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Abstract Background There is no source of data on causes of death in Senegal that covers both community and hospital deaths. Yet the death registration system in the Dakar region is relatively complete (>80%) and could be expanded to provide information on the diseases and injuries that led to death. Methods In this pilot study, we recorded all deaths that occurred over 2 months and were reported in the 72 civil registration offices in the Dakar region. We selected the deaths of residents of the region and administered a verbal autopsy to a relative of the deceased to identify the underlying causes of death. Causes of death were assigned using the InterVA5 model. Results The age structure of deaths registered at the civil registry differed from that of the census, with a proportion of infant deaths about twice as high as in the census. The main causes of death were prematurity and obstetric asphyxia in newborns. Meningitis and encephalitis, severe malnutrition, and acute respiratory infections were the leading causes from 1 month to 15 years of age. Cardiovascular diseases accounted for 27% of deaths in adults aged 15-64 and 45% of deaths among adults above age 65, while neoplasms accounted for 20% and 12% of deaths in these two age groups, respectively. Conclusions This study demonstrates that the epidemiological transition is at an advanced stage in urban areas of Dakar, and underlines the importance of conducting regular studies based on verbal autopsies of deaths reported in civil registration offices.

Background: There is no source of data on causes of death in Senegal that covers both community and hospital deaths. Yet the death registration system in the Dakar region is relatively complete (>80%) and could be expanded to provide information on the diseases and injuries that led to death. Methods: In this pilot study, we recorded all deaths that occurred over 2 months and were reported in the 72 civil registration offices in the Dakar region. We selected the deaths of residents of the region and administered a verbal autopsy to a relative of the deceased to identify the underlying causes of death. Causes of death were assigned using the InterVA5 model. Results: The age structure of deaths registered at the civil registry differed from that of the census, with a proportion of infant deaths about twice as high as in the census. The main causes of death were prematurity and obstetric asphyxia in newborns. Meningitis and encephalitis, severe malnutrition, and acute respiratory infections were the leading causes from 1 month to 15 years of age. Cardiovascular diseases accounted for 27% of deaths in adults aged 15-64 and 45% of deaths among adults above age 65, while neoplasms accounted for 20% and 12% of deaths in these two age groups, respectively. Conclusions: This study demonstrates that the epidemiological transition is at an advanced stage in urban areas of Dakar, and underlines the importance of conducting regular studies based on verbal autopsies of deaths reported in civil registration offices. [ABSTRACT FROM AUTHOR]

Background: Multidimensional issues confront the use of standard verbal autopsies (SVAs), such as the WHO's verbal autopsy standards and the Population Health Metrics Research Consortium's gold standard verbal autopsy, to improve the mortality data performance of civil registration and vital statistics (CRVS) systems in low- and middle-income countries (LMICs). Objective: This paper attempts an inclusive analysis of these issues and their implications for policies intending to integrate routine SVAs into CRVS systems to enhance mortality data coverage in LMICs. Methods: Issues were identified from the verbal autopsy and CRVS literature, official documents, and the authors' field experiences with the Nigerian CRVS system. These were analysed using a problem (key issues) analysis methodology. Results: Two classes of issues were shown to impinge on the use of SVAs within CRVS systems. One class is generic to SVAs (technical complexity, cost, and standardization issues) and to CRVS systems (contextual, resource, and infrastructural limitations) in LMICs. The other is related to the incompatibility of SVA and CRVS system functions, operations, instruments, and data. Conclusions: The results indicate a need for alternative solutions to the mortality data challenges of CRVS systems in LMICs that are more pragmatic than SVAs, especially in the short and medium term. Such alternatives must involve less complex data procedures and costs and must be adapted to CRVS system functions, operations, and socioeconomic contexts in LMICs. Contribution: The paper contributes to the discourse on the use of SVAs to improve the mortality data capacity of CRVS systems in LMICs.

