Abstract
BackgroundThe majority of low- and middle-income countries (LMICs) do not have adequate civil registration and vital statistics (CRVS) systems to properly support health policy formulation. Verbal autopsy (VA), long used in research, can provide useful information on the cause of death (COD) in populations where physicians are not available to complete medical certificates of COD. Here, we report on the application of the SmartVA tool for the collection and analysis of data in several countries as part of routine CRVS activities.MethodsData from VA interviews conducted in 4 of 12 countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative, and at different stages of health statistical development, were analysed and assessed for plausibility: Myanmar, Papua New Guinea (PNG), Bangladesh and the Philippines. Analyses by age- and cause-specific mortality fractions were compared to the Global Burden of Disease (GBD) study data by country. VA interviews were analysed using SmartVA-Analyze-automated software that was designed for use in CRVS systems. The method in the Philippines differed from the other sites in that the VA output was used as a decision support tool for health officers.ResultsCountry strategies for VA implementation are described in detail. Comparisons between VA data and country GBD estimates by age and cause revealed generally similar patterns and distributions. The main discrepancy was higher infectious disease mortality and lower non-communicable disease mortality at the PNG VA sites, compared to the GBD country models, which critical appraisal suggests may highlight real differences rather than implausible VA results.ConclusionAutomated VA is the only feasible method for generating COD data for many populations. The results of implementation in four countries, reported here under the D4H Initiative, confirm that these methods are acceptable for wide-scale implementation and can produce reliable COD information on community deaths for which little was previously known.
Highlights
The majority of low- and middle-income countries (LMICs) do not have adequate civil registration and vital statistics (CRVS) systems to properly support health policy formulation
The Ministry of Health and Sports (MoHS) and the Central Statistical Organization (CSO) of Myanmar partnered with the Data for Health (D4H) initiative to increase registration and improve information on the cause of community deaths by using automated Verbal autopsy (VA), utilising basic health staff, mandated to collect this information
Of the 55 million deaths that occur worldwide each year, about 40% go unregistered; another 40% occur in hospitals or health establishments where physicians are available, in principle at least, to certify the cause of death (COD); and the remaining 20% are notified to authorities but the underlying COD is either unknown or insufficiently specified to be of public health use [3]
Summary
The majority of low- and middle-income countries (LMICs) do not have adequate civil registration and vital statistics (CRVS) systems to properly support health policy formulation. The development of a functional CRVS system has taken countries such as Sweden, the UK and Australia several decades, if not centuries, to achieve and has generally required sufficient levels of national wealth, education and supply of physicians before reliable statistics on causes of death could be produced [5]. Circumventing this long delay by developing and implementing low-cost, alternative and efficient methods to generate the essential health intelligence for planning has become an urgent and fundamental challenge for health measurement strategies. Given the lack of trained physicians in many LMICs, verbal autopsy (VA) is the only practical alternative for collecting information on the leading causes of death in such populations, and how they are changing
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