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Pandya S, Kan L, Parr E, Twose C, Labrique AB, Agarwal S. How Can Community Data Be Leveraged to Advance Primary Health Care? A Scoping Review of Community-Based Health Information Systems. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300429. [PMID: 38626945 PMCID: PMC11057800 DOI: 10.9745/ghsp-d-23-00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Community-based health information systems (CBISs) can provide critical insights into how community health systems function, and digitized CBISs may improve the quality of community-level data and facilitate integration and use of CBISs within the broader health system. This scoping review aims to understand how CBISs have been implemented, integrated, and used to support community health outcomes in low- and middle-income countries (LMICs). METHODS Both peer-reviewed and gray literature were included; relevant articles were identified using key terms and controlled vocabulary related to community/primary health care, health information systems, digital health, and LMICs. A total of 11,611 total records were identified from 5 databases and the gray literature. After deduplication, 6,985 peer-reviewed/gray literature were screened, and 95 articles/reports were included, reporting on 105 CBIS implementations across 38 countries. RESULTS Findings show that 55% of CBISs included some level of digitization, with just 28% being fully digitized (for data collection and reporting). Data flow from the community level into the health system varied, with digitized CBISs more likely to reach national-level integration. National-level integration was primarily seen among vertical CBISs. Data quality challenges were present in both paper-based and digitized CBISs, exacerbated by fragmentation of the community health landscape with often parallel reporting systems. CBIS data use was constrained to mostly vertical and digitized (partially or fully) CBISs at national/subnational levels. CONCLUSION Digitization can play a pivotal role in strengthening CBIS use, but findings demonstrate that CBISs are only as effective as the community health systems they are embedded within. Community-level data are often not being integrated into national/subnational health information systems, undermining the ability to understand what the community health needs are. Furthermore, stronger investments within community health systems need to be in place broadly to reduce fragmentation and provide stronger infrastructural and systemic support to the community health workforce.
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Affiliation(s)
- Shivani Pandya
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lena Kan
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily Parr
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Twose
- Welch Medical Library, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Smisha Agarwal
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cervantes CE, Parameswaran S, Jaar BG. Unlocking Mysteries: Smart Verbal Autopsy's Role in CKD of Unknown Etiology Research. Kidney Int Rep 2024; 9:10-12. [PMID: 38312793 PMCID: PMC10831361 DOI: 10.1016/j.ekir.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Affiliation(s)
- C. Elena Cervantes
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Nephrology, Baltimore, Maryland, USA
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Bernard G. Jaar
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Nephrology, Baltimore, Maryland, USA
- The Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
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Tunga M, Lungo JH, Chambua J, Kateule R, Lyatuu I. Exploring challenges and recommendations for verbal autopsy implementation in low-/middle-income countries: a cross-sectional study of Iringa Region-Tanzania. BMJ Open 2023; 13:e075399. [PMID: 38086579 PMCID: PMC10729186 DOI: 10.1136/bmjopen-2023-075399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Verbal autopsy (VA) plays a vital role in providing cause-of-death information in places where such information is not available. Many low-/middle-income countries (LMICs) including Tanzania are still struggling to yield quality and adequate cause-of-death data for Civil Registration and Vital Statistics (CRVS). OBJECTIVE To highlight challenges and recommendations for VA implementation to support LMICs yield quality and adequate mortality statistics for informed decisions on healthcare interventions. DESIGN Cross-sectional study. STUDY SETTING Iringa region in Tanzania. PARTICIPANTS 41 people including 33 community health workers, 1 VA national coordinator, 5 national task force members, 1 VA regional coordinator and 1 member of the VA data management team. RESULTS The perceived challenges of key informants include a weak death notification system, lengthy VA questionnaire, poor data quality and inconsistent responses, lack of clarity in the inclusion criteria, poor commitment to roles and responsibilities, poor coordination, poor financial mechanism and no or delayed feedback to VA implementers. Based on these findings, we recommend the following strategies for effective adaptation and use of VAs: (1) reinforce or implement legislative procedures towards the legal requirement for death notification. (2) Engage key stakeholders in the overall implementation of VAs. (3) Build capacity for data collection, monitoring, processing and use of VA data. (4) Improve the VA questionnaire and quality control mechanism for optimal use in data collection. (5) Create sustainable financing mechanisms and institutionalisation of VA implementation. (6) Integrating VA Implementation in CRVS. CONCLUSION Effective VA implementation demands through planning, stakeholder engagement, upskilling of local experts and fair compensation for interviewers. Such coordinated endeavours will overcome systemic, technical and behavioural challenges hindering VA's successful implementation.
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Affiliation(s)
- Mahadia Tunga
- Computer Science and Engineering, University of Dar es Salaam College of Engineering and Technology, Dar es Salaam, Tanzania
| | - Juma Hemed Lungo
- Computer Science and Engineering, University of Dar es Salaam College of Engineering and Technology, Dar es Salaam, Tanzania
| | - James Chambua
- Computer Science and Engineering, University of Dar es Salaam College of Engineering and Technology, Dar es Salaam, Tanzania
| | - Ruthbetha Kateule
- Computer Science and Engineering, University of Dar es Salaam College of Engineering and Technology, Dar es Salaam, Tanzania
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Adair T, Mikkelsen L, Hooper J, Badr A, Lopez AD. Assessing the policy utility of routine mortality statistics: a global classification of countries. Bull World Health Organ 2023; 101:777-785. [PMID: 38046370 PMCID: PMC10680110 DOI: 10.2471/blt.22.289036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/29/2023] [Accepted: 08/16/2023] [Indexed: 12/05/2023] Open
Abstract
Objective To evaluate the utility and quality of death registration data across countries. Methods We compiled routine death and cause of death statistics data from 2015-2019 from national authorities. We estimated completeness of death registration using the Adair-Lopez empirical method. The quality of cause of death data was assessed by evaluating the assignment of usable causes of death among people younger than 80 years. We grouped data into nine policy utility categories based on data availability, registration completeness and diagnostic precision. Findings Of an estimated 55 million global deaths in 2019, 70% of deaths were registered across 156 countries, but only 52% had medically certified causes and 42% of deaths were assigned a usable cause. In 54 countries, which are mostly high-income, there is complete and high-quality mortality data. In a further 29 countries, located across different regions, death registration is complete, but cause of death data quality remains suboptimal. Additionally, 37 countries possess functional death registration systems with cause of death data of poor to moderate quality. In 30 countries, death registration ranges from limited to nascent completeness, accompanied by poor or unavailable cause of death data. Furthermore, 38 countries lack accessible data altogether. Conclusion By implementing more proactive death notification processes, expanding the use of digitized data collection platforms, streamlining data compilation procedures and improving data quality assessment, governments could enhance the policy utility of mortality data. Encouraging the routine application of automated verbal autopsy methods is crucial for accurately determining the causes of deaths occurring at home.
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Affiliation(s)
- Tim Adair
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, 32 Lincoln Square North, Carlton3053, Victoria, Australia
| | | | | | - Azza Badr
- Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
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Bo KS, Firth SM, Phyo TPP, Mar NN, Zaw KK, Kapaw NH, Adair T, Lopez AD. Estimating causes of community death of adults in Myanmar from a nationwide population sample: Application of verbal autopsy. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002426. [PMID: 37910476 PMCID: PMC10619871 DOI: 10.1371/journal.pgph.0002426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Abstract
In Myanmar 84% of deaths occur in the community, of which half are unregistered and none have a reliable cause of death (COD) recorded. Since 2018, Myanmar has introduced improved registration practices and verbal autopsy (VA) to assess whether such methods can produce policy relevant information on community COD. Community health midwives and public health supervisors grade II collected VAs on over 80,000 deaths which occurred between January 2018 and December 2019 in a nationwide sample of 42 townships in Myanmar. Electronic methods were used to collect and consolidate data. The most probable COD was assigned using the SmartVA Analyze 2.0 computer algorithm. Completeness of VA death reporting increased to 71% in 2019. Most adult (12+ years) deaths (82%) were due to non-communicable diseases, primarily stroke, ischemic heart disease and chronic respiratory disease, for both men and women. VA results were consistent with Global Burden of Disease (GBD) Study estimates, except for cirrhosis in men, which was more common, and had a younger age distribution of death than the GBD. Large scale implementation of improved death registration practices and COD diagnosis using VA is feasible and provides plausible, timely, disaggregated and policy relevant information on the leading causes of community death. Addressing the burden of non-communicable diseases, particularly cirrhosis in young men, is an important public health priority in Myanmar. Improving completeness of VA death reporting in poorly performing townships and in neonates, children and women will further improve the policy utility of the VA data.
