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01-12-2020 | Autopsy | Research article

Automated verbal autopsy: from research to routine use in civil registration and vital statistics systems

Authors: Riley H. Hazard, Mahesh P. K. Buddhika, John D. Hart, Hafizur R. Chowdhury, Sonja Firth, Rohina Joshi, Ferchito Avelino, Agnes Segarra, Deborah Carmina Sarmiento, Abdul Kalam Azad, Shah Ali Akbar Ashrafi, Khin Sandar Bo, Violoa Kwa, Alan D. Lopez

Published in: BMC Medicine | Issue 1/2020

Abstract

Background

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. 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.

Methods

Data 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.

Results

Country 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.

Conclusion

Automated 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.

See paper in this series: Better data for better outcomes: The importance of business processes management in CRVS systems.

A township in Myanmar refers to a ‘low-level’ local government unit.

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Title: Automated verbal autopsy: from research to routine use in civil registration and vital statistics systems
Authors: Riley H. Hazard
Mahesh P. K. Buddhika
John D. Hart
Hafizur R. Chowdhury
Sonja Firth
Rohina Joshi
Ferchito Avelino
Agnes Segarra
Deborah Carmina Sarmiento
Abdul Kalam Azad
Shah Ali Akbar Ashrafi
Khin Sandar Bo
Violoa Kwa
Alan D. Lopez
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Autopsy
Published in: BMC Medicine / Issue 1/2020
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-020-01520-1

At a glance: The STEP trials

Springer Medicine

Automated verbal autopsy: from research to routine use in civil registration and vital statistics systems

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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