Abstract Background Verbal autopsies with physician assignment of cause of death (COD) are commonly used in settings where medical certification of deaths is uncommon. It remains unanswered if automated algorithms can replace physician assignment. Methods We randomized verbal autopsy interviews for deaths in 117 villages in rural India to either physician or automated COD assignment. Twenty-four trained lay (non-medical) surveyors applied the allocated method using a laptop-based electronic system. Two of 25 physicians were allocated randomly to independently code the deaths in the physician assignment arm. Six algorithms (Naïve Bayes Classifier (NBC), King-Lu, InSilicoVA, InSilicoVA-NT, InterVA-4, and SmartVA) coded each death in the automated arm. The primary outcome was concordance with the COD distribution in the standard physician-assigned arm. Four thousand six hundred fifty-one (4651) deaths were allocated to physician (standard), and 4723 to automated arms. Results The two arms were nearly identical in demographics and key symptom patterns. The average concordances of automated algorithms with the standard were 62%, 56%, and 59% for adult, child, and neonatal deaths, respectively. Automated algorithms showed inconsistent results, even for causes that are relatively easy to identify such as road traffic injuries. Automated algorithms underestimated the number of cancer and suicide deaths in adults and overestimated other injuries in adults and children. Across all ages, average weighted concordance with the standard was 62% (range 79–45%) with the best to worst ranking automated algorithms being InterVA-4, InSilicoVA-NT, InSilicoVA, SmartVA, NBC, and King-Lu. Individual-level sensitivity for causes of adult deaths in the automated arm was low between the algorithms but high between two independent physicians in the physician arm. Conclusions While desirable, automated algorithms require further development and rigorous evaluation. Lay reporting of deaths paired with physician COD assignment of verbal autopsies, despite some limitations, remains a practicable method to document the patterns of mortality reliably for unattended deaths. Trial registration ClinicalTrials.gov, NCT02810366. Submitted on 11 April 2016.

Objective:There is an emerging body of research aimed at understanding the determinants of place of death, as where people die may influence the quality of their death. However, little is known about place of death for people of Southern Africa. This study describes place of death (home or hospital) and potential influencing factors (cause of death, age, gender, occupation, and district of residence).Method:We collected the death records for years 2005 and 2006 for all adult non-traumatic deaths that occurred in Botswana, described them, and looked for associations using bivariate and multivariate analyses.Results:The evaluable sample consisted of 18,869 death records. Home deaths accounted for 36% of all deaths, and were predominantly listed with “unknown” cause (82.3%). Causes of death for hospital deaths were HIV/AIDS (49.7%), cardiovascular disease (13.8%), and cancer (6.6%). The mean age at the time of all deaths was 53.2 years (SD = 20.9); with 61 years (SD = 22.5) for home deaths and 48.8 years (SD = 18.6) for hospital deaths (p < .001). Logistic regression analysis revealed the following independent predictors of dying at home: unknown cause of death; female gender; >80 years of age; and residing in a city or rural area (p < .05).Significance of Results:A major limitation of this study was documentation of cause of death; the majority of people who died at home were listed with an unknown cause of death. This finding impeded the ability of the study to determine whether cause of death influenced dying at home. Future study is needed to determine whether verbal autopsies would increase death-certificate listings of causes of home deaths. These data would help direct end-of-life care for patients in the home. [ABSTRACT FROM PUBLISHER]

Abstract: There is a problem in defining the occurrence of sudden unexplained death in persons with epilepsy (SUDEP). The diagnosis of SUDEP in the United States is under-used as many do not use the term on the death certificate. SUDEP is found to be more prevalent worldwide than assumed. However, data for developing countries, which are even more limited than those for Europe and North America, and do not depend on the use of autopsies, indicate that SUDEP is an underreported cause of death in persons with epilepsy. To glean information about the circumstances of the “sudden death event” in epilepsy, the verbal autopsy may be used, that is, talking with family members and/or close friends of the patient who has died unexpectedly. In contrast to developing countries, where verbal autopsy may be the only means of establishing a possible or probable cause of death, the technique of verbal autopsy may have a different use in more affluent countries. It is a defined technique to help clarify questions not answered by the standard methods of coroner and postmortem reports and not available in medical records. The purpose of verbal autopsy can be multifaceted. When used in conjunction with postmortem autopsy data on persons who die from SUDEP, it can focus on retrospective data that provide additional help in identifying more accurately the cause of death and in conducting retrospective analysis of these postmortem examinations. The value of these cumulative data from all sources is that they provide information for future preventative policy. In circumstances where postmortem information is not or cannot be collected, verbal autopsies offer a method to find information regarding the cause of death, whether conducted in developing countries or in developed countries. In either case, the worldwide database on persons with epilepsy who die suddenly and unexpectedly will gain information that will help in determining the prevalence of SUDEP and contribute to the quest for identification of preventive interventions. [Copyright &y& Elsevier]

