SAMRC releases first national cause-of-death validation project report

Cape Town | The South African Medical Research Council (SAMRC) has released the first National Cause-of-Death Validation Project (NCODVP) Report.

About half of the deaths in South Africa occur outside of health facilities, limiting accurate cause-of-death information. The study is part of a six-year national project that began in 2016 to evaluate the information provided on death notifications through Civil Registration and Vital Statistics (CRVS), the use of verbal autopsies was assessed for improving cause-of-death data during this study.

The main purpose of the study was to compare the registered underlying cause of death indicated on the CRVS medical notification form with the highest level of information collected in the study (forensic pathology record followed by medical records and verbal autopsy) so that correction factors could be estimated. Additionally, the study aimed to compare the medical cause of death identified from the different sources to assess their performance in identifying cause of death.

In 27 randomly selected sub-districts across South Africa, trained field workers conducted 5,387 verbal autopsies with next-of-kin informants who were carefully taken through a standardised WHO questionnaire, providing answers about the deceased symptoms and risk factors before death. These records were reviewed by medical doctors trained to independently assign an underlying cause of death from the verbal autopsy information.

Key findings:

• The study demonstrated that collecting cause of death data using a verbal autopsy nationally was feasible and could provide good quality cause of death information when reviewed by trained doctors.
• The verbal autopsy data collected for the study have demonstrated that HIV/AIDS and TB are measurable by verbal autopsy in a high HIV burden country.
• A concerning finding revealed by the information from the narratives was the number of HIV positive cases where it was reported that they had been on antiretroviral therapy and had discontinued treatment and then died from HIV-related causes. Defaulting on treatment was mentioned in 10.2% of the HIV/AIDS deaths.
• The narrative section of the verbal autopsy provided critical information for establishing the cause of death particularly for clinicians.
• The study also demonstrated that it was possible to scan medical and forensic records to provide clear images for review at centralized sites by medical professionals.

Currently the project team is continuing to review the medical records and the linkage with Stats SA records in order to calculate correction factors is underway.

According to the Principal Investigators of the study, Verbal Autopsy could be a very useful way of strengthening the accuracy of the cause-of-death information in the CRVS system. 

“South Africa has seen great improvements in it’s CRVS system in terms of the registration of births and deaths since 2000, however the cause-of-death information needs improvement. Verbal Autopsy could improve the quality of cause of death information, especially for deaths occurring outside health facilities.”

The SAMRC, through its Burden of Disease Research Unit has for many years undertaken the analyses of South Africa’s mortality data and these have shown extensive misattribution and misclassification of HIV/AIDS and TB, and a critical lack of detail in injury data. These data deficiencies, and the absence of a data field for external cause of injury deaths on the official death notification form severely constrain the use of CRVS cause-of-death information—the only national cause-of-death information available in the country to plan targeted health interventions and prioritize human, financial and infrastructural resources.

SAMRC President and CEO, Professor Glenda Gray has welcomed the Report, saying that the SAMRC has been at the forefront of tracking mortality data in South Africa for decades – a critical part of which involves cause-of-death validation. “This report is also testament to our commitment to improve death cause-specific information and the validity of mortality data that would help government in reorienting health resources,” said Gray.

NOTE TO THE EDITOR

The project was conducted in collaboration with the National Department of Health (NDoH), Statistics South Africa (Stats SA), the Department of Home Affairs (DHA) as well as Centers for Disease Control (CDC), with SAMRC taking the lead.

Full Report | Click Here