Enhancing the value of mortality data for health systems

adding Circumstances Of Mortality CATegories (COMCATs) to deaths investigated by verbal autopsy

Laith Hussain-Alkhateeb* (Corresponding Author), Lucia D'Ambruoso, Stephen Tollman, Kathleen Kahn, Maria Van Der Merwe, Rhian Twine, Linus Schiöler, Max Petzold

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Half of the world’s deaths and their causes pass unrecorded by routine registration systems, particularly in low- and middle-income countries. Verbal autopsy (VA) collects information on medical signs, symptoms and circumstances from witnesses of a death that is used to assign likely medical causes. To further contextualise information on mortality, understanding underlying determinants, such as logistics, barriers to service utilisation and health systems responses, is important for health planning. Adding systematic methods for categorising circumstantial determinants of death to conventional VA tools is therefore important. In this context, the World Health Organization (WHO) leads the development of international standards for VA, and added questions on the social and health systems circumstances of death in 2012. 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. This innovative COMCAT model is integrated with InterVA-5 software (which processes WHO-2016 VA data), for assigning numeric likelihoods to six circumstantial categories for each death. VA data from 4,116 deaths in the Agincourt Health and Socio-Demographic Surveillance System in South Africa from 2012 to 2016 were used to demonstrate proof of principle for COMCATs. Lack of resources to access health care, poor recognition of diseases and inadequate health systems responses ranked highest among COMCATs in the demonstration dataset. COMCATs correlated plausibly with age, sex, causes of death and local knowledge of the demonstration population. The COMCAT approach appears to be plausible, feasible and enhances the functionality of routine VA to account for critical limiting circumstances at and around the time of death. It is a promising tool for evaluating progress towards the Sustainable Development Goals and the roll-out of Universal Health Coverage.
Original languageEnglish
Article number1680068
JournalGlobal Health Action
Volume12
Issue number1
Early online date25 Oct 2019
DOIs
Publication statusPublished - 2019

Fingerprint

Information Systems
Autopsy
Mortality
Health
Cause of Death
Universal Coverage
Health Planning
Health Services Accessibility
Policy Making
Conservation of Natural Resources
Health Policy
South Africa
Signs and Symptoms
Health Services
Software
Demography
Costs and Cost Analysis
Population

Keywords

  • verbal autopsy
  • health systems
  • civil registration and vital statistics
  • social determinants of health
  • circumstances of health
  • circumstances of death
  • AGINCOURT HEALTH
  • Verbal autopsy
  • CIVIL REGISTRATION

Cite this

Enhancing the value of mortality data for health systems : adding Circumstances Of Mortality CATegories (COMCATs) to deaths investigated by verbal autopsy. / Hussain-Alkhateeb, Laith (Corresponding Author); D'Ambruoso, Lucia; Tollman, Stephen; Kahn, Kathleen ; Van Der Merwe, Maria; Twine, Rhian; Schiöler, Linus; Petzold, Max.

In: Global Health Action, Vol. 12, No. 1, 1680068, 2019.

Research output: Contribution to journalArticle

Hussain-Alkhateeb, Laith ; D'Ambruoso, Lucia ; Tollman, Stephen ; Kahn, Kathleen ; Van Der Merwe, Maria ; Twine, Rhian ; Schiöler, Linus ; Petzold, Max. / Enhancing the value of mortality data for health systems : adding Circumstances Of Mortality CATegories (COMCATs) to deaths investigated by verbal autopsy. In: Global Health Action. 2019 ; Vol. 12, No. 1.
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abstract = "Half of the world’s deaths and their causes pass unrecorded by routine registration systems, particularly in low- and middle-income countries. Verbal autopsy (VA) collects information on medical signs, symptoms and circumstances from witnesses of a death that is used to assign likely medical causes. To further contextualise information on mortality, understanding underlying determinants, such as logistics, barriers to service utilisation and health systems responses, is important for health planning. Adding systematic methods for categorising circumstantial determinants of death to conventional VA tools is therefore important. In this context, the World Health Organization (WHO) leads the development of international standards for VA, and added questions on the social and health systems circumstances of death in 2012. 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. This innovative COMCAT model is integrated with InterVA-5 software (which processes WHO-2016 VA data), for assigning numeric likelihoods to six circumstantial categories for each death. VA data from 4,116 deaths in the Agincourt Health and Socio-Demographic Surveillance System in South Africa from 2012 to 2016 were used to demonstrate proof of principle for COMCATs. Lack of resources to access health care, poor recognition of diseases and inadequate health systems responses ranked highest among COMCATs in the demonstration dataset. COMCATs correlated plausibly with age, sex, causes of death and local knowledge of the demonstration population. The COMCAT approach appears to be plausible, feasible and enhances the functionality of routine VA to account for critical limiting circumstances at and around the time of death. It is a promising tool for evaluating progress towards the Sustainable Development Goals and the roll-out of Universal Health Coverage.",
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note = "The authors thank the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) management team for their support of this project. Analyses are based on data collected by the Unit. Support for the Agincourt HDSS site comes from the School of Public Health and Faculty of Health Sciences, University of the Witwatersrand, and the Medical Research Council, South Africa, with core funding from the Wellcome Trust, UK (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z) and contributions from the National Institute on Aging (NIA) of the NIH, William and Flora Hewlett Foundation, and Andrew W Mellon Foundation, USA. Conceptualisation of COMCAT was supported through a parent study funded by the Joint Health Systems Research Initiative from Department for International Development (DFID)/Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/N005597/1 and MR/P014844/1).",
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N1 - The authors thank the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) management team for their support of this project. Analyses are based on data collected by the Unit. Support for the Agincourt HDSS site comes from the School of Public Health and Faculty of Health Sciences, University of the Witwatersrand, and the Medical Research Council, South Africa, with core funding from the Wellcome Trust, UK (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z) and contributions from the National Institute on Aging (NIA) of the NIH, William and Flora Hewlett Foundation, and Andrew W Mellon Foundation, USA. Conceptualisation of COMCAT was supported through a parent study funded by the Joint Health Systems Research Initiative from Department for International Development (DFID)/Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/N005597/1 and MR/P014844/1).

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