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 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.

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.

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.

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.

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.

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.

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 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 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.

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.

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 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.

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 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.

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.

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.

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 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.

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.

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.

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.