A composite metric for assessing data on mortality and causes of death: the vital statistics performance index

We created a Vital Statistics Performance Index, a composite of six dimensions of VS strength, each assessed by a separate empirical indicator. The six dimensions impacted the accuracy of data to varying extents. VS performance declines more steeply with declining simulated completeness than for any other indicator

A Framework for the Economic Analysis of Data Collection Methods for Vital Statistics

Over recent years there has been a strong movement towards the improvement of vital statistics and other types of health data that inform evidence-based policies. Collecting such data is not cost free. This framework systemically assesses the comparative costs and outcomes/benefits of the various data methods for collecting vital statistics.

A global assessment of civil registration and vital statistics systems: monitoring data quality and progress [abstract only]

This paper applies a composite index (the vital statistics performance index [VSPI]) to assess the performance of CRVS systems in 148 countries or territories during 1980–2012, classifying them into five distinct performance categories, ranging from rudimentary to satisfactory.

A missed opportunity: birth registration coverage is lagging behind Bacillus Calmette-Guérin (BCG) immunization coverage and maternal health services utilization in low- and lower middle-income countries

Using Demographic and Health Survey and Multiple Indicator Cluster Survey data in 72 low- and middle-income countries, this paper: (a) explores the status of birth registration, routine childhood immunization and maternal health services utilisation; (b) analyses indicators of birth registration, routine childhood immunization and maternal health services utilisation, and; (c) identifies missed opportunities for strengthening birth registration systems in countries with strong childhood immunization and maternal health services.

A shortened verbal autopsy instrument for use in routine mortality surveillance systems

We used data from the PHMRC validation study. Using the Tariff 2.0 method, we first established a rank order of individual questions in the PHMRC VAI according to their importance in predicting causes of death. Second, we reduced the size of the instrument by dropping questions in reverse order of their importance. We assessed the predictive performance of the instrument as questions were removed at the individual level by calculating chance-corrected concordance and at the population level with cause-specific mortality fraction (CSMF) accuracy. Finally, the optimum size of the shortened instrument was determined using a first derivative analysis of the decline in performance as the size of the VA instrument decreased for adults, children, and neonates.

Advocating for civil registration: guide to developing a business case for civil registration

Practical information on the six-step approach to preparing and using a business case in support of a civil registration system.

An economic evaluation of data collection methods for vital statistics

A systematic framework to guide investment decisions by donors and governments on methods of data collection for vital statistics.

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

Over one third of deaths in Zambian health facilities involve someone who has already died before arrival (i.e., Brought in Dead), and in most BiD cases, the causes of death (COD) have not been fully analyzed. This study was designed to evaluate the function of automated VA based on the Tariff Method 2.0 to identify the COD among the BiD cases and the usefulness by comparing the data on the death notification form.

Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999–2016

Although global birth registration coverage has improved from 58% to 71% among children under five globally, inequities in coverage by wealth, geographic location, maternal education and health facility access persist. This study examines whether inequities in birth registration in 67 low- and middle-income countries have changed over time.

Are well functioning civil registration and vital statistics systems associated with better health outcomes? [abstract only]

The paper examines whether well functioning civil registration and vital statistics (CRVS) systems are associated with improved population health outcomes. A conceptual model is presented connecting CRVS to wellbeing, and an ecological association between CRVS and health outcomes is described.

Assessing quality of medical death certification: Concordance between gold standard diagnosis and underlying cause of death in selected Mexican hospitals

In Mexico, the vital registration system relies on information collected from death certificates to generate official mortality figures. Although the death certificate has high coverage across the country, there is little information regarding its validity. The objective of this study was to assess the concordance between the underlying cause of death in official statistics obtained from death certificates and a gold standard diagnosis of the same deaths derived from medical records of hospitals.

Assessing the production, quality and use of national vital statistics: a case study of the Philippines

Findings from the review of the CRVS system in the Philippines (2009), which helped to understand how the system worked and identifying weaker areas.

Assessing the quality of cause of death data in six high-income countries: Australia, Canada, Denmark, Germany, Japan and Switzerland [abstract only]

Reprint of abstract for paper assessing the policy utility of national cause of death data in six high-income countries with highly developed health information systems.

Assessing the quality of medical death certification: a case study of concordance between national statistics and results from a medical record review in a regional hospital in the Philippines

Medical certificates of cause of death (MCCOD) issued by hospital physicians are a key input to vital registration systems. A medical record review of hospital MCCOD in the Philippines was conducted and the cause of death concordance compared with certificates coded by the Philippines Statistics Authority.

