Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations
Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations
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DOI：
10.1080/16549716.2017.1272882
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发表时间：
2017-01-01
影响因子：
2.6
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
de Savigny, Don;Riley, Ian;Lopez, Alan D.
背景资料：可靠且具有代表性的死因统计数据对于公共卫生政策、应对新出现的卫生需求以及记录可持续发展目标的进展至关重要。然而，全世界只有不到三分之一的死亡是有原因的。低收入和中低收入国家的民事登记和人口动态统计（CRVS）系统无法提供及时、完整和准确的人口动态统计数据，要为每例死亡提供医生认证的死因数据还需要一段时间。建议：口头尸检（VA）是一种确定可能死因的方法，虽然不完美，但在没有医生认证的情况下是最佳选择。VA在研究环境中有广泛的经验，但只有少数几个大规模使用的例子。使用移动的设备上的电子问卷和计算机算法进行数据收集，以分析答复并估计可能的COD，增加了在民事登记和人口动态统计系统中常规应用VA的可能性。然而，在规划、试点和实施诸如VA等全系统干预措施时，应考虑一些民事登记和人口动态统计以及卫生系统整合问题。其中包括解决所涉利益攸关方和子系统的多重性问题，与现有民事登记和人口动态统计工作流程和信息流的整合，将脆弱性和适应性评估结果与民事登记记录联系起来，信息技术要求和数据质量保证。它将对全系统产生深远的影响，在规划有效执行时应予以认真考虑。本文件确定并讨论了系统层面的主要问题和新出现的做法，提供了系统层面考虑因素的规划清单，并概述了如何将脆弱性和适应性纳入常规民事登记和人口动态统计系统。
Background: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low-and lowermiddle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death.Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance.Conclusions: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems.