Bmc Med
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The majority of low- and middle-income countries (LMICs) do not have adequate civil registration and vital statistics (CRVS) systems to properly support health policy formulation. Verbal autopsy (VA), long used in research, can provide useful information on the cause of death (COD) in populations where physicians are not available to complete medical certificates of COD. Here, we report on the application of the SmartVA tool for the collection and analysis of data in several countries as part of routine CRVS activities. ⋯ Automated VA is the only feasible method for generating COD data for many populations. The results of implementation in four countries, reported here under the D4H Initiative, confirm that these methods are acceptable for wide-scale implementation and can produce reliable COD information on community deaths for which little was previously known.
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The need to monitor the Sustainable Development Goals (SDGs) and to have access to reliable and timely mortality data has created a strong demand in countries for tools that can assist them in this. ANACONDA (Analysis of National Causes of Death for Action) is a new tool developed for this purpose which allows countries to assess how accurate their mortality and cause of death are. Applying ANACONDA will increase confidence and capacity among data custodians in countries about their mortality data and will give them insight into quality problems that will assist the improvement process. ⋯ ANACONDA has demonstrated the potential to dramatically improve knowledge about disease patterns as well as the functioning of CRVS systems and has served as a platform for galvanising wider CRVS reforms in countries.
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Editorial
Reducing ignorance about who dies of what: research and innovation to strengthen CRVS systems.
The Sustainable Development Goal (SDG) agenda offers a major impetus to consolidate and accelerate development in civil registration and vital statistics (CRVS) systems. Strengthening CRVS systems is an SDG outcome in itself. ⋯ While there has been impressive global momentum to improve CRVS systems over the past decade, several challenges remain. This article collection provides an overview of recent innovations, progress, viewpoints and key areas in which action is still required - notably around the need for better systems and procedures to notify the fact of death and to reliably diagnose its cause, both for deaths in hospital and elsewhere.
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Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the medical certificate of cause of death (MCCOD) should be a relatively straightforward procedure for physicians, but mistakes are common. Here, we present three training strategies implemented in five countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne (UoM) and evaluate the impact on the quality of certification. ⋯ The results of this study indicate that a variety of training strategies can produce benefits in the quality of certification, but further improvements are possible. The experiences of D4H suggest several aspects of the strategies that should be further developed to improve outcomes, particularly key stakeholder engagement from early in the intervention and local committees to oversee activities and support an improved culture in hospitals to support better diagnostic skills and practices.
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Despite attempts to apply standard methods proven to work in high-income nations, nearly all civil registration and vital statistics (CRVS) systems in low- and middle-income countries are failing to achieve adequate levels of registration completeness or produce the high-quality vital statistics needed to support better health outcomes and monitor progress towards the 2030 Sustainable Development Goals. This suggests that, rather than simple technical issues, these countries are facing additional or different systemic challenges, including duplication of roles and responsibilities, inefficient methods of data collection, and a reluctance to change. ⋯ The experiences from Myanmar, Papua New Guinea and Rwanda reported in this paper illustrate the benefits of process management to improve CRVS. While these three countries are at different stages of system development, each uniquely benefited. Process management is a useful tool for all CRVS systems, from the most rudimentary to the most developed. It can strengthen CRVS systems and improve the quality and completeness of vital statistics, resulting in more robust, reliable and timely vital statistics for health planning and better monitoring of the 2030 Sustainable Development Goal agenda.