Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths

Rohina Joshi; R H Hazard; Pasyodun Koralage Buddhika Mahesh; L Mikkelsen; F Avelino; Carmina Sarmiento; A Segarra; T Timbang; F Sinson; Patrick Diango; I Riley; H Chowdhury; Irma L Asuncion; G Khanom; Alan D Lopez

doi:10.1186/s12889-021-10542-0

Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths

BMC Public Health. 2021 Mar 22;21(1):563. doi: 10.1186/s12889-021-10542-0.

Authors

Rohina Joshi^{1

2

3}, R H Hazard⁴, Pasyodun Koralage Buddhika Mahesh⁴, L Mikkelsen⁴, F Avelino⁵, Carmina Sarmiento⁴, A Segarra⁵, T Timbang⁵, F Sinson⁵, Patrick Diango⁵, I Riley⁴, H Chowdhury⁴, Irma L Asuncion⁵, G Khanom⁴, Alan D Lopez⁴

Affiliations

¹ The George Institute for Global Health, University of New South Wales, Sydney, Australia. rjoshi@georgeinstitute.org.
² The George Institute for Global Health, New Delhi, India. rjoshi@georgeinstitute.org.
³ School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia. rjoshi@georgeinstitute.org.
⁴ School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
⁵ Epidemiology Bureau, Department of Health, Manila, Philippines.

Abstract

Background: The majority of deaths in the Philippines occur out-of-facility and require a medical certificate of cause of death by Municipal Health Officers (MHOs) for burial. MHOs lack a standardised certification process for out-of-facility deaths and when no medical records are available, certify a high proportion of ill-defined causes of death. We aimed to develop and introduce SmartVA Auto-Analyse, a verbal autopsy (VA) based electronic decision support tool in order to assist the MHOs in certifying out-of-facility deaths.

Method: We conducted a stakeholder consultation, process mapping and a pre-test to assess feasibility and acceptability of SmartVA Auto-Analyse. MHOs were first asked to conduct an open-ended interview from the family members of the deceased, and if they were not able to arrive at a diagnosis, continue the interview using the standardised SmartVA questionnaire. Auto-Analyse then presented the MHO with the three most likely causes of death. For the pilot, the intervention was scaled-up to 91 municipalities. We performed a mixed-methods evaluation using the cause of death data and group discussions with the MHOs.

Results: Of the 5649 deaths registered, Auto-Analyse was used to certify 4586 (81%). For the remaining 19%, doctors believed they could assign a cause of death based on the availability of medical records and the VA open narrative. When used, physicians used the Auto-Analyse diagnosis in 85% of cases to certify the cause of death. Only 13% of the deaths under the intervention had an undetermined cause of death. Group discussions identified two themes: Auto-Analyse standardized the certification of home deaths and assisted the MHOs to improve the quality of death certification.

Conclusion: Standardized VA combined with physician diagnosis using the SmartVA Auto-Analyse support tool was readily used by MHOs in the Philippines and can improve the quality of death certification of home deaths.

Keywords: Cause of death; Medical certification of cause of death; SmartVA; SmartVA for physicians; Verbal autopsy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Autopsy
Cause of Death
Death Certificates*
Electronics
Humans
Philippines
Physicians*