The shocking estimate that two-thirds of the world's deaths go unrecorded is to be addressed by research carried out by the University of Aberdeen.
- Two thirds of deaths worldwide go unrecorded
- ‘Invisible deaths’ typically occur among disadvantaged people in the global south
- Information on cause of death is crucial for the delivery of effective and equitable health care
- Aberdeen researcher awarded £100k to address this critical information gap
- The work will develop cause of death registration to account for social causes of deaths, work with communities to create new knowledge on health and illness, and connect the process to the local health system
Dr Lucia D’Ambruoso has secured £100,000 to work alongside communities and health workers to improve the way deaths are recorded so that the underlying root causes of ‘why’ rather than just ‘how’ people die can be examined.
Funded by the Medical Research Council (MRC), Economic and Social Research Council (ESRC), Wellcome Trust and Department for International Development (DFID), the study in partnership with researchers, health workers and rural communities in South Africa, aims to help local health systems to assess their own health situations, identify priorities and develop action plans for positive change.
“The lack of recorded deaths seriously limits the ability of health systems to respond to the needs of vulnerable and excluded populations,” explains Dr D’Ambruoso. “Developing methods to reliably understand why people die in populations with weak health systems is an important strategy for saving lives.
“Registering medical cause of death is essential for public health. But you cannot plan services to meet needs that are not known. In many resource-poor countries, registering of vital events - births, deaths and their causes - is neither complete nor consistent and uncertain estimates are an inadequate basis for policy and planning.
“In addition, social inequalities strongly influence health and illness for disadvantaged groups. It’s likely that people who die unregistered deaths in resource poor countries are systematically excluded from access to health care. Even with the data that are available, insufficient attention is paid to the root causes of unregistered mortality.”
Dr D’Ambruoso’s research will develop an extension to an established method called Verbal Autopsy (VA) to collect information on the background characteristics of deaths. VA is used in over 45 low and middle-income countries to provide information on the levels and medical causes of death in populations where large numbers die outside health facilities or without registration.
“The project consists of three phases. First, we will develop new ways to classify deaths combing data on medical causes with information on care seeking and use at the time of death. This aims to improve knowledge about social and health system factors associated with medical causes of death in a routine fashion.
“Second, we will review the new classifications with communities and attempt to tap into local knowledge and expertise on long-standing health challenges. This will allow us to further understand social and health systems issues and how people do or do not connect with health care. This step will also encourage inclusion in the creation of knowledge on health and prompt action on this basis
“Finally, we will connect the method to the health system as a means to provide practical, robust evidence for health systems strengthening.”
In the longer term, it is envisaged that the method will contribute to more rigorous health data at population level in an inclusive process that can affect sustainable health gains through better data and improved capacity for evaluation.
The work will be conducted in collaboration with an established research centre in rural South Africa, the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) (www.agincourt.co.za) part of the University of the Witwatersrand. Researchers from the Umeå Centre for Global Health Research at Umeå University in Sweden who have developed routine VA and championed its use as an interim measure in lieu of complete vital registration are also key partners (www.globalhealthresearch.net).
Dr D’Ambruoso adds: “The rich experience in health research from Sweden and South Africa allows us to develop a method with partners who enact a broader commitment to registration of all individuals within a population.
“Functioning vital registration systems are important global public goods that enable security, citizenship and participation in society. Working in partnership with established global health research centres and local communities can help move towards a more ‘people-centred methodology’ for health systems research.”