Automated verbal autopsy: from research to routine use in civil registration and vital statistics systems
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RESEARCH ARTICLE
Open Access
Automated verbal autopsy: from research to routine use in civil registration and vital statistics systems Riley H. Hazard1*, Mahesh P. K. Buddhika1, John D. Hart1, Hafizur R. Chowdhury1, Sonja Firth1, Rohina Joshi2, Ferchito Avelino3, Agnes Segarra3, Deborah Carmina Sarmiento1, Abdul Kalam Azad4, Shah Ali Akbar Ashrafi4, Khin Sandar Bo1, Violoa Kwa1 and Alan D. Lopez1
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. Keywords: Verbal autopsy, Civil registration and vital statistics, Cause of death, Bangladesh, Myanmar, Papua New Guinea, Philippines
* Correspondence: [email protected] 1 Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and repro
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