Abstract
BackgroundAscertaining the causes for deaths occurring outside health facilities is a significant problem in many developing countries where civil registration systems are not well developed or non-functional. Standardized and rigorous verbal autopsy methods is a potential solution to determine the cause of death. We conducted a demonstration project in Lusaka District of Zambia where verbal autopsy (VA) method was implemented in routine civil registration system.MethodsAbout 3400 VA interviews were conducted for bodies “brought-in-dead” at Lusaka’s two major teaching hospital mortuaries using a SmartVA questionnaire between October 2017 and September 2018. Probable underlying causes of deaths using VA and cause-specific mortality fractions were determined.. Demographic characteristics were analyzed for each VA-ascertained cause of death.ResultsOpportunistic infections (OIs) associated with HIV/AIDS such as pneumonia and tuberculosis, and malaria were among leading causes of deaths among bodies “brought-in-dead”. Over 21.6 and 26.9% of deaths were attributable to external causes and non-communicable diseases (NCDs), respectively. The VA-ascertained causes of death varied by age-group and sex. External causes were more prevalent among males in middle ages (put an age range like 30–54 years old) and NCDs highly prevalent among those aged 55 years and older.ConclusionsVA application in civil registration system can provide the much-needed cause of death information for non-facility deaths in countries with under-developed or non-functional civil registration systems.
Highlights
Accurate causes of death are necessary to help better understand the patterns and major causes of mortality of a country [1]
Invasive tissue sampling is an alternative approach that provides similar validity for ascertaining causes of deaths but this high-tech approach requires availability of skilled health personnel and well-equipped laboratories [5]. Both pathology diagnostic autopsy and minimally invasive tissue sampling are the most common modalities for ascertaining cause of death in health facilities [6]. These techniques require substantial resources, personnel, and appropriate infrastructure, a medical certification of cause of death, through the World Health Organisation (WHO)’s International Classification of Diseases (ICD-10), is the most common routine to ascertain the cause of death in health facilities [6]., A majority of deaths in many developing countries occurr outside health facilities and are not attended to or certified by medical practitioners [7]
Data was obtained from verbal autopsy (VA) application in routine civil registration of brought in dead” (BID) cases conducted by the Ministry of Home Affairs’ Department of National Registration Passports and Citizenship (DNRPC)
Summary
Accurate causes of death are necessary to help better understand the patterns and major causes of mortality of a country [1]. A complete diagnostic medical-pathology autopsy is the most reliable method available for ascertaining cause of death Such systems, are neither practical or attainable in many (developing) countries. Invasive tissue sampling is an alternative approach that provides similar validity for ascertaining causes of deaths but this high-tech approach requires availability of skilled health personnel and well-equipped laboratories [5]. Both pathology diagnostic autopsy and minimally invasive tissue sampling are the most common modalities for ascertaining cause of death in health facilities [6]. We conducted a demonstration project in Lusaka District of Zambia where verbal autopsy (VA) method was implemented in routine civil registration system
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