Refining Circumstances of Mortality Categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making

Lucia D'Ambruoso, Jessica Price, Eilidh Cowan, Gerhard Goosen, Edward Fottrell, Kobus Herbst, Maria Van Der Merwe, Jerry Sigudla, Justine Davies, Kathleen Kahn

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Abstract

Background
Recognising that the causes of over half the world’s deaths pass unrecorded, the World Health Organization (WHO) leads development of Verbal Autopsy (VA): a method to understand causes of death in otherwise unregistered populations. Recently, VA has been developed for use outside research environments, supporting countries and communities to recognise and act on their own health priorities. We developed the Circumstances of Mortality Categories (COMCATs) system within VA to provide complementary circumstantial categorisations of deaths.
Objectives
Refine the COMCAT system to (a) support large-scale population assessment and (b) inform public health decision-making.
Methods
We analysed VA data for 7,980 deaths from two South African Health and Socio-Demographic Surveillance Systems (HDSS) from 2012 to 2019: the Agincourt HDSS in Mpumalanga and the Africa Health Research Institute HDSS in KwaZulu-Natal. We assessed the COMCAT system’s reliability (consistency over time and similar conditions), validity (the extent to which COMCATs capture a sufficient range of key circumstances and events at and around time of death) and relevance (for public health decision-making).
Results
Plausible results were reliably produced, with ‘emergencies’, ‘recognition, ‘accessing care’ and ‘perceived quality’ characterising the majority of avoidable deaths. We identified gaps and developed an additional COMCAT ‘referral’, which accounted for a significant proportion of deaths in sub-group analysis. To support decision-making, data that establish an impetus for action, that can be operationalised into interventions and that capture deaths outside facilities are important.
Conclusions
COMCAT is a pragmatic, scalable approach enhancing functionality of VA providing basic information, not available from other sources, on care seeking and utilisation at and around time of death. Continued development with stakeholders in health systems, civil registration, community and research environments will further strengthen the tool to capture social and health systems drivers of avoidable deaths and promote use in practice settings.
Original languageEnglish
Article number2000091
Number of pages16
JournalGlobal Health Action
Volume14
DOIs
Publication statusPublished - 4 Apr 2022

Keywords

  • Causes of death
  • circumstances of mortality
  • South Africa
  • verbal autopsy
  • Autopsy/methods
  • Reproducibility of Results
  • Rural Population
  • South Africa/epidemiology
  • Humans
  • Cause of Death
  • COHORT PROFILE
  • SOUTH-AFRICA
  • INFORMATION-SYSTEM ACDIS
  • AGINCOURT
  • TRENDS
  • CARE
  • RESPONSES
  • SURVEILLANCE

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