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Abstract
Background: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death.
Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance.
Conclusions: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems.
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1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
2 Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
3 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
4 African Field Epidemiology Network (AFENET), Kisumu, Kenya
5 National Centre for Health Statistics, Centres for Disease Control and Prevention, Hyattsville, MD, USA
6 CAZ Consulting, Geneva, Switzerland
7 Africa Centre for Statistics, United Nations Economic Commission for Africa, Addis Ababa, Ethiopia
8 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
9 INDEPTH Network, Accra, Ghana; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
10 Vital Strategies, New York, NY, USA
11 WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; MRC-Wits Rural Public Health and Health Transitions Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
12 Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland