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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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Ba Z, Qin Y, Sang Z, Wu H, Wu X, Cheng H, Ya B, Chen F. Vaccine inequity-induced COVID-19 dilemma: Time to sober up. Leg Med (Tokyo) 2024; 66:102364. [PMID: 38104356 DOI: 10.1016/j.legalmed.2023.102364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The aim of the study was to discuss the catastrophic consequences of inequitable vaccine distribution and analyze the main challenges to address it, helping to guide efforts to address inequities in vaccine coverage. METHODS All published papers written in English were searched through PubMed, Web of Science, and Google Scholar with the combination of relevant terms of COVID-19 vaccine inequity. RESULTS In this paper, we first outlined the scope of inequitable vaccine distribution and identify its truly catastrophic consequences. Next, from the perspectives of political will, free markets, and profit-driven enterprises based on patent and intellectual property protection, we analyzed in depth the root causes of why this phenomenon is so difficult to combat. In addition, some specific and crucial solutions that should be undertaken in the long term were also put forward in order to provide a useful reference for the authorities, stakeholders, and researchers involved in addressing this worldwide crisis and the next one. CONCLUSIONS Achieving COVID-19 vaccine equity faces funding gaps, vaccine nationalism, and barriers to access to intellectual property and technology. Thus, the scope of global vaccine inequity is immense, and its repercussions will continue to be felt worldwide, especially among the world's most vulnerable residents, both adults and children. Beyond fundamental issues, the growing vaccine hesitancy and unreliable distribution in low-income countries must be addressed.
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Affiliation(s)
- Zaihua Ba
- Department of Physiology, Jining Medical University, Jining, China
| | - Yining Qin
- Department of Physiology, Jining Medical University, Jining, China
| | - Ziling Sang
- Department of Physiology, Jining Medical University, Jining, China
| | - Hao Wu
- Dongping County People's Hospital, Tai-an 271500, China
| | - Xiaoli Wu
- Dongping County People's Hospital, Tai-an 271500, China
| | - Hongju Cheng
- Department of Physiology, Jining Medical University, Jining, China
| | - Bailiu Ya
- Department of Physiology, Jining Medical University, Jining, China
| | - Fei Chen
- Department of Physiology, Jining Medical University, Jining, China.
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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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Acharya A, Chowdhury HR, Ihyauddin Z, Mahesh PKB, Adair T. Cardiovascular disease mortality based on verbal autopsy in low- and middle-income countries: a systematic review. Bull World Health Organ 2023; 101:571-586. [PMID: 37638359 PMCID: PMC10452938 DOI: 10.2471/blt.23.289802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To conduct a systematic review of verbal autopsy studies in low- and middle-income countries to estimate the fraction of deaths due to cardiovascular disease. Method We searched MEDLINE®, Embase® and Scopus databases for verbal autopsy studies in low- and middle-income countries that reported deaths from cardiovascular disease. Two reviewers screened the studies, extracted data and assessed study quality. We calculated cause-specific mortality fractions for cardiovascular disease for each study, both overall and according to age, sex, geographical location and type of cardiovascular disease. Findings We identified 42 studies for inclusion in the review. Overall, the cardiovascular disease cause-specific mortality fractions for people aged 15 years and above was 22.9%. This fraction was generally higher for males (24.7%) than females (20.9%), but the pattern varied across World Health Organization regions. The highest cardiovascular disease mortality fraction was reported in the Western Pacific Region (26.3%), followed by the South-East Asia Region (24.1%) and the African Region (12.7%). The cardiovascular disease mortality fraction was higher in urban than rural populations in all regions, except the South-East Asia Region. The mortality fraction for ischaemic heart disease (12.3%) was higher than that for stroke (8.7%). Overall, 69.4% of cardiovascular disease deaths were reported in people aged 65 years and above. Conclusion The burden of cardiovascular disease deaths outside health-care settings in low- and middle-income countries is substantial. Increasing coverage of verbal autopsies in these countries could help fill gaps in cardiovascular disease mortality data and improve monitoring of national, regional and global health goals.
