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Alyazidi F, Shakely D, Petzold M, Alyazidi F, Hussain-Alkhateeb L. Community perception of causes of death using verbal autopsy for diabetes mellitus in Saudi Arabia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001690. [PMID: 38051697 PMCID: PMC10697554 DOI: 10.1371/journal.pgph.0001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023]
Abstract
Diabetes mellitus is a serious global health issue which significantly impacts public health and socioeconomic development. Exploring how the community perceives the causes of death and their associated risk factors is crucial for public health. This study combines verbal autopsy (VA) with the Type 2 Diabetes Mellitus (T2DM) register to explore community perceptions of causes of death and associated influential factors in Makkah province, Saudi Arabia. 302 VA interviews were conducted with relatives or caregivers of deceased who died between 2018 and 2021 based on T2DM medical register from Alnoor Specialist Hospital in Makkah City, Saudi Arabia. Cause-specific mortality fractions (CSMFs) obtained from the VA using the InterVA-5 model were utilized to assess community perception. We used a multivariable logistic regression model to determine factors influencing community perceptions of causes of death. Lin's CCC with 95% CI was used to analyze the concordance for the CSMFs from verbal autopsy causes of death (VACoD) as a presumed reference standard and family-reported causes of death (FRCoD). The outcomes of this study demonstrate a generally broad spectrum of community perceived mortalities, with some critical misconceptions based on the type of death and other vital events like marital status, with an overall CCC of 0.60 (95% CI: 0.20-1.00; p = 003). The study findings demonstrate that community perception is weak if the deceased was male compared to female (aOR: 0.52; 95% CI: 0.26-1.03) and if the deceased was > = 80 years compared to 34-59 years (aOR: 0.48; 95% CI: 0.16-1.38), but it significantly improves among married compared to single (aOR: 2.13; 95% CI: 1.02-4.42). Exploring community perception of causes of death is crucial as it provides valuable insights into the community's understanding, beliefs, and concerns regarding mortality. Higher or lower community perception is attributed to how people may perceive risk factors associated with the causes of death, which can guide public health planning and interventional programs. The study findings further emphasize the need to employ robust and standardized VA methods within the routine medical services for a systemized assessment of families' reported causes of death.
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Affiliation(s)
- Faleh Alyazidi
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Public Health, College of Health Sciences at Al-Leith, Umm Al-Qura University, Al-Leith, Kingdom of Saudi Arabia
| | - Deler Shakely
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fawaz Alyazidi
- Infectious Diseases Control Department, Executive Directorate of Preventive Medicine, Makkah Healthcare Cluster, Makkah, Kingdom of Saudi Arabia
| | - Laith Hussain-Alkhateeb
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Population Health Research Section, King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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Andersen KN, Shittu F, Magama A, Ahmed T, Bakare D, Salako J, Burgess RA, King C. Perceptions of child death in Jigawa State, Nigeria: a mixed-methods study on how sociocultural nuances shape paediatric mortality reporting. Glob Health Action 2022; 15:2120251. [DOI: 10.1080/16549716.2022.2120251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Funmilayo Shittu
- Department of Pediatrics, University of Ibadan, Ibadan, Nigeria and University College Hospital, Ibadan, Nigeria
| | | | | | - Damola Bakare
- Department of Pediatrics, University of Ibadan, Ibadan, Nigeria and University College Hospital, Ibadan, Nigeria
| | - Julius Salako
- Department of Pediatrics, University of Ibadan, Ibadan, Nigeria and University College Hospital, Ibadan, Nigeria
| | | | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Institute for Global Health, University College London, London, UK
