CRVS Fellowship report Integrating verbal autopsy in routine mortality surveillance in Bangladesh March 2019 Resources available from the University of CRVS technical guides Melbourne, Bloomberg Philanthropies Data Specific, technical and instructive resources in the form of for Health Initiative quick reference guides, user guides and action guides. These guides provide a succinct overview and/or instructions for CRVS course prospectuses the implementation or operation of a specific CRVS-related These resources outline the context, training approach, intervention or tool. course content and course objectives for the suite of CRVS trainings delivered through the Bloomberg Philanthropies CRVS tools Data for Health Initiative. Each course focuses on a specific Interactive and practical resources designed to influence CRVS intervention or concept, and is designed to support and align CRVS processes with established international or countries to strengthen their CRVS systems and data. best-practice standards. These resources, which are used extensively in the Initiative’s training courses, aim to change CRVS Fellowship reports and profiles practice and ensure countries benefit from such changes by The CRVS Fellowship Program aims to build technical developing critical CRVS capacity among technical officers capacity in both individuals and institutions to enhance and ministries. the quality, sustainability and health policy utility of CRVS systems in Fellows’ home countries. Fellowship reports Published by the University of Melbourne, Civil Registration are written by Fellows as a component of the program, and Vital Statistics Improvement, Bloomberg Philanthropies and document, in detail, the research outcomes of their Data for Health Initiative. Fellowship. Fellowship profiles provide a summary of Melbourne School of Population and Global Health Fellows’ country context in relation to CRVS, an overview Building 379 of the Fellowship experiences, the research topic and the 207 Bouverie Street projected impact of findings. Carlton, VIC 3053 CRVS analyses and evaluations Australia These analytical and evaluative resources, generated through [email protected] the Initiative, form a concise and accessible knowledge-base www.mspgh.unimelb.edu.au/dataforhealth of outcomes and lessons learnt from CRVS initiatives and interventions. They report on works in progress, particularly for large or complex technical initiatives, and on specific Made possible through funding from components of projects that may be of more immediate Bloomberg Philanthropies relevance to stakeholders. These resources have a strong www.bloomberg.org empirical focus, and are intended to provide evidence to assist planning and monitoring of in-country CRVS technical initiatives and other projects Author CRVS best-practice and advocacy Generated through the Initiative, CRVS best-practice and Mr Saiful Islam, Ministry of Health and Family Welfare, advocacy resources are based on a combination of technical Bangladesh. knowledge, country experiences and scientific literature. These resources are intended to stimulate debate and ideas for in-country CRVS policy, planning, and capacity building, Suggested citation and promote the adoption of best-practice to strengthen Islam, S. Fellowship report: Integrating verbal autopsy in CRVS systems worldwide. routine mortality surveillance in Bangladesh. CRVS Fellowship CRVS country reports reports and profiles. Melbourne, Australia: Bloomberg CRVS country reports describe the capacity-building Philanthropies Data for Health Initiative, Civil Registration and experiences and successes of strengthening CRVS systems Vital Statistics Improvement, University of Melbourne; 2018. in partner countries. These resources describe the state of CRVS systems-improvement and lessons learnt, and provide a baseline for comparison over time and between countries. Contents Acknowledgements ..................................................................................................................................................4 Acronyms and abbreviations.....................................................................................................................................5 Summary ..................................................................................................................................................................6 Methods ...................................................................................................................................................................................6 Results ......................................................................................................................................................................................6 Discussion and next steps ........................................................................................................................................................7 Introduction ..............................................................................................................................................................8 SmartVA project in Bangladesh ................................................................................................................................................9 Methods ..................................................................................................................................................................10 Verbal autopsy interview process ...........................................................................................................................................13 Post-interview analysis ...........................................................................................................................................................14 Ethical considerations.............................................................................................................................................................15 Results: Quantitative analysis of verbal autopsy data .............................................................................................15 Characteristics of verbal autopsies conducted .......................................................................................................................15 Causes of death ......................................................................................................................................................................17 Patterns in adult mortality .......................................................................................................................................................21 Patterns in child mortality .......................................................................................................................................................27 Results: Plausibility of cause of death data generated through SmartVA ...............................................................31 Comparison with Global Burden of Disease estimates ..........................................................................................................31 Comparison with Health and Demographic Surveillance System data ..................................................................................33 Undetermined cases...............................................................................................................................................................34 Results: Qualitative study .......................................................................................................................................35 Verbal autopsy supervisors .....................................................................................................................................................35 Verbal autopsy interviewers ...................................................................................................................................................37 Discussion ..............................................................................................................................................................40 Common problems affecting verbal autopsy in Bangladesh ..................................................................................................42 CRVS Fellowship reports and profiles Fellowship CRVS Recommendations to improve SmartVA in Bangladesh ........................................................................................................43 Study limitations .....................................................................................................................................................................43 Annex 1 SmartVA implementation areas ................................................................................................................44 Annex 2 Statistical tables .......................................................................................................................................45 Related resources and products ..............................................................................................................................48 University of Melbourne, D4H Initiative, CRVS Knowledge Gateway: Library .......................................................................48 University of Melbourne, D4H Initiative, CRVS Knowledge Gateway: Learning Centre .........................................................48 University of Melbourne, D4H Initiative, CRVS Knowledge