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Affiliation(s)
- Khin Sandar Bo
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Sonja M. Firth
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | | | - Nyo Nyo Mar
- Central Statistical Organization, Nay Pyi Taw, Myanmar
| | - Ko Ko Zaw
- University of Community Health, Magway, Myanmar
| | | | - Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Alan D. Lopez
- Independent Consultant, Tamborine Mountain, QLD, Australia
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Kalkonde YV, Rangamani S, Suwanwela NC, Mathur P, Injety RJ, Sebastian IA, Vijayanand PJ, Chawla NS, Sylaja P, Sharma M, Pandian JD. Surveillance of stroke: a South-East Asia Region (SEAR) perspective. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 17:100286. [PMID: 37849929 PMCID: PMC10577148 DOI: 10.1016/j.lansea.2023.100286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023]
Abstract
Surveillance of stroke is critical to track its burden and assess progress in prevention and treatment. We reviewed the literature to evaluate stroke surveillance efforts in the South-East Asia Region (SEAR) countries, identify progress and assess gaps. Epidemiological data on all the major parameters such as the incidence, prevalence and mortality of stroke were available for India and Thailand but for none of the other SEAR countries. Most of the epidemiological data came from investigator-initiated studies. National stroke surveillance was present only in India in the form of a National Stroke Registry Programme and Thailand has a national database that was used to obtain epidemiological data for stroke. Research on novel methods for stroke registration, such as using information technology, was absent. This review identified serious gaps in the monitoring and surveillance of stroke in SEAR countries. Systematic efforts are needed to fill those gaps.
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Affiliation(s)
| | - Sukanya Rangamani
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Nijasri C. Suwanwela
- Division of Neurology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Prashant Mathur
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Ranjit J. Injety
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Ivy A. Sebastian
- Consultant Neurologist, St. Stephen's Hospital, New Delhi, India
| | - Pranay J. Vijayanand
- Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Nistara S. Chawla
- Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - P.N. Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Meenakshi Sharma
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Nguyen TNT, Nguyen TTT, Tran BQ, Pham CT, Perry KE, Haregu T, Oldenburg B, Kowal P. Putting non-communicable disease data to work in Vietnam: an investigation of community health surveillance capacity. BMC Public Health 2023; 23:321. [PMID: 36788519 PMCID: PMC9926709 DOI: 10.1186/s12889-023-14986-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Despite the public health system's critical role in non-communicable disease (NCD) surveillance in Vietnam, limited evidence exists on the implementation of NCD surveillance activities within these systems and the need for capacity building across different system levels to meet expected NCD surveillance goals. This study aimed to evaluate the status of and describe factors affecting the implementation of NCD surveillance activities and to identify the NCD surveillance capacity building needs of the public health system in Vietnam. METHODS We used a mixed-methods approach in four provinces, conducting self-completed surveys of staff from six Preventive Medicine Institutes (PHI), 53 Centres for Disease Control (CDC) and 148 commune health stations (CHS), as well as 14 in-depth interviews and 22 focus group discussions at four PHI, four CDC, and eight district health centres and CHS. RESULTS Study findings highlighted that although Vietnam has a well-functioning NCD surveillance system, a number of quality issues related to NCD surveillance data were salient. Multifactorial reasons were identified for incomplete, unconfirmed, and inaccurate mortality data and current disease surveillance data. Data on NCD management and treatment were reported to be of better quality than data for screening, targeted treatment, and counselling communication. Main factors affected the effective implementation of NCD surveillance, namely lack of complete and specific guidelines for NCD surveillance, limitations in human resource capacity within NCD departments, and shortage of funding for NCD surveillance activities. CONCLUSION Study findings provide practical strategies for strengthening health system capacity for NCD surveillance through developing policies, guidelines, and standardised tools to guide NCD surveillance and a road map for integrated NCD surveillance, developing training packages and manuals for all levels of the health system, and conducting utilisation-focused surveillance training programs.
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Affiliation(s)
- Thu Nam T. Nguyen
- FHI 360 Vietnam Office, 17Th Floor, Capital Tower, 109 Tran Hung Dao Street, Hanoi, Vietnam
| | - Thi Tho T. Nguyen
- grid.419597.70000 0000 8955 7323Noncommunicable Disease Prevention and Control Department, National Institute of Hygiene and Epidemiology, 1 Yec Xanh Street, Hanoi, Vietnam
| | - Bao Quoc Tran
- grid.67122.30Noncommunicable Disease Prevention and Control Department, General Department of Preventive Medicine, Ministry of Health, 138 Giang Vo Street, Hanoi, Vietnam
| | - Cong Tuan Pham
- FHI 360 Vietnam Office, 17Th Floor, Capital Tower, 109 Tran Hung Dao Street, Hanoi, Vietnam
| | - Kelly E. Perry
- FHI 360, Asia Pacific Regional Office, 19Th Floor, Tower 3 Sindhorn Building 130-132 Wireless Road Kwaeng Lumpini, Khet Phatumwan, Bangkok, Thailand
| | - Tilahun Haregu
- grid.1051.50000 0000 9760 5620Baker Heart & Diabetes Institute, 75 Commercial Rd, Melbourne, Melbourne, Australia
| | - Brian Oldenburg
- grid.1051.50000 0000 9760 5620Baker Heart & Diabetes Institute, 75 Commercial Rd, Melbourne, Melbourne, Australia
| | - Paul Kowal
- International Health Transitions, Canberra, Australia ,grid.7132.70000 0000 9039 7662Research Institute for Health Sciences, Chiang Mai University, 239 Huay Kaew RdMueang Chiang Mai District, Chiang Mai, Tambon Su Thep, Thailand
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Mahesh BPK, Hart JD, Acharya A, Chowdhury HR, Joshi R, Adair T, Hazard RH. Validation studies of verbal autopsy methods: a systematic review. BMC Public Health 2022; 22:2215. [PMID: 36447199 PMCID: PMC9706899 DOI: 10.1186/s12889-022-14628-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/14/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Verbal autopsy (VA) has emerged as an increasingly popular technique to assign cause of death in parts of the world where the majority of deaths occur without proper medical certification. The purpose of this study was to examine the key characteristics of studies that have attempted to validate VA cause of death against an established cause of death. METHODS A systematic review was conducted by searching the MEDLINE, EMBASE, Cochrane-library, and Scopus electronic databases. Included studies contained 1) a VA component, 2) a validation component, and 3) original analysis or re-analysis. Characteristics of VA studies were extracted. A total of 527 studies were assessed, and 481 studies screened to give 66 studies selected for data extraction. RESULTS Sixty-six studies were included from multiple countries. Ten studies used an existing database. Sixteen studies used the World Health Organization VA questionnaire and 5 studies used the Population Health Metrics Research Consortium VA questionnaire. Physician certification was used in 36 studies and computer coded methods were used in 14 studies. Thirty-seven studies used high level comparator data with detailed laboratory investigations. CONCLUSION Most studies found VA to be an effective cause of death assignment method and compared VA cause of death to a high-quality established cause of death. Nonetheless, there were inconsistencies in the methodologies of the validation studies, and many used poor quality comparison cause of death data. Future VA validation studies should adhere to consistent methodological criteria so that policymakers can easily interpret the findings to select the most appropriate VA method. PROSPERO REGISTRATION CRD42020186886.