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Affiliation(s)
- Ajay Acharya
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | | | - Zulfikar Ihyauddin
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | - Pasyodun Koralage Buddhika Mahesh
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | - Tim Adair
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
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Helleringer S, Queiroz BL. Commentary: Measuring excess mortality due to the COVID-19 pandemic: progress and persistent challenges. Int J Epidemiol 2022; 51:85-87. [PMID: 34904168 PMCID: PMC8856005 DOI: 10.1093/ije/dyab260] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Stéphane Helleringer
- New York University—Abu Dhabi Campus, Division of Social Science, Program in Social Research and Public Policy, Abu Dhabi, United Arab Emirates and
| | - Bernardo Lanza Queiroz
- Universidade Federal de Minas Gerais, Department of Demography and Centro de Desenvolvimento e Planejamento Regional (CEDEPLAR), Belo Horizonte, Minas Gerais, Brazil
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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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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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Adair T. Who dies where? Estimating the percentage of deaths that occur at home. BMJ Glob Health 2021; 6:bmjgh-2021-006766. [PMID: 34479953 PMCID: PMC8420738 DOI: 10.1136/bmjgh-2021-006766] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The majority of low-income and middle-income countries (LMICs) have incomplete death registration systems and so the proportion of deaths that occur at home (ie, home death percentage) is generally unknown. However, home death percentage is important to estimate population-level causes of death from integration of data of deaths at home (verbal autopsies) and in hospitals (medical certification), and to monitor completeness of death notification and verbal autopsy data collection systems. This study proposes a method to estimate home death percentage using data readily available at the national and subnational level. Methods Data on place of death from 152 country-years in 49 countries from 2005 to 2019, predominantly from vital registration systems, were used to model home death percentage standardised for population age and cause distribution. A national-level model was developed using Bayesian model averaging to estimate national, regional and global home death percentage. A subnational-level model was also developed and assessed in populations where alternative data on home death percentage were available. Results Globally, it is estimated that 53.4% (95% uncertainty interval (UI) 50.8%–55.9%) of deaths occur at home, slightly higher (59.7%, 95% UI 56.5%–62.7%) in LMICs, substantially higher in low-income countries (79.5%, 95% UI 77.3%–81.5%) and much lower (27.3%, 95% UI 25.2%–29.6%) in high-income countries. Countries with the highest home death percentage are mostly found in South, East and Southeast Asia and sub-Saharan Africa (above 90% in Ethiopia, Chad and South Sudan). As expected, the national model has smaller error than the subnational model. Conclusion The study demonstrates substantial diversity in the location of deaths in LMICs and fills a significant gap in knowledge about where people die, given its importance for health systems and policies. The high proportion of deaths in LMICs that occur at home reinforces the need for routine verbal autopsy to determine the causes of death.
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Affiliation(s)
- Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Hart JD, Kwa V, Dakulala P, Ripa P, Frank D, Lei T, Moiya N, Lagani W, Adair T, McLaughlin D, Riley ID, Lopez AD. Mortality surveillance and verbal autopsy strategies: experiences, challenges and lessons learnt in Papua New Guinea. BMJ Glob Health 2021; 5:bmjgh-2020-003747. [PMID: 33272944 PMCID: PMC7716660 DOI: 10.1136/bmjgh-2020-003747] [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: 08/18/2020] [Revised: 10/25/2020] [Accepted: 11/10/2020] [Indexed: 11/04/2022] Open
Abstract
Full notification of deaths and compilation of good quality cause of death data are core, sequential and essential components of a functional civil registration and vital statistics (CRVS) system. In collaboration with the Government of Papua New Guinea (PNG), trial mortality surveillance activities were established at sites in Alotau District in Milne Bay Province, Tambul-Nebilyer District in Western Highlands Province and Talasea District in West New Britain Province.Provincial Health Authorities trialled strategies to improve completeness of death notification and implement an automated verbal autopsy methodology, including use of different notification agents and paper or mobile phone methods. Completeness of death notification improved from virtually 0% to 20% in Talasea, 25% and 75% using mobile phone and paper notification strategies, respectively, in Alotau, and 69% in Tambul-Nebilyer. We discuss the challenges and lessons learnt with implementing these activities in PNG, including logistical considerations and incentives.Our experience indicates that strategies to maximise completeness of notification should be tailored to the local context, which in PNG includes significant geographical, cultural and political diversity. We report that health workers have great potential to improve the CRVS programme in PNG through managing the collection of notification and verbal autopsy data. In light of our findings, and in consultation with the main government CRVS stakeholders and the National CRVS Committee, we make recommendations regarding the requirements at each level of the health system to optimise mortality surveillance in order to generate the essential health intelligence required for policy and planning.
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Affiliation(s)
- John D Hart
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Viola Kwa
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paison Dakulala
- National Department of Health, Port Moresby, Papua New Guinea
| | - Paulus Ripa
- Western Highlands Provincial Health Authority, Mount Hagen, Papua New Guinea
| | - Dale Frank
- Milne Bay Provincial Health Authority, Alotau, Papua New Guinea
| | - Theresa Lei
- West New Britain Provincial Health Authority, Kimbe, Papua New Guinea
| | - Ninkama Moiya
- Papua New Guinea Civil and Identity Registry, Port Moresby, Papua New Guinea
| | - William Lagani
- Central Provincial Health Authority, Port Moresby, Papua New Guinea
| | - Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian D Riley
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alan D Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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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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Singh B. International comparisons of COVID-19 deaths in the presence of comorbidities require uniform mortality coding guidelines. Int J Epidemiol 2021; 50:373-377. [PMID: 33432354 PMCID: PMC7928837 DOI: 10.1093/ije/dyaa276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/14/2020] [Indexed: 01/24/2023] Open
Affiliation(s)
- Bismark Singh
- Department of Mathematics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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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] [MESH Headings] [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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