Assessment of the Data Quality of Cause of Death Registration in Iranian Hospitals in 2016 [abstract only]

This study was conducted to review the quality of cause of death registration in hospitals in Iran in 2016 using ANACONDA.

Avaliação da qualidade dos dados sobre mortalidade no 18 Brasil de 2000 a 2016

Chapter 18 of 'SAÚDE BRASIL 2018 - Uma análise da situação de saúde e das doenças e agravos crônicos: desafios e perspectivas'.

Barriers to birth registration in Indonesia

This piece, published in 2016 in the Lancet, discusses the results of a study investigating barriers to birth registration in Indonesia, where more than 24 million children are without a birth certificate.

Better health intelligence: a new era for civil registration and vital statistics?

The impetus and opportunities for improving birth, death, and cause of death data have never been more propitious. Renewed country commitment to strengthen vital registration systems is clearly evident, supported by nascent regional coalitions of technical and development organisations. The announcement of a major new investment by Bloomberg Philanthropies to strengthen data systems and capacity in selected countries has the potential to catalyse and realise significant improvements in the availability and quality of data for health. This will require technical leadership, strategic intervention choices, strong country partnerships, and efficient delivery and management of multiple technical interventions across participating countries.

Births and deaths must be registered in Africa

This piece, published in the Lancet, argues that should governments in Africa wish to measure progress towards Goal 3 of the Sustainable Development Goals, greater efforts need to be made to collect information on the number of annual deaths and the causes of these deaths.

Building Capacity for Mortality Statistics Programs: Perspectives from the Indonesian Experience

Information on deaths by age, sex, and cause are primary inputs for health policy and research. Currently, most most low income countries lack efficient death registration systems that generate these data on a routine and timely basis. The global community is promoting initiatives to establish and strengthen national mortality statistics programs across low- and middle-income countries. This paper reports the theoretical and practical perspectives gained from experiences developing human capacity in the Indonesian context.

Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Childhood mortality, particularly in the first five years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. This paper presents a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia.

Cause-specific mortality patterns among hospital deaths in Thailand: validating routine death certification

This paper reports findings from a study to measure validity of registered diagnoses in a sample of deaths that occurred in hospitals in Thailand during 2005.

Causes of death in Tonga: quality of certification and implications for statistics

Detailed cause of death data by age group and sex are critical to identify key public health issues and target interventions appropriately. In this study the quality of local routinely collected cause of death data from medical certification is reviewed, and a cause of death profile for Tonga based on amended data is presented.

Changes in the quality of cause-of-death statistics in Brazil: garbage codes among registered deaths in 1996–2016

This study found that age-standardized mortality rates due to garbage codes (GCs) in Brazil decreased from 1996 to 2016, particularly level 1 GCs. The most important GC groups were ill-defined causes (level 1) in 1996, and pneumonia unspecified (level 4) in 2016. At state level, there was a significant inverse association between SDI and the rate of level 1–2 GCs in 1996–2005, but both SDI and completeness had a non-expected significant direct association with levels 3–4. In 2006–2016, states with higher SDIs tended to have lower rates of all types of GCs. Mortality rates due to major GCs decreased in all three SDI classes in 1996–2016, but GC levels 3–4 decreased only in the high SDI category. States classified in the low or medium SDI groups were responsible for the most important decline of major GCs.

Civil registration and vital statistics: progress in the data revolution for counting and accountability [abstract only]

New momentum for civil registration and vital statistics is building. This paper argues that this country and regional momentum would benefit from global leadership, commitment and support.

Civil registration systems and vital statistics: successes and missed opportunities [abstract only]

Vital statistics generated through civil registration systems are the major source of continuous monitoring of births and deaths over time. The usefulness of vital statistics depends on their quality. This paper proposes a comprehensive and practical framework for assessment of the quality of vital statistics.

Cloud-based services for electronic civil registration and vital statistics systems

An alternative to using a data center for civil registration and vital statistics data is cloud-based hosting, which is a virtual data center hosted by a public cloud provider. This paper examines the hosting options for electronic civil registration and vital statistics systems, particularly the use of data centres versus cloud-based solutions.