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Affiliation(s)
- Buddhika P. K. Mahesh
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - John D. Hart
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Ajay Acharya
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Hafizur Rahman Chowdhury
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Rohina Joshi
- grid.464831.c0000 0004 8496 8261The George Institute for Global Health, New Delhi, India ,grid.1005.40000 0004 4902 0432School of Population Health, University of New South Wales, Sydney, Australia
| | - Tim Adair
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Riley H. Hazard
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Dheresa M, Yadeta TA, Dingeta T, Shore H, Dessie Y, Daraje G, Tura AK. Why mothers die: Analysis of verbal autopsy data from Kersa Health and Demographic Surveillance System, Eastern Ethiopia. J Glob Health 2022; 12:04051. [PMID: 35976002 PMCID: PMC9302037 DOI: 10.7189/jogh.12.04051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Despite registering tremendous improvement as part of the Millennium Development Goals, Ethiopia has still one of the highest numbers of maternal mortality. Although maternal mortality is one of the commonest indicators for comparison or measuring progress, its measurement remained a challenge. In a situation where, vital registration is not in place and only few women gave birth in facilities, alternative data sources from population-based surveys are essential to describe maternal deaths. In this paper, we reported estimates of maternal mortality and causes in a predominantly rural setting in eastern Ethiopia. Methods Data were used from the ongoing prospective open cohort of Kersa Health and Demographic Surveillance System (HDSS), located in eastern Ethiopia. At enrolment, detailed sociodemographic and household conditions were recorded for every member, followed by household visit every six months to identify any vital events: births, deaths, and migration. Whenever a death was reported, additional information about the deceased - age, sex, pregnancy status, and perceived cause of deaths - were collected through interview of the closest family member(s). Then, the probable cause of death was assigned using an automated verbal autopsy system (InterVA). In this paper, we included all deaths among women during pregnancy, childbirth or within 42 days of termination of pregnancy. To describe the trends, we calculated annual maternal mortality ratio (MMR) along with their 95% Confidence Interval (CI). Results From 2008 to 2019, a total of 32 680 live births and 720 deaths among reproductive age women were registered. Of the 720 deaths, 158 (21.9%) were during pregnancy or within 42 days of termination of pregnancy, corresponding with an MMR of 484 per 100 000 live births. The three leading causes of deaths were pregnancy related sepsis, obstetric haemorrhage and anaemia of pregnancy. There was non-significant reduction in the MMR from 744 in 2008 to 665 in 2019, with three lowest ratios recorded in 2013 (172 per 100 000 live births), 2009 (280 per 100 000 live births) and 2016 (285 per 100 000 live births). Conclusions There was no significant decrement of MMR during the study period. Most deaths occurred at home from pregnancy related sepsis and haemorrhage implicating the unfinished agenda of ensuring skilled delivery and appropriate postnatal management.
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Affiliation(s)
- Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Kersa Health and Demographic Surveillance Systems, Harar, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hirbo Shore
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gamachis Daraje
- Kersa Health and Demographic Surveillance Systems, Harar, Ethiopia,Department of Statistics, College of Computing and Informatics, Haramaya University, Haramaya
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Chen L, Xia T, Rampatige R, Li H, Adair T, Joshi R, Gu Z, Yu H, Fang B, McLaughlin D, Lopez AD, Wang C, Yuan Z. Assessing the Diagnostic Accuracy of Physicians for Home Death Certification in Shanghai: Application of SmartVA. Front Public Health 2022; 10:842880. [PMID: 35784257 PMCID: PMC9247331 DOI: 10.3389/fpubh.2022.842880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Approximately 30% of deaths in Shanghai either occur at home or are not medically attended. The recorded cause of death (COD) in these cases may not be reliable. We applied the Smart Verbal Autopsy (VA) tool to assign the COD for a representative sample of home deaths certified by 16 community health centers (CHCs) from three districts in Shanghai, from December 2017 to June 2018. The results were compared with diagnoses from routine practice to ascertain the added value of using SmartVA. Overall, cause-specific mortality fraction (CSMF) accuracy improved from 0.93 (93%) to 0.96 after the application of SmartVA. A comparison with a “gold standard (GS)” diagnoses obtained from a parallel medical record review investigation found that 86.3% of the initial diagnoses made by the CHCs were assigned the correct COD, increasing to 90.5% after the application of SmartVA. We conclude that routine application of SmartVA is not indicated for general use in CHCs, although the tool did improve diagnostic accuracy for residual causes, such as other or ill-defined cancers and non-communicable diseases.
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Affiliation(s)
- Lei Chen
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Tian Xia
- Shanghai Institutes of Preventive Medicine, Shanghai, China
| | - Rasika Rampatige
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Hang Li
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rohina Joshi
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, New Delhi, India
| | - Zhen Gu
- Vital Strategies, New York, NY, United States
| | - Huiting Yu
- Shanghai Institutes of Preventive Medicine, Shanghai, China
| | - Bo Fang
- Shanghai Institutes of Preventive Medicine, Shanghai, China
| | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alan D. Lopez
- Department of Health Metrics Sciences, IHME, University of Washington, Seattle, WA, United States
| | - Chunfang Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Zheng'an Yuan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- *Correspondence: Zheng'an Yuan
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Dheresa M, Roba HS, Daraje G, Abebe M, Tura AK, Yadeta TA, Dessie Y, Dingeta T. Uncertainties in the path to 2030: Increasing trends of under-five mortality in the aftermath of Millennium Development Goal in Eastern Ethiopia. J Glob Health 2022; 12:04010. [PMID: 35136601 PMCID: PMC8801055 DOI: 10.7189/jogh.12.04010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Although Ethiopia was applauded for achieving the Millennium Development Goal (MDG) target of reducing child mortality, whether the gains sustained beyond the MDG era was rarely studied. In this study, we reported the trends and determinants of under-five mortality (U5M) from 2015 to 2020 in a population based cohort under the Kersa Health and Demographic Surveillance System (HDSS), eastern Ethiopia. Methods We followed pregnant women and their pregnancy outcomes from 2015 to 2020. Each year, data related to death and live births among the follow up population was retrieved. Automated verbal autopsy (InterVA-4) was used to assign the cause of death and Stata 14 was used for analysis. U5M rate was calculated as death among under five children divided by all live births during the study period and described per 1000 live births along with 95% Confidence Interval (CI). A multivariable Cox proportional regression model was used to identify determinant of U5M using adjusted hazard ratio (AHR). Finally, P value <0.05 was considered for declaring statistically significant association. Results From January 2015 to December 2020, a total of 28 870 live births were registered under the Kersa HDSS, of whom 1335 died before their fifth birthday. The overall U5M rate was 46.3 per 1000 live births (95% confidence interval (CI) = 43.79-48.79), with significant increase from 27.9 in 2015 to 54.7 in 2020 (P < 0.041). Diarrheal diseases, acute respiratory tract infection including pneumonia, meningitis and encephalitis, and HIV related deaths were the leading causes of U5M. The hazard of death was higher among children born to poor household (AHR = 1.52; 95% CI = 1.27-1.81), rural residents (AHR = 6.0; 95% CI = 3.65-9.91), born to adolescent mothers (AHR = 1.41; 95% CI = 1.02-1.95), whose mother didn’t receive antenatal care (AHR = 1.43; 95% CI = 1.21-1.69), were born preterm (AHR = 14.1; 95% CI = 9.96-19.89) and had low birth-weight (AHR = 1.74; 95% CI = 1.39-2.18). Conclusion We found high level of U5M rate with an increasing trend in the aftermath of the praised MDG4 achievement. Achieving the ambitious U5M of 25 per 1000 live births by 2030 requires addressing diarrheal disease, and respiratory tract infections, and HIV/AIDS. Reasons behind the persistent increase over the study period require further inquiry.
