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. 2021 May 26:9:591237.
doi: 10.3389/fpubh.2021.591237. eCollection 2021.

Improving the Policy Utility of Cause of Death Statistics in Sri Lanka: An Empirical Investigation of Causes of Out-of-Hospital Deaths Using Automated Verbal Autopsy Methods

Lene Mikkelsen  1 , Sunil de Alwis  2 , Sridharan Sathasivam  2 , Vindya Kumarapeli  2 , Ajith Tennakoon  2 , Palitha Karunapema  2 , Kapila Jayaratne  2 , Rajitha Jayasuriya  3 , Saman Gamage  2 , Roshan Hewapathirana  4 , Rangana Wadugedara  2 , Manoj Dissanayake  2 , Chamika H Senanayake  2 , Pasyodun Koralage Buddhika Mahesh  2 , Deirdre McLaughlin  3 , Alan D Lopez  5
Affiliations

Improving the Policy Utility of Cause of Death Statistics in Sri Lanka: An Empirical Investigation of Causes of Out-of-Hospital Deaths Using Automated Verbal Autopsy Methods

Lene Mikkelsen et al. Front Public Health. .

Abstract

Background: Setting public health policies and effectively monitoring the impact of health interventions requires accurate, timely and complete cause of death (CoD) data for populations. In Sri Lanka, almost half of all deaths occur outside hospitals, with questionable diagnostic accuracy, thus limiting their information content for policy. Objectives: To ascertain whether SmartVA is applicable in improving the specificity of cause of death data for out-of-hospital deaths in Sri Lanka, and hence enhance the value of these routinely collected data for informing public policy debates. Methods: SmartVA was applied to 2610 VAs collected between January 2017 and March 2019 in 22 health-unit-areas clustered in six districts. Around 350 community-health-workers and 50 supervisory-staffs were trained. The resulting distribution of Cause-Specific-Mortality-Fractions (CSMFs) was compared to data from the Registrar-General's-Department (RGD) for out-of-hospital deaths for the same areas, and to the Global-Burden-of-Disease (GBD) estimates for Sri Lanka. Results: Using SmartVA, for only 15% of deaths could a specific-cause not be assigned, compared with around 40% of out-of-hospital deaths currently assigned garbage codes with "very high" or "high" severity. Stroke (M: 31.6%, F: 35.4%), Ischaemic Heart Disease (M: 13.5%, F: 13.0%) and Chronic Respiratory Diseases (M: 15.4%, F: 10.8%) were identified as the three leading causes of home deaths, consistent with the ranking of GBD-Study for Sri Lanka for all deaths, but with a notably higher CSMF for stroke. Conclusions: SmartVA showed greater diagnostic specificity, applicability, acceptability in the Sri Lankan context. Policy formulation in Sri Lanka would benefit substantially with national-wide implementation of VAs.

Keywords: SmartVA; Sri Lanka; cause specific mortality fractions; causes of death; home deaths; out-of-hospital deaths; verbal autopsy.

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Conflict of interest statement

Investigators affiliated with the Melbourne School of Population and Global Health, are involved in the activities related to the Tariff method-one of the algorithms used in verbal autopsies, in its SmartVA (i.e., a Verbal Autopsy methodology) method. However, the analysis does not include a component that compare the performance of Tariff method with other algorithms. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Leading 15 CSMFs for adult males estimated by SmartVA and the GBD, Sri Lanka, 2017–18. (B) Leading 15 CSMFs for adult females diagnosed by SmartVA and the GBD, Sri Lanka, 2017–18.
Figure 2
Figure 2
Comparison of the 10 leading causes of death diagnosed by SMARTVA in the Colombo CMC area before and after modification of the terminology used for stroke symptoms.
See this image and copyright information in PMC

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