Mortality in India established through verbal autopsies (MINErVA): Strengthening national mortality surveillance system in India

Abstract

Background Following data access and storage concerns, Government of India transferred the management of its Sample Registration System (SRS) based mortality surveillance (formerly known as the Million Death Study) to an Indian agency. This paper introduces the new system, challenges it faced and its vision for future. Methods The All India Institute of Medical Sciences (AIIMS), New Delhi, the new nodal agency, established the “Mortality in India Established through Verbal Autopsy” (MINErVA) platform with state level partners across India in November 2017. The network in its first three years has undertaken capacity building of supervisors conducting verbal autopsy under the SRS, established a panel of trained physician reviewers and developed three IT-based platforms for training, quality control and coding. Coding of VA forms started from January 2015 onwards, and the cause specific mortality fractions (CSMF) of the first 14 185 adult verbal autopsy (VA) records for 2015 were compared with earlier published data for 2010-2013 to check for continuity of system performance. Results The network consists of 25 institutions and a panel of 676 trained physician reviewers. 916 supervisors have been trained in conducting verbal autopsies. More than 75 000 VA forms have been coded to date. The median time taken for finalizing cause of death on the coding platform is 37 days. The level of physician agreement (67%) and proportion of VA forms requiring adjudication (12%) are consistent with published literature. Preliminary CSMF estimates for 2015 were comparable with those for 2010-2013 and identified same top ten causes of death. In addition to the delay, two major challenges identified for coding were language proficiency of physician reviewers vis-à-vis language of narratives and quality of verbal autopsies. While an initial strategic decision was made to consolidate the system to ensure continuity, future vision of the network is to move towards technology-based solutions including electronic data capture of VAs and its analysis and improving the use of mortality data in decision making. Conclusion MINErVA network is now fully functional and is moving towards achieving global standards. It provides valuable lessons for other developing countries to establish their own mortality surveillance systems.

Exploratory analysis of the suitability of data from the civil registration system for estimating excess mortality due to COVID-19 in Faridabad district of India

“…Verbal autopsies (VA) were conducted by trained field workers using a validated instrument 17 for a subset of 585 deaths in the age group of 30-69 yr which occurred in study tehsils as a part of an ongoing study to identify cardiac deaths. To assess the reliability of CoD from CRS, International Classification of Diseases-10 (ICD-10) codes for the underlying CoD based on the VA interview were assigned by the authors 18 . Appropriate ICD-10 codes were also assigned for the CoD recorded in the CRS portal for the same subset.…”

Use of standard verbal autopsies to improve the mortality data capacity of civil registration and vital statistics systems in low- and middle-income countries: Analysis of key issues

“…Evidence of mortality data incapacity or capacity latency of CRVS systems in LMICs from the DTPCM analysis of the Nigerian situation is largely corroborated by studies in other LMICs. Examples (in Table 4) include failure to produce disaggregated mortality data in Pakistan (Khan and Mursalin 2020); problems with completeness/coverage of mortality in Brazil (Queiroz et al 2020); incomplete coverage of registration facilities in India (Krishnan et al 2020); inadequate registration infrastructure relative to the size of registration districts in Zambia (DNRPC 2014); inadequate trained personnel, weak institutional structure, and financial challenges in Morocco and Sudan (UNFPA 2022); and limited information and communication technology (ICT) access and use and a weak death notification system in Bangladesh (Azad et al 2013). As shown below, the limitations of these CRVS systems' mortality data capacity form part of the key issues impinging on the use of VAs within CRVS systems in these countries.…”

Pesticide Use in Indian Agriculture: Policy Alternatives for Environmental Health

“…Second, even in cases where the death is medically certified, the underlying cause of death remains unknown and only the immediate cause is reported (Rukmini, 2020). Third, the present coverage of verbal-autopsy based reporting under SRS, which is regarded as a reliable method of determining actual cause of deaths, is currently inadequate (Krishnan et al, 2020). Fourth, incorrect data coding due to limited training of human resources is a major impediment to generating accurate mortality and morbidity statistics in India (Dhillon et al, 2018).…”