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Applying verbal autopsy to determine cause of death in rural Vietnam
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.ORCID iD: 0000-0001-5474-4361
2003 (Swedish)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no Suppl. 62, 19-25 p.Article in journal (Refereed) Published
Abstract [sv]

Aims: Verbal autopsy (VA) is an attractive method for ascertaining causes of death in settings where the proportion of

people who die under medical care is low. VA has been widely used to determine causes of childhood and maternal deaths,

but has had limited use in assessing causes in adults and across all age groups. The objective was to test the feasibility of

using VA to determine causes of death for all ages in Bavi District, Vietnam, in 1999, leading to an initial analysis of the

mortality pattern in this area. Methods: Trained lay field workers interviewed a close caretaker of the deceased using a

combination closed/open-ended questionnaire. Results: A total of 189 deaths were studied. Diagnoses were made by two

physicians separately, with good agreement (k~0.84) and then combined to reach one single underlying cause of death for

each case. The leading causes of death were cardiovascular and infectious diseases (accounting for 20.6% and 17.9% of the

total respectively). Drowning was very prevalent in children under 15 (seven out of nine cases of drowning were in this age

group). Discussion: One month seemed an acceptable minimum recall period to ensure mourning procedures were over. A

combination VA questionnaire was an appropriate instrument provided it was supported by adequate training of

interviewers. Two physicians were appropriate for making the diagnoses but predefined diagnostic methods for common

causes should be developed to ensure more replicable results and comparisons, as well as to observe trends of mortality over

time. The causes of death in this study area reflect a typical pattern for developing countries that are in epidemiological

transition. No maternal deaths and a low infant mortality rate may be the result of improvements in maternal and child

health in this study area. Using the VA gave more precise causes of death than those reported at death registration.

Although the validity of the VA method used has not been fully assessed, it appeared to be an appropriate method for

ascertaining causes of death in the study area.

Key words: cause of death, community data, field survey, mortality, verbal autopsy, Vietnam.

Place, publisher, year, edition, pages
2003. Vol. 31, no Suppl. 62, 19-25 p.
Identifiers
URN: urn:nbn:se:umu:diva-12510DOI: doi:10.1080/14034950310015068PubMedID: 14649633OAI: oai:DiVA.org:umu-12510DiVA: diva2:152181
Available from: 2006-04-26 Created: 2006-04-26 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Epidemiology of cardiovascular disease in rural Vietnam
Open this publication in new window or tab >>Epidemiology of cardiovascular disease in rural Vietnam
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the context of transitional Vietnam, although cardiovascular disease (CVD) has been shown to cause a large burden of mortality and morbidity in hospitals, little is known about the magnitude of its burden, risk factor levels and its relationship with socio-demographic status in the overall population. This thesis provides a preliminary insight into population-based knowledge of the CVD epidemiology in rural Vietnam and contributes to the development of methodologies for monitoring it. The ultimate goal of the work is to facilitate the formulation of evidence-based health interventions for reducing the burden of the CVD epidemic in Vietnam and elsewhere.

This work was located in Bavi district, a rural community in the north of Vietnam. Studies on cause-specific mortality and risk factors were conducted within the framework of an ongoing Demographic Surveillance System (DSS) (called FilaBavi). The cause-specific mortality study used a verbal autopsy (VA) approach to identify causes of death in FilaBavi during 1999-2003. The risk factor study, conducted in 2002, employed the WHO STEPwise approach to surveillance of non-communicable disease (NCD) risk factors (WHO STEPS).

Findings indicated that Bavi district, as an example of rural Vietnam, was already experiencing high rates of CVD mortality and associated risk factors. Mortality results indicated a substantial proportion of deaths due to CVD, which was the leading cause of death (20% and 25.7% of total mortality in 1999 and 2000, respectively and 32% of adult deaths during 1999-2003), exceeding infectious diseases. Hypertension was found to be a serious problem in terms both of its magnitude (14% of the population) and widespread unawareness (82% of the hypertensives). Smoking prevalence was very high among men (58% current daily smokers) and might be expected to cause a considerable number of future deaths without urgent action. CVD mortality and some risk factors seemed to be rising among disadvantaged groups (women, less educated people and the poor). The combination of DSS and WHO STEPS methodologies was shown to have potential for addressing basic epidemiological questions as to how NCD and CVD mortality and associated risk factors are distributed in populations.

