, and diarrhea among children 5–14 years; HIV, injury, and cancer among those age 15–59 years; and cancer and cardiovascular disease at age 60+ years. The COMSA-Mozambique platform offers a rich and unique system for mortality and COD determination and monitoring and an opportunity to build a comprehensive surveillance system.