Mortality measurement in transition: proof of principle for standardised multi-country comparisons

Edward Fottrell,Dao Lan Huong,Kathleen Kahn,Mesganaw Fantahun,Benn Sartorius,Peter Byass,Hoang Van Minh,Nawi Ng

doi:10.1111/j.1365-3156.2010.02601.x

Abstract

ObjectiveTo demonstrate the viability and value of comparing cause-specific mortality across four socioeconomically and culturally diverse settings using a completely standardised approach to VA interpretation.MethodsDeaths occurring between 1999 and 2004 in Butajira (Ethiopia), Agincourt (South Africa), FilaBavi (Vietnam) and Purworejo (Indonesia) health and socio-demographic surveillance sites were identified. VA interviews were successfully conducted with the caregivers of the deceased to elicit information on signs and symptoms preceding death. The information gathered was interpreted using the InterVA method to derive population cause-specific mortality fractions for each of the four settings.ResultsThe mortality profiles derived from 4784 deaths using InterVA illustrate the potential of the method to characterise sub-national profiles well. The derived mortality patterns illustrate four populations with plausible, markedly different disease profiles, apparently at different stages of health transition.ConclusionsGiven the standardised method of VA interpretation, the observed differences in mortality cannot be because of local differences in assigning cause of death. Standardised, fit-for-purpose methods are needed to measure population health and changes in mortality patterns so that appropriate health policy and programmes can be designed, implemented and evaluated over time and place. The InterVA approach overcomes several longstanding limitations of existing methods and represents a valuable tool for health planners and researchers in resource-poor settings.

Highlights

Epidemiological understanding of health and changing morbidity and mortality patterns globally is limited by inadequate measurement of population health status
Simple computer procedures were written to select the relevant information from the Health and Demographic Surveillance Sites (HDSS) verbal autopsy (VA) databases and transform it into the batch file, spreadsheet format used by InterVA
Verbal autopsy data were available for 351 deaths from Butajira (96% of all deaths), 3380 from Agincourt (95%), 189 from FilaBavi (86%) and 864 from Purworejo (44%) between 1999 and 2004 and all were included in the study

Summary

Introduction

Epidemiological understanding of health and changing morbidity and mortality patterns globally is limited by inadequate measurement of population health status. In the absence of routine death registration, verbal autopsy (VA) methods gather information from a close caregiver about the signs and symptoms of the deceased’s terminal illness, as well as lifestyle behaviours and other characteristics. This information is used to derive a 2010 Blackwell Publishing Ltd. Tropical Medicine and International Health E. The time that physicians must devote to assessing large numbers of VAs is far from ideal in areas with insufficient medical personnel Such issues in interpreting VA data have been tackled with efforts culminating in the development of various algorithmic approaches based on the concept of distilling the process of physician review into standardised rules (Murray et al 2007). Whilst being more transparent and repeatable, algorithmic procedures make it impossible to consider parallel possibilities of multiple causes of death and very often require specific questionnaires that are designed for specific contexts (Fottrell & Byass 2010)

Methods

Results

Discussion

Conclusion