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Affiliation(s)
- Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health and Demographic Surveillance Systems, Harar, Ethiopia
| | - Hirbo Shore Roba
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gamachis Daraje
- Hararghe Health and Demographic Surveillance Systems, Harar, Ethiopia
- Department of statistics, College of Computing and Informatics, Haramaya University
| | - Mesfin Abebe
- Hararghe Health and Demographic Surveillance Systems, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Hart JD, Kwa V, Dakulala P, Ripa P, Frank D, Golpak V, Adair T, Mclaughlin D, Riley ID, Lopez AD. How advanced is the epidemiological transition in Papua New Guinea? New evidence from verbal autopsy. Int J Epidemiol 2022; 50:2058-2069. [PMID: 34999867 PMCID: PMC8743130 DOI: 10.1093/ije/dyab088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Reliable cause of death (COD) data are not available for the majority of deaths in Papua New Guinea (PNG), despite their critical policy value. Automated verbal autopsy (VA) methods, involving an interview and automated analysis to diagnose causes of community deaths, have recently been trialled in PNG. Here, we report VA results from three sites and highlight the utility of these methods to generate information about the leading CODs in the country. METHODS VA methods were introduced in one district in each of three provinces: Alotau in Milne Bay; Tambul-Nebilyer in Western Highlands; and Talasea in West New Britain. VA interviews were conducted using the Population Health Metrics Research Consortium (PHMRC) shortened questionnaire and analysed using the SmartVA automated diagnostic algorithm. RESULTS A total of 1655 VAs were collected between June 2018 and November 2019, 87.0% of which related to deaths at age 12 years and over. Our findings suggest a continuing high proportion of deaths due to infectious diseases (27.0%) and a lower proportion of deaths due to non-communicable diseases (NCDs) (50.8%) than estimated by the Global Burden of Disease Study (GBD) 2017: 16.5% infectious diseases and 70.5% NCDs. The proportion of injury deaths was also high compared with GBD: 22.5% versus 13.0%. CONCLUSIONS Health policy in PNG needs to address a 'triple burden' of high infectious mortality, rising NCDs and a high fraction of deaths due to injuries. This study demonstrates the potential of automated VA methods to generate timely, reliable and policy-relevant data on COD patterns in hard-to-reach populations in PNG.
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Affiliation(s)
- John D Hart
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Viola Kwa
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Paison Dakulala
- National Department of Health, Islander Drive, Port Moresby, Papua New Guinea
| | - Paulus Ripa
- Western Highlands Provincial Health Authority, Mt Hagen, Papua New Guinea
| | - Dale Frank
- Milne Bay Provincial Health Authority, Alotau, Papua New Guinea
| | - Victor Golpak
- West New Britain Provincial Health Authority, Kimbe, Papua New Guinea
| | - Timothy Adair
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Deirdre Mclaughlin
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Ian D Riley
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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13
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Hart JD, de André PA, de André CDS, Adair T, Barroso LP, Valongueiro S, Bierrenbach AL, de Carvalho PI, Antunes MBDC, de Oliveira CM, Pereira LAA, Minto CM, Bezerra TMDS, Costa SP, de Azevedo BA, de Lima JRA, Mota DSDM, Ramos AMDO, de Souza MDFM, da Silva LFF, França EB, McLaughlin D, Riley ID, Saldiva PHN. Validation of SmartVA using conventional autopsy: A study of adult deaths in Brazil. LANCET REGIONAL HEALTH. AMERICAS 2022; 5:100081. [PMID: 36776454 PMCID: PMC9904092 DOI: 10.1016/j.lana.2021.100081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy (VA) is increasingly used to provide population-level cause of death data. VAs are now widely interpreted using the automated algorithms SmartVA and InterVA. Here we use conventional autopsy as the gold standard to validate SmartVA methodology. METHODS This study included adult deaths from natural causes in São Paulo and Recife for which conventional autopsy was indicated. VA was conducted with a relative of the deceased using an amended version of the SmartVA instrument to suit the local context. Causes of death from VA were produced using the SmartVA-Analyze program. Physician coded verbal autopsy (PCVA), conducted on the same questionnaires, and Global Burden of Disease Study data were used as additional comparators. Cause of death data were grouped into 10 broad causes for the validation due to the real-world utility of VA lying in identifying broad population cause of death patterns. FINDINGS The study included 2,060 deaths in São Paulo and 1,079 in Recife. The cause specific mortality fractions (CSMFs) estimated using SmartVA were broadly similar to conventional autopsy for: cardiovascular diseases (46.8% vs 54.0%, respectively), cancers (10.6% vs 11.4%), infections (7.0% vs 10.4%) and chronic respiratory disease (4.1% vs 3.7%), causes accounting for 76.1% of the autopsy dataset. The SmartVA CSMF estimates were lower than autopsy for "Other NCDs" (7.8% vs 14.6%) and higher for diabetes (13.0% vs 6.6%). CSMF accuracy of SmartVA compared to autopsy was 84.5%. CSMF accuracy for PCVA was 93.0%. INTERPRETATION The results suggest that SmartVA can, with reasonable accuracy, predict the broad cause of death groups important to assess a population's epidemiological transition. VA remains a useful tool for understanding causes of death where medical certification is not possible.
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Affiliation(s)
- John D. Hart
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | | | | | - Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Lucia Pereira Barroso
- University of São Paulo, Institute of Mathematics and Statistics, São Paulo, São Paulo, Brazil
| | | | - Ana Luiza Bierrenbach
- Sírio-Libanês Hospital, São Paulo, São Paulo, Brazil
- Vital Strategies, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Ana Maria de Oliveira Ramos
- Federal University of Rio Grande do Norte, Health Sciences Center, Natal, Rio Grande do Norte, Brazil
- Natal Autopsy Service, Natal, Rio Grande do Norte, Brazil
| | | | - Luiz Fernando Ferraz da Silva
- University of São Paulo, School of Medicine, São Paulo, São Paulo, Brazil
- São Paulo Autopsy Service, University of São Paulo, Sao Paulo, Brazil
| | | | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Ian D. Riley
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Dheresa M, Tura AK, Daraje G, Abebe M, Dingeta T, Shore H, Dessie Y, Yadeta TA. Trend and Determinants of Mortality Among Women of Reproductive Age: A Twelve-Year Open Cohort Study in Eastern Ethiopia. Front Glob Womens Health 2022; 2:762984. [PMID: 34970651 PMCID: PMC8712503 DOI: 10.3389/fgwh.2021.762984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: With only less than a decade left till 2030, it is essential to research the burden and trends of women of reproductive age (WRA) mortality in order to design appropriate interventions toward achieving goal three of the sustainable development goals (SDGs), good health and well-being. For several low-income countries, such data are often lacking or sometimes extrapolated from non-representative facility-based studies. In this paper, we presented trends, causes, and determinants of mortality among reproductive-age women under follow-up for 12 years through the Health and Demographic Surveillance System (HDSS) located in eastern Ethiopia. Methods: We used 12 years of (2008 to 2019) open cohort data of women aged 15–49 living in Kersa HDSS in Eastern Ethiopia. In the HDSS, data on socio-demographic and basic household conditions are recorded for every household member at enrollment, and data on vital events such as births, deaths, and migration were collected and updated biannually as the event happened. Mortality was determined by automated verbal autopsy (InterVA) algorism. We assessed trends in women's reproductive age mortality and the associated determinants using crude and adjusted Cox regression models. Results: In the 12-years cohort, we followed 74,790 women of reproductive age for 339,909.26 person-years-at-risk of observation (PYO), of whom 919 died. Overall, the standardized mortality rate was 270 per 100,000 PYO. There was a notable increase in mortality in the first 3 years (2009 to 2011) which then declined significantly (p = 0.0001) until 2019. Most of the deaths were caused by HIV/AIDS (27.88%) and pulmonary tuberculosis (10.62%). In the adjusted Cox regression analysis, the hazard of death was higher among rural residents (AHR, 2.03: 95% CI: 1.60–2.58), unemployed women (AHR, 1.50: 95% CI: 1.19–1.89), and women with no formal education (AHR, 1.24: 95% CI: 1.01–1.52). Conclusion: The study showed a high number of women of reproductive age are still dying mainly due to causes for which preventable strategies are known and have been successfully implemented. The study identified that the main causes of death were related to HIV/AIDS and tuberculosis, and there was a higher hazard of mortality among rural residents, unemployed women, and those with no formal education, who need effective implementation in achieving the SDG three.