Collecting verbal autopsies: improving and streamlining data collection processes using electronic tablets

As countries increase verbal autopsy surveillance, it is important to consider the best way to design sustainable systems for data collection. Electronic data capture has the potential to greatly reduce the time and costs associated with data collection. For long-term, large-scale surveillance required by national vital statistical systems, electronic data capture reduces costs and allows data to be available sooner. This study collected verbal autopsy interviews using paper and pencil, and using electronic tablets at two sites, and measured the cost and time required to process the surveys for analysis.

Comparative analysis of completeness of death registration, adult mortality and life expectancy at birth in Brazil at the subnational leve

This study provides a descriptive and comparative analysis of aforementioned estimates from four sources of estimates at subnational level (26 states and one Federal District) in Brazil from two different points in time. The study found significant differences in estimates that affect both levels and trends of completeness of adult mortality in Brazil and states.

Comparing tariff and medical assistant assigned causes of death from verbal autopsy interviews in Matlab, Bangladesh: implications for a health and demographic surveillance system

Deaths in developing countries often occur outside health facilities, making it difficult to gather reliable cause of death (COD) information. Automated COD assignment using a verbal autopsy instrument has been proposed as a reliable and cost-effective alternative to traditional physician-certified verbal autopsy, but its performance is still being evaluated. This study compared the similarity of diagnosis by medical assistants in the Matlab Health and Demographic Surveillance System with the SmartVA Analyze 1.2 (Tariff 2.0) diagnosis.

Comparison of physician-certified verbal autopsy with computer-coded verbal autopsy for cause of death assignment in hospitalized patients in low- and middle-income countries: systematic review

Computer-coded verbal autopsy (CCVA) methods to assign causes of death (CODs) for medically unattended deaths have been proposed as an alternative to physician-certified verbal autopsy (PCVA). A systematic review of 19 published comparison studies was conducted, most of which used hospital-based deaths as the reference standard. The performance of PCVA and five CCVA methods was assessed: Random Forest, Tariff, InterVA, King-Lu, and Simplified Symptom Pattern.

Completeness of birth and death registration in a rural area of South Africa: the Agincourt health and demographic surveillance, 1992-2014

Completeness of vital registration remains very low in sub-Saharan Africa, especially in rural areas. This paper presents the findings of an investigation of trends and factors in completeness of birth and death registration from 1992-2014 in a rural area of South Africa.

CRVS systems: a cornerstone of sustainable development

This editorial piece argues that increased investment in CRVS systems is vital if sustainable development is to be achieved.

Death Certification: Errors and Interventions

Despite the importance of accurate certification, errors remain common. This study evaluates the frequency of death certification errors at an academic center in the US, implementing a standardised method of categorising error severity, and analysing sources of errors to better identify ways to improve death certification accuracy.

Deaths due to suicide: the effects of certification and coding practices in Australia

This paper presents an outline of the way in which the official Australian suicide data is captured and coded and highlights issues relating to the classification used, coronial processes, documentation requirements and data sources that have an impact on the final reported data.

Differences in barriers to birth and death registration in Guinea-Bisseau: implications for monitoring national and global health objectives

This paper presents the results of survey among women of reproductive age in Guinea-Bissau who had given birth in the past two years. Information was elicited on the birth and registration of children to better understand challenges and barriers.

Direct estimation of cause-specific mortality fractions from verbal autopsies: multisite validation study using clinical diagnostic gold standards

Verbal autopsy (VA) is used to estimate the causes of death in areas with incomplete vital registration systems. The King and Lu method (KL) for direct estimation of cause-specific mortality fractions (CSMFs) from VA studies is an analysis technique that estimates CSMFs in a population without predicting individual-level cause of death as an intermediate step. This study applied the KL method to VA datasets from the PHMRC gold standard VA validation study to assess the quality of the KL estimates.

Does smoking kill? A study of death certification and smoking [abstract only]

This retrospective study of of 2128 death certificates and 236 postmortem reports aims to assess how frequently smoking is cited as a cause of death on death certificates.

Effects of recall time on cause-of-death findings using verbal autopsy: empirical evidence from rural South Africa

Verbal autopsy (VA) is a widely used technique for assigning causes to non-medically certified deaths using information gathered from a close caregiver. Both operational and cultural factors may cause delays in follow-up of deaths. The resulting time lag-from death to VA interview-can influence ways in which terminal events are remembered, and thus affect cause-of-death assignment. This study investigates the impact of recall period on causes of death determined by VA.

