Associated Press: Verbal autopsies used in push to better track global deaths - Social autopsies

5 October, 2019

Extract and comment from me, below. Full text here: https://apnews.com/8368ad6b33604514918c4bdee12c6408

KIGALI, Rwanda (AP) — One afternoon last month, a young woman with a tablet computer sat next to Alphonsine Umurerwa on the living room couch, asking questions, listening carefully.

She learned that the woman’s 23-year-old daughter, Sandrine Umwungeri, had been very sick for about a year, gradually becoming so weak she stopped leaving their tin-roofed home in a hilly section of Rwanda’s capital city. The family thought she had malaria.

Medicines from a local pharmacy didn’t help. In March, she died.

The interviewer asked: When did Sandrine begin to feel weak? Did she have a fever? Did her skin take on a yellow hue? Each typed answer determined the next question to pose, like following a phone tree.

This was a “verbal autopsy” — an interview in which a trained health worker asks a close relative or caretaker about a recently deceased person. Increasingly, health officials are using these tools and their computer algorithms to learn more about the global course of human disease.

About 50 countries have attempted verbal autopsy projects, and the list is growing. On Tuesday, Bloomberg Philanthropies — a major funder of international health data initiatives — announced it will devote another $120 million over the next four years to continue projects in 20 previously funded countries, and add five more...

“With more and better data on causes of death, more countries can save more lives,” said Michael Bloomberg, the philanthropy’s founder, in a statement...

Some health advocates — including the philanthropists Bill and Melinda Gates — have pushed for other methods like minimally invasive tissue sampling, a technique in which fine needles are inserted into a dead person’s body, gathering samples from different organs for rapid analysis...

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Comment (NPW): Arguably it is even more important to identify care-related causes of death rather than to identify medical causes of death. This approach, sometimes called social autopsy (rather than verbal autopsy) uses interviews to reconstruct the care provided from the onset of illness (or even before) through to death: including the care decisions taken by family, community and health workers. Social autopsy includes therefore the period preceding facility-based care (the latter is ideally assessed through audit). It gives important pointers to remediable, avoidable factors that predicpose to death. Unfortunately this approach is very rare, even in research. A classic example was published by Merlin Willcox and colleagues last year in The Lancet Global Health:

Circumstances of child deaths in Mali and Uganda: a community-based confidential enquiry

Merlin L Willcox et al. Published:June, 2018 DOI: https://doi.org/10.1016/S2214-109X(18)30215-8

It would be interesting to know whether the Gates Foundation and other funders are investing in social autopsy to understand care-related causes of death, to complement verbal autopsy to identify medical causes of death.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org