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Affiliation(s)
- Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Kersa Health and Demographic Surveillance System, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Gamachis Daraje
- Kersa Health and Demographic Surveillance System, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Statistics, College of Computing and Informatics, Haramaya University, Harar, Ethiopia
| | - Mesfin Abebe
- Kersa Health and Demographic Surveillance System, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hirbo Shore
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Kersa Health and Demographic Surveillance System, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Generating cause of death information to inform health policy: implementation of an automated verbal autopsy system in the Solomon Islands. BMC Public Health 2021; 21:2080. [PMID: 34774055 PMCID: PMC8590305 DOI: 10.1186/s12889-021-12180-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Good quality cause of death (COD) information is fundamental for formulating and evaluating public health policy; yet most deaths in developing countries, including the Solomon Islands, occur at home without medical certification of cause of death (MCCOD). As a result, COD data in such contexts are often of limited use for policy and planning. Verbal autopsies (VAs) are a cost-effective way of generating reliable COD information in populations lacking comprehensive MCCOD coverage, but this method has not previously been applied in the Solomon Islands. This study describes the establishment of a VA system to estimate the cause specific mortality fractions (CSMFs) for community deaths that are not medically certified in the Solomon Islands. Methods Automated VA methods (SmartVA) were introduced into the Solomon Islands in 2016. Trained data collectors (nurses) conducted VAs on eligible deaths to December 2020 using electronic tablet devices and VA responses were analysed using the Tariff 2.0 automated diagnostic algorithm. CSMFs were generated for both non-inpatient deaths in hospitals (i.e. ‘dead on/by arrival’) and community deaths. Results VA was applied to 914 adolescent-and-adult deaths with a median (IQR) age of 62 (45–75) years, 61% of whom were males. A specific COD could be diagnosed for more than 85% of deaths. The leading causes of death for both sexes combined were: ischemic heart disease (16.3%), stroke (13.5%), diabetes (8.1%), pneumonia (5.7%) and chronic-respiratory disease (4.8%). Stroke was the top-ranked cause for females, and ischaemic heart disease the leading cause for males. The CSMFs from the VAs were similar to Global Burden of Disease (GBD) estimates. Overall, non-communicable diseases (NCDs) accounted for 73% of adult deaths; communicable, maternal and nutritional conditions 15%, and injuries 12%. Six of the ten leading causes reported for facility deaths in the Solomon Islands were also identified as leading causes of community deaths based on the VA diagnoses. Conclusions NCDs are the leading cause of adult deaths in the Solomon Islands. Automated VA methods are an effective means of generating reliable COD information for community deaths in the Solomon Islands and should be routinely incorporated into the national mortality surveillance system. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12180-y.
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Firth SM, Hart JD, Reeve M, Li H, Mikkelsen L, Sarmiento DC, Bo KS, Kwa V, Qi JL, Yin P, Segarra A, Riley I, Joshi R. Integrating community-based verbal autopsy into civil registration and vital statistics: lessons learnt from five countries. BMJ Glob Health 2021; 6:bmjgh-2021-006760. [PMID: 34728477 PMCID: PMC8565529 DOI: 10.1136/bmjgh-2021-006760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/12/2021] [Indexed: 01/09/2023] Open
Abstract
This paper describes the lessons from scaling up a verbal autopsy (VA) intervention to improve data about causes of death according to a nine-domain framework: governance, design, operations, human resources, financing, infrastructure, logistics, information technologies and data quality assurance. We use experiences from China, Myanmar, Papua New Guinea, Philippines and Solomon Islands to explore how VA has been successfully implemented in different contexts, to guide other countries in their VA implementation. The governance structure for VA implementation comprised a multidisciplinary team of technical experts, implementers and staff at different levels within ministries. A staged approach to VA implementation involved scoping and mapping of death registration processes, followed by pretest and pilot phases which allowed for redesign before a phased scale-up. Existing health workforce in countries were trained to conduct the VA interviews as part of their routine role. Costs included training and compensation for the VA interviewers, information technology (IT) infrastructure costs, advocacy and dissemination, which were borne by the funding agency in early stages of implementation. The complexity of the necessary infrastructure, logistics and IT support required for VA increased with scale-up. Quality assurance was built into the different phases of the implementation. VA as a source of cause of death data for community deaths will be needed for some time. With the right technical and political support, countries can scale up this intervention to ensure ongoing collection of quality and timely information on community deaths for use in health planning and better monitoring of national and global health goals.
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Affiliation(s)
- Sonja Margot Firth
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John D Hart
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Reeve
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hang Li
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lene Mikkelsen
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Khin Sandar Bo
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Viola Kwa
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jin-Lei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Agnes Segarra
- Epidemiological Bureau, Republic of the Philippines Department of Health, Manila, Philippines
| | - Ian Riley
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rohina Joshi
- The George Institute for Global Health, Newtown, New South Wales, Australia,The George Institute for Global Health India, New Delhi, Delhi, India
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Adair T, Gamage USH, Mikkelsen L, Joshi R. Are there sex differences in completeness of death registration and quality of cause of death statistics? Results from a global analysis. BMJ Glob Health 2021; 6:bmjgh-2021-006660. [PMID: 34625458 PMCID: PMC8504355 DOI: 10.1136/bmjgh-2021-006660] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/11/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Recent studies suggest that more male than female deaths are registered and a higher proportion of female deaths are certified as 'garbage' causes (ie, vague or ill-defined causes of limited policy value). This can reduce the utility of sex-specific mortality statistics for governments to address health problems. To assess whether there are sex differences in completeness and quality of data from civil registration and vital statistics systems, we analysed available global death registration and cause of death data. METHODS Completeness of death registration for females and males was compared in 112 countries, and in subsets of countries with incomplete death registration. For 64 countries with medical certificate of cause of death data, the level, severity and type of garbage causes was compared between females and males, standardised for the older age distribution and different cause composition of female compared with male deaths. RESULTS For 42 countries with completeness of less than 95% (both sexes), average female completeness was 1.2 percentage points (p.p.) lower (95% uncertainty interval (UI) -2.5 to -0.2 p.p.) than for males. Aggregate female completeness for these countries was 7.1 p.p. lower (95% UI -12.2 to -2.0 p.p.; female 72.9%, male 80.1%), due to much higher male completeness in nine countries including India. Garbage causes were higher for females than males in 58 of 64 countries (statistically significant in 48 countries), but only by an average 1.4 p.p. (1.3-1.6 p.p.); results were consistent by severity and type of garbage. CONCLUSION Although in most countries analysed there was no clear bias against females in death registration, there was clear evidence in a few countries of systematic undercounting of female deaths which substantially reduces the utility of mortality data. In countries with cause of death data, it was only of marginally poorer quality for females than males.
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Affiliation(s)
- Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - U S H Gamage
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Lene Mikkelsen
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Rohina Joshi
- The George Institute for Global Health, Newtown, New South Wales, Australia.,The George Institute for Global Health, New Delhi, India
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Sempé L, Lloyd-Sherlock P, Martínez R, Ebrahim S, McKee M, Acosta E. Estimation of all-cause excess mortality by age-specific mortality patterns for countries with incomplete vital statistics: a population-based study of the case of Peru during the first wave of the COVID-19 pandemic. LANCET REGIONAL HEALTH. AMERICAS 2021; 2:None. [PMID: 34693394 PMCID: PMC8507430 DOI: 10.1016/j.lana.2021.100039] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND All-cause excess mortality is a comprehensive measure of the combined direct and indirect effects of COVID-19 on mortality. Estimates are usually derived from Civil Registration and Vital Statistics (CRVS) systems, but these do not include non-registered deaths, which may be affected by changes in vital registration coverage over time. METHODS Our analytical framework and empirical strategy account for registered mortality and under-registration. This provides a better estimate of the actual mortality impact of the first wave of the COVID-19 pandemic in Peru. We use population and crude mortality rate projections from Peru's National Institute of Statistics and Information (INEI, in Spanish), individual-level registered COVID-19 deaths from the Ministry of Health (MoH), and individual-level registered deaths by region and age since 2017 from the National Electronic Deaths Register (SINADEF, in Spanish).We develop a novel framework combining different estimates and using quasi-Poisson models to estimate total excess mortality across regions and age groups. Also, we use logistic mixed-effects models to estimate the coverage of the new SINADEF system. FINDINGS We estimate that registered mortality underestimates national mortality by 37•1% (95% CI 23% - 48•5%) across 26 regions and nine age groups. We estimate total all-cause excess mortality during the period of analysis at 173,099 (95% CI 153,669 - 187,488) of which 108,943 (95% CI 96,507 - 118,261) were captured by the vital registration system. Deaths at age 60 and over accounted for 74•1% (95% CI 73•9% - 74•7%) of total excess deaths, and there were fewer deaths than expected in younger age groups. Lima region, on the Pacific coast and including the national capital, accounts for the highest share of excess deaths, 87,781 (95% CI 82,294 - 92,504), while in the opposite side regions of Apurimac and Huancavelica account for less than 300 excess deaths. INTERPRETATION Estimating excess mortality in low- and middle-income countries (LMICs) such as Peru must take under-registration of mortality into account. Combining demographic trends with data from administrative registries reduces uncertainty and measurement errors. In countries like Peru, this is likely to produce significantly higher estimates of excess mortality than studies that do not take these effects into account. FUNDING None.