Elements of a strategic approach for strengthening national mortality statistics programmes

Information on cause-specific mortality from civil registration and vital statistics (CRVS) systems is essential for health policy and epidemiological research. This article describes an evidence-based strategic approach for strengthening mortality data from CRVS systems. National mortality data availability scores from the Global Burden of Disease study were used to group countries into those with adequate, partial or negligible mortality data.

Engaging physicians in improved cause of death certification: evaluation of an education intervention [Meeting Abstract]

Accurate cause of death (CoD) data is one of the most important public health datasets that informs burden of disease assessments. The aim of this paper is to present the results of an education intervention designed to educate doctors on correct death certification.

Enhancing the value of mortality data for health systems: adding Circumstances Of Mortality CATegories (COMCATs) to deaths investigated by verbal autopsy

This paper introduces a pragmatic and scalable approach for assigning relevant Circumstances Of Mortality CATegories (COMCATs) within VA tools, and examines their consistency, reproducibility and plausibility for health policy making, as well as assessing additional effort and cost to the routine VA process.

Estimating Adult Mortality in Papua New Guinea, 2011

Mortality in Papua New Guinea (PNG) is poorly measured because routine reporting of deaths is incomplete and inaccurate. This study provides the first estimates in the academic literature of adult mortality in PNG by province and sex. These results are compared to a Composite Index of provincial socioeconomic factors and health access.

Estimating the completeness of death registration: An empirical method

Many national and subnational governments need to routinely measure the completeness of death registration for monitoring and statistical purposes. Existing methods, such as death distribution and capture-recapture methods, have a number of limitations such as inaccuracy and complexity that prevent widespread application. This paper presents a novel empirical method to estimate completeness of death registration at the national and subnational level.

Estimating the pattern of causes of death in Papua New Guinea

Papua New Guinea (PNG) is a diverse country with high mortality and evidence of increased prevalence of non-communicable diseases (NCDs), but there is no reliable cause of death data because civil registration is insufficient and routine health data comprise only a small proportion of deaths. This study aims to estimate cause specific mortality fractions for five broad groups of causes (endemic infections, emerging infections, endemic NCDs, emerging NCDs and injuries), by sex for each of PNG’s provinces.

Evaluating an educational intervention to improve the accuracy of death certification among trainees from various specialties

The inaccuracy of death certification can lead to the misallocation of resources in health care programs and research. This study evaluates the rate of errors in the completion of death certificates among medical residents from various specialties, before and after an educational intervention which was designed to improve the accuracy in the certification of the cause of death.

Evaluating national cause-of-death statistics: principles and application to the case of China

Mortality statistics systems provide basic information on the levels and causes of mortality in populations. Only a third of the world’s countries have complete civil registration systems that yield adequate cause-specific mortality data for health policymaking and monitoring. This paper describes the development of a set of criteria for evaluating the quality of national mortality statistics and applies them to China as an example.

Evaluation of a smartphone application to improve medical certification of the cause of death

A smartphone application named AtestaDO was developed to support physicians with medical certification of the cause of death. The objective of this study is to evaluate the acceptability of the app.

Evaluation of approaches to strengthen civil registration and vital statistics systems: A systematic review and synthesis of policies in 25 countries

Although many countries have made substantial progress in strengthening their CRVS systems, most low- and middle-income countries still have underdeveloped systems. This systematic review aims to identify national policies that can help countries strengthen their systems.

Excess mortality in Wuhan city and other parts of China during the three months of the COVID-19 outbreaks: findings from nationwide mortality registries

This study assesses excess all cause and cause specific mortality during the three months (1 January to 31 March 2020) of the COVID-19 outbreak in Wuhan city and other parts of China.

Framework and Standards for Country Health Information Systems (second edition)

Developed by the Health Metrics Network, this Framework sets out a global standard for guiding the collection, reporting and use of health information by all developing countries and global agencies.

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries.

Health and demographic surveillance systems: a step towards full civil registration and vital statistics systems in sub-Sahara Africa?

In many low-and middle-income countries, especially those in sub-Saharan Africa (SSA), there is a lack of effective and comprehensive national civil registration and vital statistics system. This paper argues that, in the absence of an adequate national CRVS, health and demographic surveillance systems should be more effectively utilised to generate relevant public health data.

Hospital cause-of-death statistics: what should we make of them?

Recommends the implementation of interventions to rapidly improve knowledge about the true causes of death in populations and avoid basing policy on flawed data.