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Aim: A mortality surveillance system was developed to identify and document causes of death among children enrolled in a tuberculosis vaccine field trial in South Africa. The aims of this study were to describe causes of mortality in children enrolled in a phase IV trial comparing intradermal with percutaneous administration of Bacille Calmette Guerin, and to compare causes of mortality recorded on death certificates with those obtained by clinical record review combined with verbal autopsies (CR/VA). Methods: For children who died, certified causes of death were compared with those determined by CR/VA. Results: Among 11 677 children enrolled, 177 deaths were notified over 4 years. The incidence rate of death was 6.8/1000 person-years. Follow-up time ranged from 0.03 to 35.3 months (median 4 months; interquartile range 1.4–8.5). The infant mortality rate was 12.5/1000 live births and the neonatal mortality was 3/1000 live births. Pneumonia, gastroenteritis and septicaemia were among top causes of mortality by both methods. ‘Sudden unexplained’ and ‘ill-defined’ causes were among top causes of mortality based on CR/VA, while tuberculosis and ‘natural causes’ were among top causes based on death certificates. Important underlying causes of mortality by CR/VA include HIV/AIDS, prematurity/low birth weight and malnutrition. In 47% of deaths there was agreement on immediate causes of death. This increased to 54% when ‘natural causes’ and ‘sudden unexplained deaths’ were included. Conclusion: In this cohort mortality was largely due to infectious diseases. While CR/VA provided additional information on most deaths, this was not always sufficient to assign specific causes of death. [ABSTRACT FROM AUTHOR]

A 'population observatory' is a study in which a whole population of a defined geographical area is monitored over a long period (several years or decades), and information on the events that happen (births, deaths, marriages, migration) is collected on a regular basis. This paper presents the collection method used in population observatories, the type of results that they provide, and how they are useful for the study of mortality in the nations of the South. In the first part, the different observatories in the developing countries are reviewed, and certain specific aspects of their methodology are studied in detail. In the second part two examples are presented - the observatories of Bandafassi and Mlomp, in Senegal.

The distribution of deaths by cause provides crucial information for public health planning, response and evaluation. About 60% of deaths globally are not registered or given a cause, limiting our ability to understand disease epidemiology. Verbal autopsy (VA) surveys are increasingly used in such settings to collect information on the signs, symptoms and medical history of people who have recently died. This article develops a novel Bayesian method for estimation of population distributions of deaths by cause using verbal autopsy data. The proposed approach is based on a multivariate probit model where associations among items in questionnaires are flexibly induced by latent factors. Using the Population Health Metrics Research Consortium labeled data that include both VA and medically certified causes of death, we assess performance of the proposed method. Further, we estimate important questionnaire items that are highly associated with causes of death. This framework provides insights that will simplify future data.

Background: Verbal autopsies with physician assignment of cause of death (COD) are commonly used in settings where medical certification of deaths is uncommon. It remains unanswered if automated algorithms can replace physician assignment.Methods: We randomized verbal autopsy interviews for deaths in 117 villages in rural India to either physician or automated COD assignment. Twenty-four trained lay (non-medical) surveyors applied the allocated method using a laptop-based electronic system. Two of 25 physicians were allocated randomly to independently code the deaths in the physician assignment arm. Six algorithms (Naïve Bayes Classifier (NBC), King-Lu, InSilicoVA, InSilicoVA-NT, InterVA-4, and SmartVA) coded each death in the automated arm. The primary outcome was concordance with the COD distribution in the standard physician-assigned arm. Four thousand six hundred fifty-one (4651) deaths were allocated to physician (standard), and 4723 to automated arms.Results: The two arms were nearly identical in demographics and key symptom patterns. The average concordances of automated algorithms with the standard were 62%, 56%, and 59% for adult, child, and neonatal deaths, respectively. Automated algorithms showed inconsistent results, even for causes that are relatively easy to identify such as road traffic injuries. Automated algorithms underestimated the number of cancer and suicide deaths in adults and overestimated other injuries in adults and children. Across all ages, average weighted concordance with the standard was 62% (range 79-45%) with the best to worst ranking automated algorithms being InterVA-4, InSilicoVA-NT, InSilicoVA, SmartVA, NBC, and King-Lu. Individual-level sensitivity for causes of adult deaths in the automated arm was low between the algorithms but high between two independent physicians in the physician arm.Conclusions: While desirable, automated algorithms require further development and rigorous evaluation. Lay reporting of deaths paired with physician COD assignment of verbal autopsies, despite some limitations, remains a practicable method to document the patterns of mortality reliably for unattended deaths.Trial Registration: ClinicalTrials.gov , NCT02810366. Submitted on 11 April 2016. [ABSTRACT FROM AUTHOR]