Background and Objectives: Due to the importance of mortality statistics for planning, setting priorities and equal allocation of health services in population; it is essential to assess quality of reporting mortality data in health systems. The aim of this study was to evaluate the completeness and accuracy of the Iranian Vital Horoscope reports for maternal and the under-five mortality (U5M) in rural areas through its comparison with other data sources in Iran.
Methods: The mortality data of Vital Horoscope reported from 30 selected cities over country was compared with the related data obtained from other data sources including Vital Horoscope's Fieldwork reports, Death Registration System and Maternal Mortality Surveillance System of Ministry of Health and Medical Education.
Results: Overall completeness of Vital Horoscope's Fieldwork reports for U5M in rural areas was about % 62.1. In terms of cause of death in children under-five,estimated sensitivity values were % 47.2 (95% CI: 22.9-72.2), % 66.6(95% CI: 22.7-95.7),  %78.2 (95% CI: 64.3-89.3)for respiratory infections, diarrhea and vomiting, and injuries-burning and poisoning respectively. The vital horoscope reports had 12.5% misclassification in determining the cause of maternal death.
Conclusion: Our findings indicate the Vital Horoscope's data might need some corrections because of underestimating of the mortality indicators. The comparison of this source with Death Registration System report for causes of death in children under-five (reported by Vital Horoscope) suggests that the vital horoscope might have suboptimal quality.