IHS
Mission & Goals: |
Groom
Skills,
Gather Evidence and
Generate Knowledge for people's health.
To Improve the
Efficacy,
Quality & Equity
of Health Systems. |
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Cause of Death |
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As can be seen in the above
table , most of the causes for which some expert opinion is available are infant deaths,
respiratory and diarrhoeal diseases. For 21 out of these 24 causes the SCD questions
appear to be in accordance with expert opinion and validity information available in the
literature. The three causes for which there is major discrepancy are (a) cord infection,
(b) pre maturity, and (c) cancer. Most experts agree and validation studies show that
verbal autopsy is good at detecting neonatal tetanus. In SCD-Rural, neonatal tetanus is
included under cord infection and thereby misses an opportunity for accurate estimation of
deaths due to a cause which is very important from public health point of view. Experts
opine that it is usually difficult to distinguish between prematurity and low birth weight
(Garene and Fontaine, 1989; Gray, 1989). Hence they ought to be lumped together for
accuracy of VA-based statistics. The SCD-Rural list does not include low birth weight in
its list. It can be added to prematurity without any disturbance to the structure of the
rest of the questionnaire. The SCD-Rural list homogenizes all cancers into one cause. Some
expert opinion is usually available by site of cancer. Moreover some cancers would have
symptoms which may be confused with the filter questions for other modules. For example,
stomach cancer cases may be investigated as deaths due to digestive diseases. In that
case, the field agent may not get to consider stomach cancer at all since there is no
mention of it in the digestive causes module. So is the case for lung cancer. |
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Nonavailability of expert
opinion or information pertaining to validity in the SCD-Rural nonmedical list does not
imply that they are primaital facie not valid. The SCD-Rural design was based on expert
opinion obtained at the time of drawing up blue print of the scheme and revision of
manuals. The SCD-Rural design process included a phase of field testing of provisional
questionnaires and finalisation by expert consultation. Considering the large extent to
which questions for specific causes are in accord with expert opinion and information from
VA validity studies, the SCD-Rural questionnaire appears to be prima facie valid. |
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The prima facie validity of
SCD-Rural questionnaire is reassuring in the sense that the scheme design is largely in
accord with current knowledge about verbal autopsy. But it does not assure us that the
cause of death statistics are accurate for all causes. In case of causes for which VA is
known to be highly sensitive and specific (say more than 75% for each) the SCD statistics
can be mapped to medical causes directly. For other causes, more detailed algorithms for
mapping of SCD statistics onto the desired set of medical causes will have to take into
account available knowledge about the sensitivity and specificity of VA in general and
specific peculiarities of SCD as also implementation. |
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SRS-COD
Component: |
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From January 1999, the
survey of cause of death was integrated with the SRS (RGI, 1999). It is understood that
the SCD-Rural guidelines have been extended to the SRS-COD component. Although formal
communication regarding this is yet to be made available, we were able to obtain a copy of
the RGI rules and regulations on "Collection of data on causes of death"
(Director of Census Operations, Andhra Pradesh, 1999). The elimination of the symptom
record (SCD-Rural Form-7) has been a major departure from the SCD-Rural design. The
SCD-Rural symptom record was similar in content to the WHO's cause of death report format,
which requires information about the underlying causes of death. The SRS-COD component
asks field agents to record the code to which the cause of death is assigned. No further
information about symptoms and circumstances of death need be reported. This later
information is required for the systematic screening and coding of cause of death reports.
The phasing out of the structured questionnaire constitutes another significant departure
from the SCD - Rural. Instead the instructions contain a list of causes, related symptoms
for some diseases, and the corresponding ICD10 code. For some causes, no description of
expected symptoms has been furnished. However, it is too early to sit in judgment on the
new system. It will nevertheless be helpful if specific research studies are taken up to
evaluate the performance of the new cause of death reporting system in rural areas. |
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The SRS-COD component is
designed to generate verbal autopsy-based information on the causes of death for urban and
rural areas, since SRS operates both in rural and urban areas. This will result in two
sources of cause of death data from urban areas, namely the (a) SRS-COD component, and (b)
the Medical Certification of Cause of Death (MCCD) reports. It is claimed that this will
allow for comprehensive statistics on cause of death for all areas of India. While the
availability of verbal autopsy-based cause of death data for urban areas will allow for
some plausibility checks and comparisons with the MCCD based data, the latter source is
certainly more preferable, as it is based on medical certification. Urban areas face the
hazard of poor co-operation offered by hospitals and medical attendants. This is mainly
due to the fact that there is no effort, whatsoever by municipal authorities in demanding
compliance with provisions of the Registration of BD Act. about reporting of cause of
death. |
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Incidence of
improbable age sex distribution by cause: |
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Age distribution of
deaths attributed to selected causes by SCD-Rural and MCCD. |
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