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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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Seal AJ, Jelle M, Grijalva-Eternod CS, Mohamed H, Ali R, Fottrell E. Use of verbal autopsy for establishing causes of child mortality in camps for internally displaced people in Mogadishu, Somalia: a population-based, prospective, cohort study. LANCET GLOBAL HEALTH 2021; 9:e1286-e1295. [PMID: 34416214 DOI: 10.1016/s2214-109x(21)00254-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND People in humanitarian emergencies are likely to experience excess mortality but information on the causes of death is often unreliable or non-existent. This study aimed to provide evidence on the causes of death among children younger than 5 years in camps for internally displaced people in southern Somalia, during periods of protracted displacement and emergency influx amid the 2017 drought and health emergency. METHODS We did a prospective, cohort study in 25 camps in the Afgooye corridor, on the outskirts of Mogadishu, Somalia. All internally displaced children aged 6-59 months were included and followed up with monthly household visits by community health workers. Nutrition, health, and vaccination status were ascertained and verbal autopsy interviews were done with the caregivers of deceased children. We calculated death rates in these children and used verbal autopsy to establish the cause-specific mortality fraction (CSMF). Bayesian InterVA software was used to assign likely causes to each death. FINDINGS Between March, 2016, and March, 2018, 3898 children were followed up. 153 deaths were recorded during 34 746 person-months of observation. The death rate among children younger than 5 years exceeded emergency thresholds (>2 deaths per 10 000 children per day), reaching a peak of seven deaths per 10 000 children per day during the emergency influx. Verbal autopsy data were gathered for 80% of deaths, and the CSMF for the three leading causes of death were diarrhoeal diseases (25·9%), measles (17·8%), and severe malnutrition (8·8%). Coverage of measles vaccination during the first 3 months of the emergency was 42% and the CSMF for measles doubled during the influx. During protracted displacement, symptoms that could be attributable to HIV/AIDS related deaths accounted for 1·6% of the CSMF. INTERPRETATION It is feasible to establish a health and nutrition surveillance system that ascertains causes of death, using verbal autopsy, in this humanitarian context. These data can inform policy, response planning, and priority setting. The high mortality rate from infectious diseases and malnutrition among children younger than 5 years suggests the need for strengthening a range of public health interventions, including vaccination and provision of water, sanitation, and hygiene. FUNDING UK Department of International Development.
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Affiliation(s)
- Andrew J Seal
- Institute for Global Health, University College London, London, UK.
| | - Mohamed Jelle
- Institute for Global Health, University College London, London, UK
| | | | | | - Raha Ali
- Concern Worldwide Somalia, Mogadishu, Somalia
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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Aden JA, Ahmed HJ, Östergren PO. Causes and contributing factors of maternal mortality in Bosaso District of Somalia. A retrospective study of 30 cases using a Verbal Autopsy approach. Glob Health Action 2020; 12:1672314. [PMID: 31599213 PMCID: PMC6792038 DOI: 10.1080/16549716.2019.1672314] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Somali women suffer from one of the highest maternal mortality rates in the world. Somalia characterises a specific low-income country situation with a mix of newly urbanized and nomadic culture combined with a frail health care infrastructure set in a post-conflict era. Very little is known about the effects that these contextual factors can have on maternal mortality. Objectives: To explore and describe causes and contributing factors concerning maternal deaths in the Bosaso District, Puntland State of Somalia. Methods: Data was collected using an adapted Verbal Autopsy tool. In 2017 30 cases of maternal deaths occurring in 2016 in the Bosaso District were reviewed. Information was assessed by three independent reviewers who classified the cause of death and the contributing factors. The Three Delay Model was employed to identify socio-cultural and economic and health system factors that may have contributed to these maternal deaths. Results: Direct obstetric deaths accounted for 28 cases. Among these, haemorrhage was the leading cause, followed by eclampsia, sepsis and obstructed labour. Two cases were indirect obstetric deaths, caused by anaemia. All three types of delay were frequent among the studied cases. Delay in deciding to seek care was found in 25 cases, delay in reaching care in 22 cases and delay in receiving health care in 24 cases. Lack of knowledge, money, transportation, poor access and availability of adequate services, as well as substandard management by health care providers, were all underlying the delays. Conclusion: A comprehensive intervention programme is needed in order to decrease maternal mortality among Somali women. Such a programme must include health education, improved referral systems and strategic upgrading of care services.