How much does a verbal autopsy based mortality surveillance system cost in rural India?

This paper, published in PLoS ONE, aims to determine the cost of establishing and sustaining a verbal autopsy-based mortality surveillance system in rural India

How to deal with the suffering: Utility of an emotional containment strategy to collect data for verbal autopsies in Mexico [abstract only]

Verbal autopsies are often used to establish cause of death but can be emotionally taxing on the interviewers. This study used focus groups with interviewers (N = 15) to collect data for verbal autopsies in Mexico in order to explore the utility of an emotional containment strategy designed to boost self-confidence and resilience.

How useful are registered birth statistics for health and social policy? A global systematic assessment of the availability and quality of birth registration data

Since 1980, approximately one billion births were registered and shared in public databases. Compared to estimates of fertility, this represents only 40.0% of total births in the peak year, 2011. Approximately 74 million births (53.1%) per year occur in countries whose systems do not systematically register them and release the aggregate records. Considering data quality, timeliness, and completeness in country-years where data are available, only about 12 million births per year (8.6%) occur in countries with high-performing registration systems. This study highlights the gaps in available data.

Immunization programmes and notifications of vital events

This perspective, published in the Bulletin of the World Health Organisation, argues that childhood immunisation programmes present an opportunity to increase birth registration rates in countries whose civil registration and vital statistics systems rely on passive reporting, and where registration rates are low.

Impact of an educational intervention on errors in death certification: An observational study from the intensive care unit of a tertiary care teaching hospital

A high incidence of errors occur while filling up death certificates in hospitals. The purpose of this study was to analyze the impact of an educational intervention on errors in death certification in an intensive care unit. This study was designed to see if any improvement could be brought about in filling death certificates.

Implementing the PHMRC shortened questionnaire: Survey duration of open and closed questions in three sites

We use the PHMRC shortened questionnaire to conduct verbal autopsy interviews at three sites and collect data on the length of time required to complete the interview. This instrument uses a novel checklist of keywords to capture relevant information from the open response.

Improving civil registration and vital statistics systems - Lessons learned from the application of health information tools in Asia and the Pacific

A review of the application of the comprehensive CRVS assessment tool in Asia and the Pacific.

Improving COD certification practices in the Pacific

Findings of study to determine the efficacy and accessibility of the certification module of the WHO's web-based ICD training tool.

Improving hospital death certification in Viet Nam: results of a pilot study implementing an adapted WHO hospital death report form in two national hospitals

At the time of publication, Viet Nam did not have a system for the national collection of death data that met international requirements for mortality reporting. This paper reports on the outcomes of a 23-month study to improve hospital death certification in two national hospitals

Improving performance of the Tariff Method for assigning causes of death to verbal autopsies

Tariff 2.0 addresses the main shortcomings of the application of the Tariff Method to analyze data from VAs in community settings. It provides an estimation of COD from VAs with better performance at the individual and population level than the previous version of this method, and it is publicly available for use.

Interim measures for meeting needs for health sector data: births, deaths and causes of death [abstract only]

Most developing countries do not have fully effective civil registration systems to provide necessary information about population health. Interim approaches - both innovative strategies for collection of data, and methods of assessment or estimation of these data - to fill the resulting information gaps have been developed and refined over the past four decades. These approaches are discussed in this paper.

Is the long-term decline in cardiovasculardisease mortality in high-income countries over? Evidence from national vital statistics

We used vital statistics since 2000 for 23 high-income countries published in the World Health Organization Mortality Database. Age-standardized CVD death rates by sex for all ages, and at ages 35–74 years, were calculated and smoothed using LOWESS regression. Findings were contrasted with the Global Burden of Disease (GBD) Study.

Lessons learned in legal reform and notification of vital events: experiences from the Bloomberg Philanthropies Data for Health Initiative

This paper shares lessons learned through implementing the Bloomberg Philanthropies Data for Health Initiative. The paper focuses on two important topics in CRVS improvement: CRVS legal and regulatory review and reform, and notification of vital events.

Measuring causes of death in populations: a new metric that corrects cause-specific mortality fractions for chance

We developed a baseline approach of random allocation and measured its performance analytically and through Monte Carlo simulation. We used this to develop a new metric of population-level estimation accuracy, the Chance Corrected CSMF Accuracy (CCCSMF Accuracy), which has value near zero for random guessing, and negative quality values for estimation methods that are worse than random at the population level.

