Feature Public Health

Coding a million deaths in India, one interview at a time

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5800 (Published 26 September 2014) Cite this as: BMJ 2014;349:g5800
  1. Meera Kay, journalist, Bangalore, India
  1. meerakay{at}ymail.com

A huge 10 year study assigns cause of death by verbal autopsy, giving information essential for informing health policy, writes Meera Kay

“Most deaths in India occur outside hospitals and are not attended by doctors; nor are they medically certified,” according to Abhay T Bang, director of the Society for Education, Action, and Research in Community Health (SEARCH). “This crucial information is incomplete and often of poor quality.”

Knowing the cause of death is vital in formulating development strategies. “Without such information, governments, donors, and other development partners are proceeding in the dark,” says Alan D Lopez, director of the global burden of disease group at Melbourne School of Population and Global Health.

“They do not know the comparative importance of the various causes of health loss in their populations, for many of which cost effective interventions to prevent deaths, particularly premature deaths, already exist. And they do not know how effective are their efforts to address them,” he adds.

Registering all deaths and assigning them a medically certified cause is difficult. “Doctors are either not trained, not available, not competent, or not interested in certifying causes of death. And they are generally unfamiliar with the critical role that this information plays in generating evidence for health policy,” Lopez says.

One way to improve information in settings without a dedicated registration system is to use verbal autopsy to determine causes of death.1 Verbal autopsy was used to determine cause of death among people younger than 70 in the recently concluded Million Deaths Study. Non-medical field workers were trained to record written narratives from families or other reliable informants in the local language describing the events that preceded the death. Answers to standard questions about key symptoms were also recorded.

Prabhat Jha, an epidemiologist from the University of Toronto and …

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