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Affiliation(s)
- Lucas Sempé
- University of East Anglia, Norwich, UK & Universidad Católica San Pablo, Arequipa, Peru
| | | | | | - Shah Ebrahim
- London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Enrique Acosta
- Max Planck Institute for Demographic Research, Rostock, Germany
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The ethical implications of verbal autopsy: responding to emotional and moral distress. BMC Med Ethics 2021; 22:118. [PMID: 34481510 PMCID: PMC8418286 DOI: 10.1186/s12910-021-00683-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Verbal autopsy is a pragmatic approach for generating cause-of-death data in contexts without well-functioning civil registration and vital statistics systems. It has primarily been conducted in health and demographic surveillance systems (HDSS) in Africa and Asia. Although significant resources have been invested to develop the technical aspects of verbal autopsy, ethical issues have received little attention. We explored the benefits and burdens of verbal autopsy in HDSS settings and identified potential strategies to respond to the ethical issues identified. Methods This research was based on a case study approach centred on two contrasting HDSS in Kenya and followed the Mapping-Framing-Shaping Framework for empirical bioethics research. Data were collected through individual interviews, focus group discussions, document reviews and non-participant observations. 115 participants were involved, including 86 community members (HDSS residents and community representatives), and 29 research staff (HDSS managers, researchers, census field workers and verbal autopsy interviewers). Results The use of verbal autopsy data for research and public health was described as the most common potential benefit of verbal autopsy in HDSS. Community members mentioned the potential uses of verbal autopsy data in addressing immediate public health problems for the local population while research staff emphasized the benefits of verbal autopsy to research and the wider public. The most prominent burden associated with the verbal autopsy was emotional distress for verbal autopsy interviewers and respondents. Moral events linked to the interview, such as being unsure of the right thing to do (moral uncertainty) or knowing the right thing to do and being constrained from acting (moral constraint), emerged as key causes of emotional distress for verbal autopsy interviewers. Conclusions The collection of cause-of-death data through verbal autopsy in HDSS settings presents important ethical and emotional challenges for verbal autopsy interviewers and respondents. These challenges include emotional distress for respondents and moral distress for interviewers. This empirical ethics study provides detailed accounts of the distress caused by verbal autopsy and highlights ethical tensions between potential population benefits and risks to individuals. It includes recommendations for policy and practice to address emotional and moral distress in verbal autopsy. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00683-7.
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Basu JK, Adair T. Have inequalities in completeness of death registration between states in India narrowed during two decades of civil registration system strengthening? Int J Equity Health 2021; 20:195. [PMID: 34461914 PMCID: PMC8403822 DOI: 10.1186/s12939-021-01534-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022] Open
Abstract
Background In India the number of registered deaths increased substantially in recent years, improving the potential of the civil registration and vital statistics (CRVS) system to be the primary source of mortality data and providing more families of decedents with the benefits of possessing a death certificate. This study aims to identify whether inequalities in the completeness of death registration between states in India, including by sex, have narrowed during this period of CRVS system strengthening. Methods Data used in this study are registered deaths by state and year from 2000 to 2018 (and by sex from 2009 to 2018) reported in the Civil Registration Reports published by the Office of Registrar General of India. Completeness of death registration is calculated using the empirical completeness method. Levels and trends inequalities in completeness are measured in each state a socio-economic indicator – the Socio-Demographic Index (SDI). Results Estimated completeness of death registration in India increased from 58% in 2000 to 81% in 2018. Male completeness rose from 60% in 2009 to 85% in 2018 and was much higher than female completeness, which increased from 54 to 74% in the same period. Completeness remained very low in some states, particularly from the eastern (e.g. Bihar) and north-eastern regions. However, in states from the northern region (e.g. Uttar Pradesh) completeness increased significantly from a low level. There was a narrowing of inequalities in completeness according to the SDI during the period, however large inequalities between states remain. Conclusions The increase in completeness of death registration in India is a substantial achievement and increases the potential of the death registration system as a routine source of mortality data. Although narrowing of inequalities in completeness demonstrates that the benefits of higher levels of death registration have spread to relatively poorer states of India in recent years, the continued low completeness in some states and for females are concerning. The Indian CRVS system also needs to increase the number of registered deaths with age at death reported to improve their usability for mortality statistics. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01534-y.
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Affiliation(s)
| | - Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Level 5, Building 379, 207 Bouverie St, Carlton, 3053 VIC, Australia.
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Development and Evaluation of a Community Surveillance Method for Estimating Deaths Due to Injuries in Rural Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178912. [PMID: 34501502 PMCID: PMC8430737 DOI: 10.3390/ijerph18178912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 01/22/2023]
Abstract
Almost 10% of global deaths are secondary to injuries, yet in the absence of routine injury surveillance and with few studies of injury mortality, the number and cause of injury deaths in many countries are not well understood. This study aimed to develop and evaluate the feasibility of a method to identify injury deaths in rural Nepal. Working with local government authorities, health post staff and female community health volunteers (FCHVs), we developed a two-stage community fatal injury surveillance approach. In stage one, all deaths from any cause were identified. In stage two, an interview with a relative or friend gathered information about the deceased and the injury event. The feasibility of the method was evaluated prospectively between February 2019 and January 2020 in two rural communities in Makwanpur district. The data collection tools were developed and evaluated with 108 FCHVs, 23 health post staff and two data collectors. Of 457 deaths notified over one year, 67 (14.7%) fatal injury events were identified, and interviews completed. Our method suggests that it is feasible to collect data on trauma-related deaths from rural areas in Nepal. These data may allow the development of injury prevention interventions and policy.
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Durrani MIA, Naz T, Atif M, Khalid N, Amelio A. A Semantic-Based Framework for Verbal Autopsy to Identify the Cause of Maternal Death. Appl Clin Inform 2021; 12:910-923. [PMID: 34553359 PMCID: PMC8458039 DOI: 10.1055/s-0041-1735180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Verbal autopsy is a technique used to collect information about a decedent from his/her family members using questionnaires, conducting interviews, making observations, and sampling. In substantial parts of the world, particularly in Africa and Asia, many deaths are unrecorded. In 2017, globally pregnant women were dying daily around 810 and 295,000 in a year because of pregnancy-related problems, pointed out by World Health Organization. Identifying the cause of a death is a complex process which requires in-depth medical knowledge and practical experience. Generally, medical practitioners possess different knowledge levels, set of abilities, and problem-solving skills. Additionally, the medical negligence plays a significant part in further worsening the situation. Accurate identification of the cause of death can help a government to take strategic measures to focus on, particularly increasing the death rate in a specific region. METHODS This research provides a solution by introducing a semantic-based verbal autopsy framework for maternal death (SVAF-MD) to identify the cause of death. The proposed framework consists of four main components as follows: (1) clinical practice guidelines, (2) knowledge collection, (3) knowledge modeling, and (4) knowledge codification. Maternal ontology for the framework is developed using Protégé knowledge editor. Resource description framework application programming interface (API) for PHP (RAP) is used as a Semantic Web toolkit along with Simple Protocol and RDF Query Language (SPARQL) is used for querying with ontology to retrieve data. RESULTS The results show that 92% of maternal causes of deaths assigned using SVAF-MD correctly matched manual reports already prepared by gynecologists. CONCLUSION SVAF-MD, a semantic-based framework for the verbal autopsy of maternal deaths, assigns the cause of death with minimum involvement of medical practitioners. This research helps the government to ease down the verbal autopsy process, overcome the delays in reporting, and facilitate in terms of accurate results to devise the policies to reduce the maternal mortality.
