Ascertaining Cause of non-Facility Deaths and Associated Demographic Characteristics: An Application of Verbal Autopsy in Routine Civil Registration in Lusaka District of Zambia

Abstract BACKGROUND: Ascertaining the cause for deaths occurring outside health facilities is a significant problem in many developing countries where civil registration systems are poor or non-functional. Standardized and rigorous verbal autopsy methods is a potential solution determine the cause of death. We conducted a demonstration project in Lusaka District of Zambia where verbal autopsy (VA) method was implemented in routine civil registration system. METHODS: About 3400 VA interviews were conducted for the “brought-in-dead” cases at Lusaka’s two major hospital mortuaries using a SmartVA questionnaire between October 2017 and September 2018. Probable underlying causes of deaths using VA and cause-specific mortality fractions were determined for each cause. Demographic characteristics associated with each cause were analyzed. RESULTS: Opportunistic infections associated with HIV/AIDS such as pneumonia, tuberculosis and malaria were among leading causes of deaths among cases of “brought-in-dead”. Over 21% and 27% of deaths were attributable to external causes and non-communicable diseases, respectively. The VA-ascertained causes of death varied by age-group and sex. External causes were more prevalent among males in middle ages (put an age range like 30-54 years old) and NCDs highly prevalent among those aged 55 years and older CONCLUSIONS: VA application in civil registration system can provide the much needed cause of death information for non-facility deaths in countries with poor civil registration system.