Measuring pre-existing health conditions in death certification - deaths involving COVID-19: March 2020

A method for deciding which pre-existing condition mentioned on death certificates is the main pre-existing condition. Developed by the Office for National Statistics, United Kingdom.

Medical certification of death in South Africa – moving forward

Despite improvements to the Death Notification Form (DNF) used in South Africa (SA), the quality of cause-of-death information remains suboptimal. To address these inadequacies, the government ran a train-the-trainer program on completion of the DNF, targeting doctors in public sector hospitals. This article reflects on the lessons learnt from the training and highlights issues that need to be addressed to improve medical certification and cause-of-death data in SA.

Meeting on strengthening the quality of information on causes of death in Brazil

The objective of the meeting was to discuss the improvement of the quality of the information on causes of death in Brazil, with the participation of the three spheres of Government, Civil Society, Universities, and International Institutions. This report summarises the main outcomes of the meeting, including each of the main sessions, comments from participants, and links to additional resources.

Multiple Forces Working in Unison: The Case of Rapid Improvement of Vital Statistics in South Africa Post-1996

Between 1997 to 2002, South Africa remarkably improved the coverage and production of its vital statistics. Some of the important factors contributing to this achievement were lessons learned from study tours to Australia, Sweden and the USA. This paper describes these lessons and how they were adapted to suit the South African reality.

New challenges for verbal autopsy: Considering the ethical and social implications of verbal autopsy methods in routine health information systems [abstract only]

Harnessing the experiences of applying and rolling out verbal autopsies (VAs) as part of routine CRVS systems in a number of low and middle income countries, we identify potential issues that countries and implementing institutions need to consider when incorporating VAs into CRVS systems and point to areas that could benefit from further research and deliberation.

Performance criteria for verbal autopsy-based systems to estimate national causes of death: development and application to the Indian Million Death Study

Verbal autopsy (VA) has been proposed to determine the cause of death (COD) distributions in settings where most deaths occur without medical certification. This study uses performance criteria for VA-based COD systems and applies these to the Registrar General of India’s ongoing, nationally representative Indian Million Death Study.

Performance of InSilicoVA for assigning causes of death to verbal autopsies: multisite validation study using clinical diagnostic gold standards

We perform a standard procedure for analysing the predictive accuracy of verbal autopsy classification methods using the same data and the publicly available implementation of the algorithm released by the authors. We extend the original analysis to include children and neonates, instead of only adults, and test accuracy using different sets of predictors, including the set used in the original paper and a set that matches the released software.

Performance of InterVA for assigning causes of death to verbal autopsies: multisite validation study using clinical diagnostic gold standards

InterVA is a widely disseminated tool for cause of death attribution using information from verbal autopsies. This study assesses the performance of InterVA compared to physician-certified verbal autopsies (PCVA) and alternative automated methods for analysis.

Performance of physician-certified verbal autopsies: multisite validation study using clinical diagnostic gold standards

Physician review of a verbal autopsy (VA) and completion of a death certificate remains the most widely used approach for VA analysis. This study provides new evidence about the performance of physician certified verbal autopsy (PCVA) using defined clinical diagnostic criteria as a gold standard for a multisite sample of 12,542 VAs. The study was also designed to analyze issues related to PCVA.

Performance of the Tariff Method: validation of a simple additive algorithm for analysis of verbal autopsies

Verbal autopsies (VAs) provide valuable information for studying mortality patterns in populations that lack reliable vital registration data. Methods for transforming VA results into meaningful information for health workers and policymakers, however, are often costly or complicated to use. This study presents a simple additive algorithm, the Tariff Method, which can be used for assigning individual cause of death and for determining cause-specific mortality fractions from VA data.

Physicians’ knowledge and practice on death certification in the North West Bank, Palestine: across sectional study

Mortality data are essential for many aspects of everyday public health practices at both national and international levels. The aim of this study is to assess physicians’ knowledge and practice on completing death notification forms.

Promoting the periodic assessment of the quality of medical records and cause-of-death data

A rare look into the validation of cause of death information from routine reporting systems.

Rapid assessment of vital statistics systems

Evaluation of the application of the WHO/Health Information Systems Knowledge Hub tool in 26 countries in the Asia–Pacific region.

