Estimation of national and subnational all-cause mortality indicators in Nepal, 2017.

BACKGROUND: Despite the civil registration and vital statistics (CRVS) system in Nepal operating for several decades, it has not been used to produce routine mortality statistics. Instead, mortality statistics rely on irregular surveys and censuses that primarily focus on child mortality. To fill this knowledge gap, this study estimates levels and subnational differentials in mortality across all ages in Nepal, primarily using CRVS data adjusted for incompleteness. METHODS: We analyzed death registration data (offline or paper-based) and CRVS survey reported death data, estimating the true crude death rate (CDR) and number of deaths by sex and year for each province and ecological belt. The estimated true number of deaths for 2017 was used with an extension of the empirical completeness method to estimate the adult mortality (45q15) and life expectancy at birth by sex and subnational level. Plausibility of subnational mortality estimates was assessed against poverty head count rates. RESULTS: Adult mortality in Nepal for 2017 is estimated to be 159 per 1000 for males and 116 for females, while life expectancy was estimated as 69.7 years for males and 73.9 years for females. Subnationally, male adult mortality ranges from 129 per 1000 in Madhesh to 224 in Karnali and female adult mortality from 89 per 1000 in Province 1 to 159 in Sudurpashchim. Similarly, male life expectancy is between 64.9 years in Karnali and 71.8 years in Madhesh and female male life expectancy between 69.6 years in Sudurpashchim and 77.0 years in Province 1. Mountain ecological belt and Sudurpashchim and Karnali provinces have high mortality and high poverty levels, whereas Terai and Hill ecological belts and Province 1, Madhesh, and Bagmati and Gandaki provinces have low mortality and poverty levels. CONCLUSIONS: This is the first use of CRVS system data in Nepal to estimate national and subnational mortality levels and differentials. The national results are plausible when compared with Global Burden of Disease and United Nations World Population Prospects estimates. Understanding of the reasons for inequalities in mortality in Nepal should focus on improving cause of death data and further strengthening CRVS data.

Assessment of the national and subnational completeness of death registration in Nepal.

BACKGROUND: Reliable and timely mortality data from a civil registration and vital statistics (CRVS) system are of crucial importance for generating evidence for policy and monitoring the progress towards national and global development goals. In Nepal, however, the death registration system is not used to produce mortality statistics, because it does not providing data on age at death and only reporting deaths by year of registration. This study assesses the completeness of death registration in Nepal - both the existing offline system and the newer online system - as well as the completeness of death reporting from a CRVS Survey, and assesses differences by year, sex, ecological belt, and province. METHODS: The empirical completeness method is used to estimate completeness at all ages from the offline (paper-based) registration system (2013-17), the online registration system (2017-19) and the CRVS Survey (2014-15). RESULTS: Completeness of the offline death registration system was 69% in 2017, not increasing since 2013 and being higher for males (73%) than females (65%). Completeness of online registration was only 32% in 2019, but almost double the 2017 figure. Completeness of death reporting in the CRVS Survey was 75% in 2015. The largest subnational differentials in completeness exist for the offline registration system, ranging from 90% in Gandaki to just 39% in Karnali. CONCLUSIONS: Improvement in the utility of the Nepalese death registration system for mortality statistics is dependent on continued roll-out of the online death registration system (which reports age at death and deaths by year of occurrence) throughout the country, focusing on areas with low registration, building a strong coordination mechanism among CRVS stakeholders and implementing public awareness programs about death registration.