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Affiliation(s)
| | - Tabbasum Naz
- Department of Computer Science & IT, The University of Lahore, Lahore, Pakistan
| | - Muhammad Atif
- Department of Computer Science & IT, The University of Lahore, Lahore, Pakistan
| | - Numra Khalid
- Department of Computer Science & IT, The University of Lahore, Lahore, Pakistan
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Adair T, Firth S, Phyo TPP, Bo KS, Lopez AD. Monitoring progress with national and subnational health goals by integrating verbal autopsy and medically certified cause of death data. BMJ Glob Health 2021; 6:bmjgh-2021-005387. [PMID: 34059494 PMCID: PMC8169488 DOI: 10.1136/bmjgh-2021-005387] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction The measurement of progress towards many Sustainable Development Goals (SDG) and other health goals requires accurate and timely all-cause and cause of death (COD) data. However, existing guidance to countries to calculate these indicators is inadequate for populations with incomplete death registration and poor-quality COD data. We introduce a replicable method to estimate national and subnational cause-specific mortality rates (and hence many such indicators) where death registration is incomplete by integrating data from Medical Certificates of Cause of Death (MCCOD) for hospital deaths with routine verbal autopsy (VA) for community deaths. Methods The integration method calculates population-level cause-specific mortality fractions (CSMFs) from the CSMFs of MCCODs and VAs weighted by estimated deaths in hospitals and the community. Estimated deaths are calculated by applying the empirical completeness method to incomplete death registration/reporting. The resultant cause-specific mortality rates are used to estimate SDG Indicator 23: mortality between ages 30 and 70 years from cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. We demonstrate the method using nationally representative data in Myanmar, comprising over 42 000 VAs and 7600 MCCODs. Results In Myanmar in 2019, 89% of deaths were estimated to occur in the community. VAs comprised an estimated 70% of community deaths. Both the proportion of deaths in the community and CSMFs for the four causes increased with older age. We estimated that the probability of dying from any of the four causes between 30 and 70 years was 0.265 for men and 0.216 for women. This indicator is 50% higher if based on CSMFs from the integration of data sources than on MCCOD data from hospitals. Conclusion This integration method facilitates country authorities to use their data to monitor progress with national and subnational health goals, rather than rely on estimates made by external organisations. The method is particularly relevant given the increasing application of routine VA in country Civil Registration and Vital Statistics systems.
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Affiliation(s)
- Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Sonja Firth
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | | | - Khin Sandar Bo
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Hart JD, Mahesh P, Kwa V, Reeve M, Chowdhury HR, Jilini G, Jagilly R, Kamoriki B, Ruskin R, Dakulala P, Ripa P, Frank D, Lei T, Adair T, McLaughlin D, Riley ID, Lopez AD. Diversity of epidemiological transition in the Pacific: Findings from the application of verbal autopsy in Papua New Guinea and the Solomon Islands. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 11:100150. [PMID: 34327359 PMCID: PMC8315473 DOI: 10.1016/j.lanwpc.2021.100150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/17/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cause of death data are essential for rational health planning yet are not routinely available in Papua New Guinea (PNG) and Solomon Islands. Indirect estimation of cause of death patterns suggests these populations are epidemiologically similar, but such assessments are not based on direct evidence. METHODS Verbal autopsy (VA) interviews were conducted at three sites in PNG and nationwide in Solomon Islands. Training courses were also facilitated to improve data from medical certificates of cause of death (MCCODs) in both countries. Data were categorised into broad groups of endemic and emerging conditions to aid assessment of the epidemiological transition. FINDINGS Between 2017 and 2020, VAs were collected for 1,814 adult deaths in PNG and 819 adult deaths in Solomon Islands. MCCODs were analysed for 662 deaths in PNG and 1,408 deaths in Solomon Islands. The VA data suggest lower NCD mortality (48.8% versus 70.3%); higher infectious mortality (27.0% versus 18.3%) and higher injury mortality (24.5% versus 11.4%) in PNG compared to Solomon Islands. Higher infectious mortality in PNG was evident for both endemic and emerging infections. Higher NCD mortality in Solomon Islands reflected much higher emerging NCDs (43.6% vs 21.4% in PNG). A similar pattern was evident from the MCCOD data. INTERPRETATION The cause of death patterns suggested by VA and MCCOD indicate that PNG is earlier in its epidemiological transition than Solomon Islands, with relatively higher infectious mortality and lower NCD mortality. Injury mortality was also particularly high in PNG.This study was funded by Bloomberg Philanthropies.
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Affiliation(s)
- John D Hart
- The University of Melbourne, Melbourne School of Population and Global Health, Australia
| | - Pkb Mahesh
- The University of Melbourne, Melbourne School of Population and Global Health, Australia
| | - Viola Kwa
- The University of Melbourne, Melbourne School of Population and Global Health, Australia
| | - Matthew Reeve
- The University of Melbourne, Melbourne School of Population and Global Health, Australia
| | | | | | | | | | - Rodley Ruskin
- CRVS country coordinator, D4H Initiative, Solomon Islands
| | | | - Paulus Ripa
- Western Highlands Provincial Health Authority, Papua New Guinea
| | - Dale Frank
- Milne Bay Provincial Health Authority, Papua New Guinea
| | - Theresa Lei
- West New Britain Provincial Health Authority, Papua New Guinea
| | - Tim Adair
- The University of Melbourne, Melbourne School of Population and Global Health, Australia
| | - Deirdre McLaughlin
- The University of Melbourne, Melbourne School of Population and Global Health, Australia
| | - Ian D Riley
- The University of Melbourne, Melbourne School of Population and Global Health, Australia
| | - Alan D Lopez
- The University of Melbourne, Melbourne School of Population and Global Health, Australia
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Mikkelsen L, de Alwis S, Sathasivam S, Kumarapeli V, Tennakoon A, Karunapema P, Jayaratne K, Jayasuriya R, Gamage S, Hewapathirana R, Wadugedara R, Dissanayake M, Senanayake CH, Mahesh PKB, McLaughlin D, Lopez AD. Improving the Policy Utility of Cause of Death Statistics in Sri Lanka: An Empirical Investigation of Causes of Out-of-Hospital Deaths Using Automated Verbal Autopsy Methods. Front Public Health 2021; 9:591237. [PMID: 34123981 PMCID: PMC8187752 DOI: 10.3389/fpubh.2021.591237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Setting public health policies and effectively monitoring the impact of health interventions requires accurate, timely and complete cause of death (CoD) data for populations. In Sri Lanka, almost half of all deaths occur outside hospitals, with questionable diagnostic accuracy, thus limiting their information content for policy. Objectives: To ascertain whether SmartVA is applicable in improving the specificity of cause of death data for out-of-hospital deaths in Sri Lanka, and hence enhance the value of these routinely collected data for informing public policy debates. Methods: SmartVA was applied to 2610 VAs collected between January 2017 and March 2019 in 22 health-unit-areas clustered in six districts. Around 350 community-health-workers and 50 supervisory-staffs were trained. The resulting distribution of Cause-Specific-Mortality-Fractions (CSMFs) was compared to data from the Registrar-General's-Department (RGD) for out-of-hospital deaths for the same areas, and to the Global-Burden-of-Disease (GBD) estimates for Sri Lanka. Results: Using SmartVA, for only 15% of deaths could a specific-cause not be assigned, compared with around 40% of out-of-hospital deaths currently assigned garbage codes with "very high" or "high" severity. Stroke (M: 31.6%, F: 35.4%), Ischaemic Heart Disease (M: 13.5%, F: 13.0%) and Chronic Respiratory Diseases (M: 15.4%, F: 10.8%) were identified as the three leading causes of home deaths, consistent with the ranking of GBD-Study for Sri Lanka for all deaths, but with a notably higher CSMF for stroke. Conclusions: SmartVA showed greater diagnostic specificity, applicability, acceptability in the Sri Lankan context. Policy formulation in Sri Lanka would benefit substantially with national-wide implementation of VAs.