Record-linkage comparison of verbal autopsy and routine civil registration death certification in rural north-east South Africa: 2006-09

South African civil registration provides a key data source for local health decision making, and informs the levels and causes of mortality in data-lacking sub-Saharan African countries. This paper links mortality data from civil registration and the Agincourt Health and Socio-demographic Surveillance System to examine the quality of rural civil registration data.

Reporting of ethics in peer-reviewed verbal autopsy studies: a systematic review

Verbal autopsy (VA) is a method that determines the cause of death by interviewing a relative of the deceased about the events occurring before the death, in regions where medical certification of cause of death is incomplete. This paper aims to review the ethical standards reported in peer-reviewed VA studies.

Robustness of the Tariff method for diagnosing verbal autopsies: impact of additional site data on the relationship between symptom and cause

Verbal autopsy (VA) is increasingly being considered as a cost-effective method to improve cause of death information in countries with low quality vital registration. VA algorithms that use empirical data have an advantage over expert derived algorithms in that they use responses to the VA instrument as a reference instead of physician opinion. It is unclear how stable these data driven algorithms, such as the Tariff 2.0 method, are to cultural and epidemiological variations in populations where they might be employed. VAs were conducted in three sites in the Philippines, Bangladesh and Papua New Guinea as part of the Improving Methods to Measure Comparable Mortality by Cause (IMMCMC) study. Similar diagnostic criteria and cause lists as the Population Health Metrics Research Consortium (PHMRC) study were used to identify gold standard deaths. This paper presents the assessment of changes in Tariffs by examining the proportion of Tariffs that changed significantly after the addition of the IMMCMC dataset to the PHMRC dataset.

Setting international standards for verbal autopsy

Editorial published in the Bulletin of the World Health Organization discussing the utility and reliability of verbal autopsy for countries.

Simplified Symptom Pattern Method for verbal autopsy analysis: multisite validation study using clinical diagnostic gold standards

Verbal autopsy (VA) can be a useful tool for generating cause of death data in data-sparse regions around the world. The Symptom Pattern (SP) Method is one promising approach to analysing VA data, but it has not been tested rigorously with gold standard diagnostic criteria. This study proposes a simplified version of SP and evaluates its performance using VA data with accompanying true cause of death.

Strategic planning to strengthen civil registration and vital statistics systems

Guidance for using findings from a comprehensive assessment.

Strengthening civil registration and vital statistics for births, deaths and causes of death: Resource Kit

This Resource Kit is designed to support countries in planning and implementing improvements to their civil registration and vital statistics (CRVS) systems. It has been compiled using critically assessed materials drawn from many sources, and is presented in a user-friendly way that is accessible to both experts and users with a general interest in evidence-based decision-making. The Resource Kit will enable all users to identify, locate and make use of core standards, tools, materials and country experiences.

Strengthening health information systems in the Asia-Pacific region

Aims, objectives and contributions of the Health Information Systems Knowledge Hub at the University of Queensland, 2008-2013

Strengthening mortality data for health policy and planning: the Bloomberg Data for Health Initiative in Latin America

This paper charts efforts and outcomes achieved through the Bloomberg Data for Health Initiative to improve mortality data in four Latin American countries since 2014: Brazil, Peru, Ecuador and Colombia.

Symptom recall and the diagnostic accuracy of verbal autopsies

Determines how recall of item responses varied between interviews over time and how much loss of recall affected the accuracy of CSMFs.

Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers

We searched Google Scholar, Pubmed and Biblioteca Virtual de la Salud for articles in English, Spanish and Portuguese that reported validation studies of data on cause of death. We analysed the results of 199 studies that had used medical record reviews to validate the cause of death reported on death certificates or by the vital registration system.

The GBD Brazil network: better information for health policy decision-making in Brazil

The Global Burden of Disease (GBD) project provides a long-term, comprehensive, and comparable picture of what disables and kills people across countries, time, age, and sex. Insights at the national and sub-national levels can be gained from the GBD estimates if provided with sufficient detail. For Brazil, obtaining sufficiently fine-grained burden estimates is challenging but needed. Recognizing this challenge, the GBD Brazil Network was created in 2014 as a collaboration among the Brazilian Ministry of Health, a network of Universities, Research Institutes and Health Departments, led by the Universidade Federal de Minas Gerais (UFMG), and the Institute for Health Metrics and Evaluation (IHME) of the University of Washington, which leads the global project.

The paradox of verbal autopsy in cause of death assignment: symptom question unreliability but predictive accuracy

It is important that governments understand the reliability of the mortality data used to guide policy decisions. This paper assesses the relationship between the reliability and completeness of symptom responses and the reliability and accuracy of cause of death prediction.

