Much of the developing world, especially sub-Saharan Africa, is characterised by incomplete or no vital registration systems. With the majority of deaths occurring at home in such poor settings, they are usually not registered and causes of death are hardly ascertained. The unavailability of cause-of-death information in these areas limits efforts to establish a solid evidence base for health policy formulation. It also presents significant challenges for effective planning, monitoring and evaluation of health care delivery systems.