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Affiliation(s)
- Jamila Ahmed Aden
- Faculty of Medicine and Health Sciences, East Africa University , Bosaso , Puntland State of Somalia, Somalia.,Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University , Lund , Sweden.,Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Hinda Jama Ahmed
- Faculty of Medicine and Health Sciences, East Africa University , Bosaso , Puntland State of Somalia, Somalia
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University , Lund , Sweden
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Morrison J, Fottrell E, Budhatokhi B, Bird J, Basnet M, Manandhar M, Shrestha R, Manandhar D, Wilson J. Applying a Public Health Ethics Framework to Consider Scaled-Up Verbal Autopsy and Verbal Autopsy with Immediate Disclosure of Cause of Death in Rural Nepal. Public Health Ethics 2018. [DOI: 10.1093/phe/phy017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Jon Bird
- Department of Computer Science, School of Mathematics, Computer Science and Engineering, City University of London
| | | | | | | | | | - James Wilson
- Department of Philosophy, University College London
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Gouda HN, Flaxman AD, Brolan CE, Joshi R, Riley ID, AbouZahr C, Firth S, Rampatige R, Lopez AD. New challenges for verbal autopsy: Considering the ethical and social implications of verbal autopsy methods in routine health information systems. Soc Sci Med 2017; 184:65-74. [PMID: 28501755 DOI: 10.1016/j.socscimed.2017.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
Abstract
Verbal autopsy (VA) methods are designed to collect cause-of-death information from populations where many deaths occur outside of health facilities and where death certification is weak or absent. A VA consists of an interview with a relative or carer of a recently deceased individual in order to gather information on the signs and symptoms the decedent presented with prior to death. These details are then used to determine and assign a likely cause-of-death. At a population level this information can be invaluable to help guide prioritisation and direct health policy and services. To date VAs have largely been restricted to research contexts but many countries are now venturing to incorporate VA methods into routine civil registration and vital statistics (CRVS) systems. Given the sensitive nature of death, however, there are a number of ethical, legal and social issues that should be considered when scaling-up VAs, particularly in the cross-cultural and socio-economically disadvantaged environments in which they are typically applied. Considering each step of the VA process this paper provides a narrative review of the social context of VA methods. Harnessing the experiences of applying and rolling out VAs as part of routine CRVS systems in a number of low and middle income countries, we identify potential issues that countries and implementing institutions need to consider when incorporating VAs into CRVS systems and point to areas that could benefit from further research and deliberation.
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Affiliation(s)
- Hebe N Gouda
- University of Queensland, School of Public Health, Australia; University of Queensland, Queensland Centre for Mental Health Research, Australia.
| | - Abraham D Flaxman
- University of Washington, Institute of Health Metrics and Evaluation, USA
| | - Claire E Brolan
- University of Melbourne, Melbourne School of Population and Global Health, Australia; University of Toronto, Dalla Lana School of Public Health, Canada
| | - Rohina Joshi
- University of Melbourne, Melbourne School of Population and Global Health, Australia; University of Sydney, The George Institute of Public Health, Australia
| | - Ian D Riley
- University of Queensland, School of Public Health, Australia; University of Melbourne, Melbourne School of Population and Global Health, Australia
| | | | - Sonja Firth
- University of Melbourne, Melbourne School of Population and Global Health, Australia
| | - Rasika Rampatige
- University of Melbourne, Melbourne School of Population and Global Health, Australia
| | - Alan D Lopez
- University of Melbourne, Melbourne School of Population and Global Health, Australia
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Hussain-Alkhateeb L, Petzold M, Collinson M, Tollman S, Kahn K, Byass P. Effects of recall time on cause-of-death findings using verbal autopsy: empirical evidence from rural South Africa. Emerg Themes Epidemiol 2016; 13:10. [PMID: 27777600 PMCID: PMC5069872 DOI: 10.1186/s12982-016-0051-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Verbal autopsy (VA) is a widely used technique for assigning causes to non-medically certified deaths using information gathered from a close caregiver. Both operational and cultural factors may cause delays in follow-up of deaths. The resulting time lag-from death to VA interview-can influence ways in which terminal events are remembered, and thus affect cause-of-death assignment. This study investigates the impact of recall period on causes of death determined by VA. METHODS A total of 10,882 deaths from the Agincourt Health and Demographic Surveillance System (HDSS) with complete VAs, including recall period, were incorporated in this study. To measure seasonal effect, cause specific mortality fractions (CSMFs) were calculated and compared by every cause for VAs undertaken within six months of death and those undertaken from six to 12 months of death. All causes were classified into eight broad categories and entered in a multiple logistic regression to explore outcome by recall period in relation to covariates. RESULTS The majority of deaths (83 %) had VAs completed within 12 months. There was a tendency towards longer recall periods for deaths of those under one year or over 65 years of age. Only the acute respiratory, diarrhoeal and other unspecified non-communicable disease groups showed a CSMF ratio significantly different from unity at the 99 % confidence level between the two recall periods. Only neonatal deaths showed significantly different OR for recall exceeding 12 months (OR 1.69; p value = 0.004) and this increased when adjusting for background factors (OR 2.58; p value = 0.000). CONCLUSION A recall period of up to one year between death and VA interview did not have any consequential effects on the cause-of-death patterns derived, with the exception of neonatal causes. This is an important operational consideration given the planned widespread use of the VA approach in civil registration, HDSS sites and occasional surveys.
