Verbal autopsies help to understand the burden of disease in Uganda

Researchers at the University of North Carolina at Chapel learned how to train community health workers to conduct verbal autopsy interviews with more accurate and complete data on the number and causes of death in a rural sub-county of Chapel. Uganda that current surveillance methods depend on health facilities. Hill and their partners in the country. These results were published in PLOS ONE.

"Overall, our results show that in rural Uganda, and probably in much of sub-Saharan Africa, people are dying and policy makers are not aware of it. "said Ross Boyce, MD, M.Sc., senior author of the study and badistant professor. from Medicine to the Division of Infectious Diseases of the UNC. "This has been called an" invisibility scandal "and touches on important issues of social justice and fractures between rural and urban areas."

Traditionally, only deaths of people who die in a health facility are reported through an institution-based health management information system (HMIS) in Uganda. However, Boyce says that many people living in rural areas never reach health centers. In addition, the registration of patients in these health centers may be incomplete and inaccurate, further aggravating the problem of effective disease reporting.

This study focuses on the 36 villages of Bugoye Subcounty, in western Uganda, where the basin population is 46,000 people. Community health workers conducted a survey to identify households in which a person had died in the past year. Community health workers were trained to interview close relatives using the 2014 World Health Organization (WHO) Verbal Autopsy Questionnaire, which is used to determine the cause of death. depending on the symptoms present at the time of death.

Community health workers identified 230 deaths in Bugoye sub-county. Seventy-seven of these deaths, or 34%, occurred in children under five. More than half of the 230 deaths occurred outside of a health facility. And while the remaining 107 people died in a health facility, 73 of them, or 69%, were not registered in the HMIS system. The leading causes of death estimated from verbal autopsies in adults were HIV / AIDS, pulmonary tuberculosis and malaria. Malaria, premature birth and neonatal pneumonia were the leading causes of death in children.

"While we were expecting these leading causes of death, which was truly amazing, it was the extent of underreporting," said Doreen Nabukalu, MPH, author of the study. of the Community Health Department of the Mbarara University of Science and Technology in Mbarara, Uganda. "We found that more than 50% of deaths occurred at home.The civil registration system in many rural areas of Uganda is non-functional, which means that deaths occurring outside a health facility are never reported health facility, mismanagement of record keeping also prevented accurate vital statistics on these deaths.This underreporting has real implications for monitoring and treatment of the disease. "

On the basis of the accuracy and increased number of recordings obtained through verbal autopsies performed by community health workers, Mr. Boyce stated that the research team had submitted a grant to the Fogarty International Center of the United States. This funding would be used to provide community health workers with smartphones to record births and deaths in real time. The goal is to continue to use this cost-effective method of reporting health problems, which can then be used to design public health interventions, inform Ugandan decision-makers and put an end to deadly epidemics.

"Giving community health workers the power to conduct regular verbal autopsies in their communities is a cost-effective and sustainable way to improve the quality and availability of mortality data," Nabukalu said. "This approach will also strengthen disease surveillance programs at the community level, especially in rural areas."

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University of North Carolina Health Care