The quality of certification of deaths due to external causes in the city of Fortaleza in the State of Ceará, Brazil

The article analyses the quality of information of deaths from external causes in Fortaleza, in the State of Ceará, Brazil. The authors analysed the completeness of the information of the death certificate and the correlation between the underlying cause of death described in the death certificate and registered in the Mortality Information System.

The quality of medical death certification of cause of death in hospitals in rural Bangladesh

Accurate and timely data on cause of death are critically important for guiding health programs and policies. Physicians in Bangladeshi hospitals had difficulties in completing the MCCD correctly. Physicians routinely made errors in death certification practices and medical record quality was poor. There is an urgent need to improve death certification practices and the quality of hospital data in Bangladesh if these data are to be useful for policy.

The role of COVID-19 in the death of SARS-CoV-2-positive patients: A study based on death certificates

Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of this study was to examine death certificates of persons who tested positive for SARS-CoV-2 to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities.

The role of overweight and obesity in adverse cardiovascular disease mortality trends: an analysis of multiple cause of death data from Australia and the USA

This study uses multiple cause of death (MCOD) data in Australia and the USA to assess the role of overweight and obesity in recent trends in cardiovascular disease mortality.

The way forward

Each country faces a different set of challenges for establishing and maintaining civil registration systems, and strategies must be tailored accordingly. To address these challenges, this paper proposes an approach that couples the application of methods to generate better vital statistics in the short term with capacity-building for comprehensive civil registration systems in the long run.

The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0

This VA instrument offers the opportunity to harmonise the automated diagnostic algorithms in the future

Time for civil registration with verbal autopsy

This piece, published in the Lancet, argues for the inclusion of VA in CRVS systems in countries with incomplete death registration and certification.

Towards universal civil registration and vital statistics systems: the time is now [abstract only]

The health and development challenges of the coming decades cannot be tackled effectively without reliable data for births, deaths, and causes of death, which only a comprehensive civil registration and vital statistics (CRVS) system can deliver. This paper argues that further development towards universal, comprehensive CRVS systems is essential.

Usefulness of the Population Health Metrics Research Consortium gold standard verbal autopsy data for general verbal autopsy methods

PHMRC undertook a study at six tertiary hospitals in low- and middle-income countries which documented over 12 000 deaths clinically and subsequently undertook VA interviews. This dataset, now in the public domain, was compared with the WHO 2012 VA standard and the InterVA-4 interpretative model.

Using verbal autopsy to measure causes of death: the comparative performance of existing methods

Monitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability. This study investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established.

Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam

Information on causes of death is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam.

Validation of verbal autopsy procedures for adult deaths in China [abstract only]

A new international VA form is being considered for data collection in China, but it first needs to be validated to determine its operating characteristics. This study assesses the validity of the VA procedure using standard measurement criteria of sensitivity, specificity, and positive predictive value.

Verbal autopsy in health policy and systems: a literature review

This literature review, including papers published between 2010 and 2017, examines the use of verbal autopsy to inform health policy and systems improvement in 15 low- and middle-income countries in Africa, Asia, the Middle East and South America.

What is the optimal recall period for verbal autopsies? Validation study based on repeat interviews in three populations

This study used information from the Population Health Metrics Research Consortium (PHMRC) Study, which collected VAs for “gold standard” cases where cause of death (COD) was supported by clinical criteria. This study repeated VA interviews within 3–52 months of death in PHMRC study sites in Andhra Pradesh, India, and Bohol and Manila, Philippines.

Who and where are the uncounted children? Inequalities in birth certificate coverage among children under five years in 94 countries using nationally representative household surveys

Access to birth certificates remains challenging and unequal in many low- and middle-income countries. This paper examines wealth, urban/rural and gender inequalities in birth certificate coverage.

WHO Civil Registration and Vital Statistics Strategic Implementation Plan 2021-2025

The WHO CRVS Strategic Implementation Plan 2021-2025 aims to empower Member States to more effectively mobilise their health sector to lead, or contribute to, CRVS system strengthening efforts in order to ensure maximum benefit from routine data systems for policy and development.

Widening inequalities in premature mortality in Australia, 2006-16

This study uses Australian death registration data from 2006-2016 to measure the extent of and change in inequalities in premature mortality (under 75 years) by socio-economic status and remoteness.