Analysis of Causes of Death Among Brought-in-Dead Cases in a Third-Level Hospital in Lusaka, Republic of Zambia, Using the Tariff Method 2.0 for Verbal Autopsy: A Cross-Sectional Study

Abstract

Background Over one third of deaths in Zambian health facilities involve someone who has already died before arrival (i.e., brought in dead [BiD]), and in most BiD cases, the causes of death (CoD) have not been fully analyzed. Therefore, this study aimed to analyze the CoD of BiD cases using the Tariff Method 2.0 for automated verbal autopsy (VA), which is called SmartVA.Methods The target site was one third-level hospital in the Republic of Zambia’s capital city. All BiD cases aged 13 years and older at this facility from January to August 2017 were included. The deceased’s closest relatives were interviewed using a structured VA questionnaire (Population Health Metrics Research Consortium Shortened Questionnaire) and the data were analyzed using the SmartVA to determine the CoD at the individual and population level. The CoDs were compared with description on the death notification forms by using t-test and Cohen’s kappa coefficient.Results Approximately 1500 cases were included (average age = 47.2 years, 61.8% males). The top CoD were infectious diseases, including acquired immunodeficiency syndrome, tuberculosis, and malaria, followed by non-communicable diseases, such as stroke, cardiovascular diseases, and diabetes mellitus (DM). The comparison with the CoD distribution among hospital deaths showed that the trends were similar except for DM, which was greater among hospital deaths, and malaria and accident, which were less frequent in the main CoD. The proportion of cases with a determined CoD was significantly higher when using the SmartVA (75%) than the death notification form (61%). A proportion (42.7%) of the CoD-determined cases matched in both sources, with a low concordance rate (kappa coefficient = 0.1385).Conclusions The CoD of the BiD cases were successfully analyzed using the SmartVA for the first time in Zambia. While there many erroneous descriptions on the death notification form, the SmartVA could determine the CoD among more BiD cases. Since the information on the death notification form is reflected in the national vital statistics, more accurate and complete CoD data are required. In order to strengthen the death registration system with accurate CoD, it will be useful to embed the SmartVA in Zambia’s health information system.

Underreported Breast and Cervical Cancer Deaths Among Brought-In-Dead Cases in Zambia

“…7 In a growing number of cases, when a death occurs, the deceased is taken to a health facility by the relatives to obtain a death notification form required for death registration and burial permission from the civil registration office. 8 Investigations revealed that more than one third of deaths recorded at health facilities were those that occurred before their arrival (ie, brought-in-dead cases). Facility health information officers reported that the CoD of brought-indead cases was difficult to ascertain because of little medical information available regarding what led to death.…”

“…The details of this study have been described elsewhere. 8 In brief, for 1,571 brought-in-dead cases more than 1 month old, trained staff interviewed the deceased's relatives and CoD was derived using SmartVA, an automated verbal autopsy computer program validated in previous studies and recommended by the WHO. [9][10][11] The CoD written in the officially issued death notification form was also retrieved for each case.…”