Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making
Background Recognising that the causes of over half the world’s deaths pass unrecorded, the World Health Organization (WHO) leads development of Verbal Autopsy (VA): a method to understand causes of death in otherwise unregistered populations. Recently, VA has been developed for use outside research...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2021-10-01
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| Series: | Global Health Action |
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| Online Access: | http://dx.doi.org/10.1080/16549716.2021.2000091 |
| _version_ | 1818011591633797120 |
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| author | Lucia D’Ambruoso Jessica Price Eilidh Cowan Gerhard Goosen Edward Fottrell Kobus Herbst Maria van der Merwe Jerry Sigudla Justine Davies Kathleen Kahn |
| author_facet | Lucia D’Ambruoso Jessica Price Eilidh Cowan Gerhard Goosen Edward Fottrell Kobus Herbst Maria van der Merwe Jerry Sigudla Justine Davies Kathleen Kahn |
| author_sort | Lucia D’Ambruoso |
| collection | DOAJ |
| description | Background Recognising that the causes of over half the world’s deaths pass unrecorded, the World Health Organization (WHO) leads development of Verbal Autopsy (VA): a method to understand causes of death in otherwise unregistered populations. Recently, VA has been developed for use outside research environments, supporting countries and communities to recognise and act on their own health priorities. We developed the Circumstances of Mortality Categories (COMCATs) system within VA to provide complementary circumstantial categorisations of deaths. Objectives Refine the COMCAT system to (a) support large-scale population assessment and (b) inform public health decision-making. Methods We analysed VA data for 7,980 deaths from two South African Health and Socio-Demographic Surveillance Systems (HDSS) from 2012 to 2019: the Agincourt HDSS in Mpumalanga and the Africa Health Research Institute HDSS in KwaZulu-Natal. We assessed the COMCAT system’s reliability (consistency over time and similar conditions), validity (the extent to which COMCATs capture a sufficient range of key circumstances and events at and around time of death) and relevance (for public health decision-making). Results Plausible results were reliably produced, with ‘emergencies’, ‘recognition, ‘accessing care’ and ‘perceived quality’ characterising the majority of avoidable deaths. We identified gaps and developed an additional COMCAT ‘referral’, which accounted for a significant proportion of deaths in sub-group analysis. To support decision-making, data that establish an impetus for action, that can be operationalised into interventions and that capture deaths outside facilities are important. Conclusions COMCAT is a pragmatic, scalable approach enhancing functionality of VA providing basic information, not available from other sources, on care seeking and utilisation at and around time of death. Continued development with stakeholders in health systems, civil registration, community and research environments will further strengthen the tool to capture social and health systems drivers of avoidable deaths and promote use in practice settings. |
| first_indexed | 2024-04-14T06:10:31Z |
| format | Article |
| id | doaj.art-914535be15724989ac2185553f9f9bb9 |
| institution | Directory Open Access Journal |
| issn | 1654-9880 |
| language | English |
| last_indexed | 2024-04-14T06:10:31Z |
| publishDate | 2021-10-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj.art-914535be15724989ac2185553f9f9bb92022-12-22T02:08:23ZengTaylor & Francis GroupGlobal Health Action1654-98802021-10-0114S110.1080/16549716.2021.20000912000091Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-makingLucia D’Ambruoso0Jessica Price1Eilidh Cowan2Gerhard Goosen3Edward Fottrell4Kobus Herbst5Maria van der Merwe6Jerry Sigudla7Justine Davies8Kathleen Kahn9Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of AberdeenUniversity of the WitwatersrandAberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of AberdeenMpumalanga Department of Health, South AfricaInstitute for Global Health, University College LondonAfrica Health Research InstituteAberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of AberdeenMpumalanga Department of Health, South AfricaInstitute for Applied Health Research, University of BirminghamUniversity of the WitwatersrandBackground Recognising that the causes of over half the world’s deaths pass unrecorded, the World Health Organization (WHO) leads development of Verbal Autopsy (VA): a method to understand causes of death in otherwise unregistered populations. Recently, VA has been developed for use outside research environments, supporting countries and communities to recognise and act on their own health priorities. We developed the Circumstances of Mortality Categories (COMCATs) system within VA to provide complementary circumstantial categorisations of deaths. Objectives Refine the COMCAT system to (a) support large-scale population assessment and (b) inform public health decision-making. Methods We analysed VA data for 7,980 deaths from two South African Health and Socio-Demographic Surveillance Systems (HDSS) from 2012 to 2019: the Agincourt HDSS in Mpumalanga and the Africa Health Research Institute HDSS in KwaZulu-Natal. We assessed the COMCAT system’s reliability (consistency over time and similar conditions), validity (the extent to which COMCATs capture a sufficient range of key circumstances and events at and around time of death) and relevance (for public health decision-making). Results Plausible results were reliably produced, with ‘emergencies’, ‘recognition, ‘accessing care’ and ‘perceived quality’ characterising the majority of avoidable deaths. We identified gaps and developed an additional COMCAT ‘referral’, which accounted for a significant proportion of deaths in sub-group analysis. To support decision-making, data that establish an impetus for action, that can be operationalised into interventions and that capture deaths outside facilities are important. Conclusions COMCAT is a pragmatic, scalable approach enhancing functionality of VA providing basic information, not available from other sources, on care seeking and utilisation at and around time of death. Continued development with stakeholders in health systems, civil registration, community and research environments will further strengthen the tool to capture social and health systems drivers of avoidable deaths and promote use in practice settings.http://dx.doi.org/10.1080/16549716.2021.2000091causes of deathcircumstances of mortalityverbal autopsysouth africa |
| spellingShingle | Lucia D’Ambruoso Jessica Price Eilidh Cowan Gerhard Goosen Edward Fottrell Kobus Herbst Maria van der Merwe Jerry Sigudla Justine Davies Kathleen Kahn Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making Global Health Action causes of death circumstances of mortality verbal autopsy south africa |
| title | Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making |
| title_full | Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making |
| title_fullStr | Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making |
| title_full_unstemmed | Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making |
| title_short | Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making |
| title_sort | refining circumstances of mortality categories comcat a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision making |
| topic | causes of death circumstances of mortality verbal autopsy south africa |
| url | http://dx.doi.org/10.1080/16549716.2021.2000091 |
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