Given this evidence, actions to prevent CVD in Bavi and similar settings are clearly urgent. Interventions should be comprehensive and integrated, including both primary and secondary approaches, as well as policy-level involvement. Further studies, continuing on similar lines, plus qualitative approaches and deeper cross-site comparisons, are also needed to give further insights into CVD epidemiology in this type of setting.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin, 2006. 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1018
Keyword
Cardiovascular disease, epidemiology, risk factors, rural Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-779 (URN)91-7264-049-9 (ISBN)
Public defence
2006-05-19, Sal 135, 9B, Allmänmedicin, Norrlands Universitetssjukhus, 901 85 Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2006-04-28 Created: 2006-04-28 Last updated: 2009-10-20Bibliographically approved
2. Mortality in transitional Vietnam
Open this publication in new window or tab >>Mortality in transitional Vietnam
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Understanding mortality patterns is an essential pre-requisite for guiding public health action and for supporting development of evidence-based policy. However, such information is not sufficiently available in Vietnam. Mortality statistics and causes of death are solely collected from health facilities while most deaths occur at home without the presence of health professionals. Facility-based data cannot represent what happened in the wider community. This thesis studies the patterns and burdens of mortality as well as their relationships with socio-economic status in rural Vietnam. The overall aim is to contribute to the improvement of the current system of mortality data collection in the country for the purposes of public health planning and priority setting.

The study was carried out within the framework of an ongoing Demographic Surveillance System (DSS) in Bavi district, Hatay province, northern rural Vietnam. This study used a verbal autopsy (VA) approach to identify cause of death in a cohort of approximately 250,000 person- years over a five-year period from 1999 to 2003.

During the five year study, a total of 1,240 deaths were recorded and VA was successfully completed for 1,220 cases. Results revealed that VA was an appropriate and useful method for ascertaining cause of death in this rural Vietnamese community where specific data were otherwise scarce. The mortality pattern reflected a transitional pattern of disease in which the leading cause of death was cardiovascular diseases (CVD), followed by neoplasms, infectious and parasitic diseases, and external causes, accounting for 28.9%, 14.5%, 11.2%, and 9.8%, respectively. In terms of premature mortality, there were 85 and 55 Years of Life Lost (YLL) per 1,000 population for males and females respectively. The largest contributions to YLL were CVDs, malignant neoplasms, unintentional injuries, and perinatal and neonatal causes. In general, men had higher mortality rates than women for all mortality categories. In adults of 20 years and above, mortality rates increased substantially with age, and showed similar age effects for all mortality categories with the strongest association for non-communicable diseases (NCD). Education was an important factor for survival in general, and high economic status seemed to benefit men more than women. Compared with cancer and other NCD causes, higher CVD rates were observed among males, the elderly, and those without formal education, using a Cox proportional hazards model.

This study is an initial effort to provide information on mortality patterns in a community using longitudinal follow-up of a dynamic cohort. Continuing the study using the VA approach as part of routine data collection in the setting will help to show trends in mortality patterns for the community over time, which may be useful for priority setting and health planning purposes, not only locally but also at the national level. Further analyses are needed to understand mortality inequality across all ages to have a comprehensive picture of mortality burdens in the setting. Validation studies and further standardization of VA methods should be carried out whenever possible to improve the performance and extension of the technique.

Publisher
67 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1036
Keyword
cause of death, verbal autopsy, mortality, rural Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-878 (URN)91-7264-126-6 (ISBN)
Public defence
2006-10-19, Sal D, 1D, Tandläkarhögskolan, NUS, 13:00 (English)
Opponent
Supervisors
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2009-10-20Bibliographically approved

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