Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations

Abstract

Background: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death. Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance. Conclusions: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems.

Global statistics on alcohol, tobacco and illicit drug use: 2017 status report

“…Future research on the validity of code redistribution methods (e.g. for drug overdose deaths) and higher‐quality original data (including integrating verbal autopsies with vital statistics) will improve mortality estimates . Further details on the limitations on the cause of death modelling method in the GBD study are published elsewhere .…”

Pelaksanaan Registrasi Kematian dan Penyebab Kematian di Kota Ambon Tahun 2014

“…16 sedangkan target WHO adalah peningkatan pelaporan pada tahun 2020: 60% pencatatan kematian lengkap dengan karakteristik, 80% kematian di RS memiliki keterangan penyebab kematian yang baik dan tersertifikasi, 50% kematian di masyarakat ditentukan dengan AV secara real time. 7 Target tersebut dapat dicapai dengan usaha bersama, melakukan perbaikan di beberapa simpul yang menjadi kendala dalam pelaksanaan CRVS. Kota Ambon dilihat dari sisi kebijakan sudah mempunyai landasan hukum pencatatan statistik vital yang kuat mulai dari undangundang hingga peraturan daerah, bahkan ada pemberian uang duka bagi keluarga almarhum/ almarhumah untuk setiap kejadian kematian yang dilaporkan.…”

Where there is no hospital: improving the notification of community deaths

“…Reliable evidence on the level and causes of the estimated two-thirds of global deaths that occur in the community is poor [1], with less than half of these deaths ever registered in civil registration and vital statistics (CRVS) systems [2,3]. Even when community deaths are registered, information on the underlying cause of death (COD) is generally of poor quality due to both the lack of physicians to perform medical certification and poor certification practices [4].…”