Surveillance of Excess Mortality Based on Community Perceptions of Funeral Frequency in Northern Malawi during the COVID-19 Pandemic

Supplementary methods of mortality surveillance are needed in settings with incomplete death registration. Local perceptions of mortality levels might be useful indicators of excess deaths. Early in the COVID-19 pandemic, we developed a survey question asking respondents to evaluate the recent frequency of funerals in their community relative to a pre-pandemic baseline. We asked this question of more than 400 residents of Karonga district in Malawi, who were interviewed up to five times during a panel survey conducted by mobile phone between June 2020 and May 2021. The proportion of respondents reporting more funerals than usual in their community increased in early 2021, indicating excess mortality not otherwise detected by case-based surveillance and only partially visible in reports of inpatient deaths at health facilities. Systems assessing changes in perceptions of mortality can be rapidly established during an epidemic and may help detect excess deaths at local levels.