Use of verbal autopsy in a national health information system: Effects of the investigation of ill-defined causes of death on proportional mortality due to injury in small municipalities in Brazil

Abstract

BackgroundThe Mortality Information System (MIS) in Brazil records mortality data in hospitals and civil registries with the responsibility of compiling underlying cause of death. Despite continuous improvements in the MIS, some areas still maintain a high proportion of deaths assigned to ill-defined causes. Deaths coded to this category have most likely been considered as miscoded deaths from communicable and noncommunicable diseases. However, some local studies have provided evidence of underreporting of injury in Brazil. The aim of this study was to investigate ill-defined causes of death using the verbal autopsy (VA) method to estimate injury-specific mortality fraction in small municipalities in northeastern Minas Gerais, Brazil.MethodsA sample size of reported death certificates with ill-defined conditions in a random sample of 10 municipalities was obtained, and then trained interviewers questioned family members using a standardized VA questionnaire to elicit information on symptoms experienced by the deceased before death. All attempts were made to collect existing information about the disease or death using health facilities records. Probable causes of death were assigned by a physician after review of the completed questionnaires following rules of the 10th revision of the International Classification of Diseases (ICD-10).ResultsOf 202 eligible ill-defined deaths, 151 were investigated using the VA methodology, and 12.6% had injury as the underlying cause of death. The proportional mortality fraction from injury among all causes of death increases from 4.4% to 8.2% after investigation. Different specific injury category causes were observed between recorded injury causes and those detected by VA. Drowning was the top specific injury cause detected after investigation.ConclusionsThis study provides evidence that the use of VA in the investigation of registered ill-defined conditions in an existing MIS can furnish information on the relevance of injury as a priority health problem in small municipalities of Minas Gerais. Local research with VA should be brought to the attention of regional health policymakers to improve the quality of data for their planning.

Evolution of the deaths registry system in Brazil: associations with changes in the mortality profile, under-registration of death counts, and ill-defined causes of death

“…The observed improvements seem to be very closely associated with investments in the public health care system and administrative procedures to collect vital statistics 1,32,33 . Thus, the quality of mortality data for adults seems to have expressively improved through the years and across many regions.…”

“…Previous studies showed that a higher proportion of ill-defined causes of death are found among the elderly and small children, are more concentrated in less-developed regions of the country and that most of them happened outside a health facility 1,25,31,33 . We should expect that the number of ill-defined causes of death would decrease as improvements in diseasediagnosis develop over time.…”

“…The analysis suggests that efforts made by central and local governments to improve data quality in Brazil 32,33 are showing signs of success, and that they will allow a better understanding of the dynamics of health and mortality transition in Brazil. It is clear, however, that more investments are necessary in some parts of the country that are still lagging behind in this area.…”

“…According to them, the most relevant factor that contributes to a greater proportion of ill-defined deaths at old ages in Brazil is an inadequate report by the physicians of the actual causes of death (underlying, associated and complications) in the death certificates 25,33 . It should be highlighted that the tradition of curative medicine in Brazil -and the lack of preventive and continuous health service 26 -sometimes makes it difficult for physicians to judge accurately the main cause of death in the elderly.…”

Mortalidade por câncer de colo do útero no Estado de Minas Gerais, Brasil, 2004-2006: análise da magnitude e diferenciais regionais de óbitos corrigidos

“…13 As áreas com sistemas de informações que apresentem baixos valores nos indicadores de qualidade merecem, portanto, ações específicas que levem em consideração suas peculiaridades, para que o avanço na qualidade da informação seja evidenciado em todas as regiões do país e dos estados. 31 Assim como na maior parte mundo, as taxas de incidência e mortalidade do CCU têm mostrado um declínio nos dados nacionais do Brasil, 3,4,10,16,20,32 onde, nos últimos anos, as doenças crônicas não transmissí-veis -DCNT -têm sido foco de políticas de prevenção, promoção da saúde, e de trabalhos intersetoriais integrados com a assistência médica. 33,34 Desde então, o país vem ampliando a cobertura populacional de oferta de exames citopatológicos e o número de laboratórios com capacidade para realizá-los.…”