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

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Study Justification:
– Verbal autopsy (VA) is a technique used in low and middle-income countries to determine the medical causes of death for individuals who die outside of hospitals and without registration.
– This study aims to extend the use of VA to collect information on the social and health systems determinants of deaths, allowing for an examination of social exclusion from access to health systems.
– By understanding the circumstances surrounding deaths, policymakers and health planners can develop targeted interventions to improve access to care and reduce mortality rates.
Study Highlights:
– The study analyzed data from two census rounds in the Agincourt Health and Socio-Demographic Surveillance Site in South Africa.
– Infectious and non-communicable conditions accounted for the majority of deaths, with smaller proportions attributed to external, neonatal, and maternal causes.
– The study revealed multiple problems with access to care at the time of death, including a lack of calls for help, unaffordable care, and not seeking care at a facility.
– These problems were consistent across different age and sex sub-groups.
– The study suggests extending and promoting existing provisions for transport and financial access to address these issues.
Study Recommendations:
– Further contextualization of the study’s method and results is underway with health systems stakeholders.
– The study recommends developing an interpretation sequence as part of a health policy and systems research approach.
– Policymakers and health planners should consider implementing targeted interventions to improve access to care, particularly in the areas of transport and financial access.
Key Role Players:
– Health systems stakeholders
– Policymakers
– Health planners
Cost Items for Planning Recommendations:
– Transportation provisions
– Financial access provisions

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it presents findings from a study conducted in the Agincourt Health and Socio-Demographic Surveillance Site in South Africa. The study collected and analyzed data on social and health systems determinants of deaths using verbal autopsy. The results revealed problems with access to care at the time of death, which were consistent across different age and sex sub-groups. The study suggests extending and promoting existing provisions for transport and financial access. However, to improve the evidence, it would be helpful to provide more details about the methodology used and the specific findings related to the social and health systems determinants of deaths.

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 circumstances of mortality provides complementary information to CSMFs relevant for health planning. Further contextualisation of the method and results are underway with health systems stakeholders to develop the interpretation sequence as part of a health policy and systems research approach.

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The publication “Moving from medical to health systems classifications of deaths: extending verbal autopsy to collect information on the circumstances of mortality” proposes the development of a system that collects and interprets information on the social and health systems determinants of deaths investigated through verbal autopsy (VA). Verbal autopsy is a technique used in low and middle-income countries to determine the medical causes of death for individuals who die outside of hospitals and/or without registration.

To implement this recommendation, a 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. This additional information provides insights into the barriers and challenges individuals face in accessing healthcare at the time of their death.

The study conducted in the Agincourt Health and Socio-Demographic Surveillance Site in South Africa revealed that a significant proportion of deaths did not involve calling for help, found care unaffordable, or did not seek care at a healthcare facility. These issues were consistent across different age and sex sub-groups.

Based on these findings, the authors suggest extending and promoting existing provisions for transport and financial access to improve access to care in this setting. This recommendation aims to address the identified barriers and improve maternal health outcomes.

Overall, supplementing verbal autopsy with questions on the circumstances of mortality provides valuable information for health planning and policy development. Further research and collaboration with health systems stakeholders are necessary to contextualize the findings and develop effective strategies to improve access to maternal health.
AI Innovations Description
The recommendation proposed in the publication “Moving from medical to health systems classifications of deaths: extending verbal autopsy to collect information on the circumstances of mortality” is to develop a system that collects and interprets information on social and health systems determinants of deaths investigated through verbal autopsy (VA).

Verbal autopsy is a technique used in low and middle-income countries to determine the medical causes of death for individuals who die outside of hospitals and/or without registration. By expanding the scope of VA to include information on the circumstances surrounding deaths, it becomes an opportunity to examine social exclusion from access to health systems.

To implement this recommendation, a 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. This additional information provides insights into the barriers and challenges individuals face in accessing healthcare at the time of their death.

The study conducted in the Agincourt Health and Socio-Demographic Surveillance Site in South Africa revealed that a significant proportion of deaths did not involve calling for help, found care unaffordable, or did not seek care at a healthcare facility. These issues were consistent across different age and sex sub-groups.

Based on these findings, the authors suggest extending and promoting existing provisions for transport and financial access to improve access to care in this setting. This recommendation aims to address the identified barriers and improve maternal health outcomes.

Overall, supplementing verbal autopsy with questions on the circumstances of mortality provides valuable information for health planning and policy development. Further research and collaboration with health systems stakeholders are necessary to contextualize the findings and develop effective strategies to improve access to maternal health.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Data Collection: Collect data on maternal health indicators, such as maternal mortality rates, access to antenatal care, institutional delivery rates, and availability of transportation and financial support for healthcare.

2. Baseline Assessment: Analyze the current situation and identify the existing barriers to accessing maternal health services, including factors like lack of transportation, financial constraints, and limited availability of healthcare facilities.

3. Intervention Design: Based on the recommendations from the publication, design interventions to address the identified barriers. For example, develop programs to improve transportation infrastructure, provide financial support for healthcare expenses, and promote awareness about the importance of seeking healthcare during pregnancy and childbirth.

4. Simulation Modeling: Use simulation modeling techniques to estimate the potential impact of the interventions on improving access to maternal health. This can involve creating a mathematical model that incorporates various factors like population demographics, healthcare infrastructure, and the proposed interventions. The model can simulate different scenarios and predict the potential changes in maternal health indicators.

5. Sensitivity Analysis: Conduct sensitivity analysis to assess the robustness of the simulation results. This involves testing the model with different assumptions and parameters to evaluate the potential variations in the outcomes.

6. Policy Recommendations: Based on the simulation results, provide policy recommendations for implementing the interventions. These recommendations should consider the feasibility, cost-effectiveness, and sustainability of the proposed interventions.

7. Monitoring and Evaluation: Implement the recommended interventions and establish a monitoring and evaluation framework to track the progress and impact of the interventions on improving access to maternal health. Regularly assess the maternal health indicators and adjust the interventions as needed.

By following this methodology, policymakers and health systems stakeholders can gain insights into the potential impact of the recommendations on improving access to maternal health and make informed decisions regarding the implementation of interventions.

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