Moving from medical to health systems classifications of deaths:extending verbal autopsy to collect information on the circumstances of mortality  

作　　者：Lucia D’Ambruoso Kathleen Kahn Ryan G.Wagner Rhian Twine Barry Spies Maria van der Merwe F.Xavier Gómez-Olivé Stephen Tollman Peter Byass 

机构地区：[1]Institute of Applied Health Sciences,University of Aberdeen,Scotland,UK [2]UmeåCentre for Global Health Research,UmeåUniversity,Umeå,Sweden [3]MRC/Wits Rural Public Health and Health Transitions Research Unit,School of Public Health,Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa [4]Directorate for Maternal,Child,Women and Youth Health and Nutrition,Mpumalanga Department of Health,Nelspruit,Mpumalanga,South Africa [5]INDEPTH:An International Network for the Demographic Evaluation of Populations and Their Health,Accra,Ghana.

出　　处：《Global Health Research and Policy》2016年第1期3-17,共15页全球健康研究与政策（英文）

基　　金：A Health Systems Research Initiative Development Grant from the UK Department for International Development(DFID),Economic and Social Research Council(ESRC),Medical Research Council(MRC(and the Wellcome Trust(MR/N005597/1)funds the research presented in this paper;Support for the Agincourt HDSS including verbal autopsies was provided by The Wellcome Trust,UK(grants 058893/Z/99/A;069683/Z/02/Z;085477/Z/08/Z;085477/B/08/Z),and the University of the Witwatersrand and Medical Research Council,South Africa.

摘　　要：Background:Verbal autopsy(VA)is a health surveillance technique used in low and middle-income countries to establish medical causes of death(CODs)for people who die outside hospitals and/or without registration.By virtue of the deaths it investigates,VA is also an opportunity to examine social exclusion from access to health systems.The aims were to develop a system to collect and interpret information on social and health systems determinants of deaths investigated in VA.Methods:A short set of questions on care pathways,circumstances and events at and around the time of death were developed and integrated into the WHO 2012 short form VA(SF-VA).Data were subsequently analysed from two census rounds in the Agincourt Health and Socio-Demographic Surveillance Site(HDSS),South Africa in 2012 and 2013 where the SF-VA had been applied.InterVA and descriptive analysis were used to calculate cause-specific mortality fractions(CSMFs),and to examine responses to the new indicators and whether and how they varied by medical CODs and age/sex sub-groups.Results:One thousand two hundred forty-nine deaths were recorded in the Agincourt HDSS censuses in 2012-13 of which 1,196(96%)had complete VA data.Infectious and non-communicable conditions accounted for the majority of deaths(47%and 39%respectively)with smaller proportions attributed to external,neonatal and maternal causes(5%,2%and 1%respectively).5%of deaths were of indeterminable cause.The new indicators revealed multiple problems with access to care at the time of death:39%of deaths did not call for help,36%found care unaffordable overall,and 33%did not go to a facility.These problems were reported consistently across age and sex sub-groups.Acute conditions and younger age groups had fewer problems with overall costs but more with not calling for help or going to a facility.An illustrative health systems interpretation suggests extending and promoting existing provisions for transport and financial access in this setting.Conclusions:Supplementing VA with questions on the

关 键 词：Verbal autopsy Social determinants Health systems Civil registration and vital statistics Health surveillance South Africa 

分 类 号：TP3[自动化与计算机技术—计算机科学与技术]