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Affiliation(s)
- Laith Hussain-Alkhateeb
- Health Metrics, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden
| | - Max Petzold
- Health Metrics, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden ; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Collinson
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Accra, Ghana ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Accra, Ghana ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Accra, Ghana ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Byass
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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D’Ambruoso L, Kahn K, Wagner RG, Twine R, Spies B, van der Merwe M, Gómez-Olivé FX, Tollman S, Byass P. Moving from medical to health systems classifications of deaths: extending verbal autopsy to collect information on the circumstances of mortality. Glob Health Res Policy 2016; 1:2. [PMID: 29202052 PMCID: PMC5675065 DOI: 10.1186/s41256-016-0002-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Verbal autopsy (VA) is a health surveillance technique used in low and middle-income countries to establish medical causes of death (CODs) for people who die outside hospitals and/or without registration. By virtue of the deaths it investigates, VA is also an opportunity to examine social exclusion from access to health systems. The aims were to develop a system to collect and interpret information on social and health systems determinants of deaths investigated in VA. METHODS A short set of questions on care pathways, circumstances and events at and around the time of death were developed and integrated into the WHO 2012 short form VA (SF-VA). Data were subsequently analysed from two census rounds in the Agincourt Health and Socio-Demographic Surveillance Site (HDSS), South Africa in 2012 and 2013 where the SF-VA had been applied. InterVA and descriptive analysis were used to calculate cause-specific mortality fractions (CSMFs), and to examine responses to the new indicators and whether and how they varied by medical CODs and age/sex sub-groups. RESULTS One thousand two hundred forty-nine deaths were recorded in the Agincourt HDSS censuses in 2012-13 of which 1,196 (96 %) had complete VA data. Infectious and non-communicable conditions accounted for the majority of deaths (47 % and 39 % respectively) with smaller proportions attributed to external, neonatal and maternal causes (5 %, 2 % and 1 % respectively). 5 % of deaths were of indeterminable cause. The new indicators revealed multiple problems with access to care at the time of death: 39 % of deaths did not call for help, 36 % found care unaffordable overall, and 33 % did not go to a facility. These problems were reported consistently across age and sex sub-groups. Acute conditions and younger age groups had fewer problems with overall costs but more with not calling for help or going to a facility. An illustrative health systems interpretation suggests extending and promoting existing provisions for transport and financial access in this setting. CONCLUSIONS Supplementing VA with questions on the circumstances of mortality provides complementary information to CSMFs relevant for health planning. Further contextualisation of the method and results are underway with health systems stakeholders to develop the interpretation sequence as part of a health policy and systems research approach.
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Affiliation(s)
- Lucia D’Ambruoso
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Ryan G. Wagner
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Barry Spies
- Directorate for Maternal, Child, Women and Youth Health and Nutrition, Mpumalanga Department of Health, Nelspruit, Mpumalanga South Africa
| | - Maria van der Merwe
- Directorate for Maternal, Child, Women and Youth Health and Nutrition, Mpumalanga Department of Health, Nelspruit, Mpumalanga South Africa
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Stephen Tollman
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Peter Byass
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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