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Affiliation(s)
- Lene Mikkelsen
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Sunil de Alwis
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | - Vindya Kumarapeli
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Ajith Tennakoon
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Palitha Karunapema
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Kapila Jayaratne
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Rajitha Jayasuriya
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Saman Gamage
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | - Rangana Wadugedara
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Manoj Dissanayake
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | | | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Alan D Lopez
- University of Washington, Seattle, WA, United States
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26
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Qi J, Adair T, Chowdhury HR, Li H, McLaughlin D, Liu Y, Liu J, Zeng X, You J, Firth S, Sorchik R, Yin P, Wang L, Zhou M, Lopez AD. Estimating causes of out-of-hospital deaths in China: application of SmartVA methods. Popul Health Metr 2021; 19:25. [PMID: 33947434 PMCID: PMC8097770 DOI: 10.1186/s12963-021-00256-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background Most deaths in China occur at home, making it difficult to collect reliable cause of death (CoD) information. Verbal autopsy (VA) was applied using the SmartVA tool to a sample of home deaths in China to explore its feasibility as a means of improving the quality of CoD data. Methods The study was carried out in 22 districts in 9 provinces, located in north-east, central, and western areas of China during 2017 and 2018. Trained interviewers selected suitable respondents in each household to collect information using the Population Health Metrics Research Consortium (PHMRC) shortened and validated electronic VA questionnaire on tablets. The CoD was diagnosed from the interview data using the SmartVA-Analyze 2.0 software (Tariff 2.0). Results Non-communicable diseases (NCDs) dominated the leading causes of death in all age groups and for both sexes. After redistribution of undetermined causes, stroke (24%), ischemic heart diseases (IHD) (21%), chronic respiratory diseases (11%), and lung cancer (6%) were the leading causes of death. The cause fractions for level-one cause categories and ranking of specific causes were similar between SmartVA and results from the Global Burden of Disease (GBD) study. Conclusion Evidence from this large pilot study suggests that SmartVA is a feasible and plausible tool and could be a valuable tool to improve the quality and standardization of CoD information across China. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00256-1.
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Affiliation(s)
- Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, Australia
| | - Hafizur R Chowdhury
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, Australia
| | - Hang Li
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, Australia
| | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, Australia
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Xinying Zeng
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Jinling You
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Sonja Firth
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, Australia
| | - Renee Sorchik
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, Australia
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China.
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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27
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Joshi R, Hazard RH, Mahesh PKB, Mikkelsen L, Avelino F, Sarmiento C, Segarra A, Timbang T, Sinson F, Diango P, Riley I, Chowdhury H, Asuncion IL, Khanom G, Lopez AD. Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths. BMC Public Health 2021; 21:563. [PMID: 33752622 PMCID: PMC7986549 DOI: 10.1186/s12889-021-10542-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background The majority of deaths in the Philippines occur out-of-facility and require a medical certificate of cause of death by Municipal Health Officers (MHOs) for burial. MHOs lack a standardised certification process for out-of-facility deaths and when no medical records are available, certify a high proportion of ill-defined causes of death. We aimed to develop and introduce SmartVA Auto-Analyse, a verbal autopsy (VA) based electronic decision support tool in order to assist the MHOs in certifying out-of-facility deaths. Method We conducted a stakeholder consultation, process mapping and a pre-test to assess feasibility and acceptability of SmartVA Auto-Analyse. MHOs were first asked to conduct an open-ended interview from the family members of the deceased, and if they were not able to arrive at a diagnosis, continue the interview using the standardised SmartVA questionnaire. Auto-Analyse then presented the MHO with the three most likely causes of death. For the pilot, the intervention was scaled-up to 91 municipalities. We performed a mixed-methods evaluation using the cause of death data and group discussions with the MHOs. Results Of the 5649 deaths registered, Auto-Analyse was used to certify 4586 (81%). For the remaining 19%, doctors believed they could assign a cause of death based on the availability of medical records and the VA open narrative. When used, physicians used the Auto-Analyse diagnosis in 85% of cases to certify the cause of death. Only 13% of the deaths under the intervention had an undetermined cause of death. Group discussions identified two themes: Auto-Analyse standardized the certification of home deaths and assisted the MHOs to improve the quality of death certification. Conclusion Standardized VA combined with physician diagnosis using the SmartVA Auto-Analyse support tool was readily used by MHOs in the Philippines and can improve the quality of death certification of home deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10542-0.
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Affiliation(s)
- Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia. .,The George Institute for Global Health, New Delhi, India. .,School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | - R H Hazard
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - L Mikkelsen
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - F Avelino
- Epidemiology Bureau, Department of Health, Manila, Philippines
| | - Carmina Sarmiento
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - A Segarra
- Epidemiology Bureau, Department of Health, Manila, Philippines
| | - T Timbang
- Epidemiology Bureau, Department of Health, Manila, Philippines
| | - F Sinson
- Epidemiology Bureau, Department of Health, Manila, Philippines
| | - Patrick Diango
- Epidemiology Bureau, Department of Health, Manila, Philippines
| | - I Riley
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - H Chowdhury
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Irma L Asuncion
- Epidemiology Bureau, Department of Health, Manila, Philippines
| | - G Khanom
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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Shawon MTH, Ashrafi SAA, Azad AK, Firth SM, Chowdhury H, Mswia RG, Adair T, Riley I, Abouzahr C, Lopez AD. Routine mortality surveillance to identify the cause of death pattern for out-of-hospital adult (aged 12+ years) deaths in Bangladesh: introduction of automated verbal autopsy. BMC Public Health 2021; 21:491. [PMID: 33706739 PMCID: PMC7952220 DOI: 10.1186/s12889-021-10468-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Bangladesh, a poorly functioning national system of registering deaths and determining their causes leaves the country without important information on which to inform health programming, particularly for the 85% of deaths that occur in the community. In 2017, an improved death registration system and automated verbal autopsy (VA) were introduced to 13 upazilas to assess the utility of VA as a routine source of policy-relevant information and to identify leading causes of deaths (COD) in rural Bangladesh. METHODS Data from 22,535 VAs, collected in 12 upazilas between October 2017 and August 2019, were assigned a COD using the SmartVA Analyze 2.0 computer algorithm. The plausibility of the VA results was assessed using a series of demographic and epidemiological checks in the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) software tool. RESULTS Completeness of community death reporting was 65%. The vast majority (85%) of adult deaths were due to non-communicable diseases, with ischemic heart disease, stroke and chronic respiratory disease comprising about 60% alone. Leading COD were broadly consistent with Global Burden of Disease study estimates. CONCLUSIONS Routine VA collection using automated methods is feasible, can produce plausible results and provides critical information on community COD in Bangladesh. Routine VA and VIPER have potential application to countries with weak death registration systems.
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Affiliation(s)
- Md Toufiq Hassan Shawon
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | - Abul Kalam Azad
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Sonja M Firth
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | - Hafizur Chowdhury
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Tim Adair
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Ian Riley
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Carla Abouzahr
- Data for Health Initiative, Vital Strategies, Geneva, Switzerland
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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Lopez AD, McLaughlin D, Richards N. Reducing ignorance about who dies of what: research and innovation to strengthen CRVS systems. BMC Med 2020; 18:58. [PMID: 32146906 PMCID: PMC7061482 DOI: 10.1186/s12916-020-01526-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 11/13/2022] Open
Abstract
The Sustainable Development Goal (SDG) agenda offers a major impetus to consolidate and accelerate development in civil registration and vital statistics (CRVS) systems. Strengthening CRVS systems is an SDG outcome in itself. Moreover, CRVS systems are the best - if not essential - source of data to monitor and guide health policy debates and to assess progress towards numerous SDG targets and indicators. They also provide the necessary documentation and proof of identity for service access and are critical for disaster preparedness and response. While there has been impressive global momentum to improve CRVS systems over the past decade, several challenges remain. This article collection provides an overview of recent innovations, progress, viewpoints and key areas in which action is still required - notably around the need for better systems and procedures to notify the fact of death and to reliably diagnose its cause, both for deaths in hospital and elsewhere.
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Affiliation(s)
- Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia.
| | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia
| | - Nicola Richards
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia
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Boyce RM, Reyes R. Implementing and scaling verbal autopsies: into the unknown. BMC Med 2020; 18:53. [PMID: 32146905 PMCID: PMC7061463 DOI: 10.1186/s12916-020-01527-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/20/2022] Open
Abstract
Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01520-1.
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Affiliation(s)
- Ross M Boyce
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
| | - Raquel Reyes
- Division of Hospital Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7085, Chapel Hill, NC, 27599, USA
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