Enhancing the value of mortality data for health systems : adding Circumstances Of Mortality CATegories (COMCATs) to deaths investigated by verbal autopsy
Date
2019-10-25
Journal Title
Journal ISSN
Volume Title
Publisher
Taylor & Francis
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.
Description
CITATION: Hussain-Alkhateeb, L. et al. 2019. Enhancing the value of mortality data for health systems : adding Circumstances Of Mortality CATegories (COMCATs) to deaths investigated by verbal autopsy. Global Health Action, 12:1680068, doi:10.1080/16549716.2019.1680068.
The original publication is available at https://www.tandfonline.com
The original publication is available at https://www.tandfonline.com
Keywords
Mortality -- Tables, Circumstances Of Mortality CATegories (COMCATs), Autopsy -- Reporting, Autopsy -- Statistics
Citation
Hussain-Alkhateeb, L. et al. 2019. Enhancing the value of mortality data for health systems : adding Circumstances Of Mortality CATegories (COMCATs) to deaths investigated by verbal autopsy. Global Health Action, 12:1680068, doi:10.1080/16549716.2019.1680068.