Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Notzon F [original query] |
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Mixed-methods analysis of select issues reported in the 2016 World Health Organization verbal autopsy questionnaire
Nichols E , Pettrone K , Vickers B , Gebrehiwet H , Surek-Clark C , Leitao J , Amouzou A , Blau DM , Bradshaw D , Abdelilah EM , Groenewald P , Munkombwe B , Mwango C , Notzon FS , Biko Odhiambo S , Scanlon P . PLoS One 2022 17 (10) e0274304 BACKGROUND: Use of a standardized verbal autopsy (VA) questionnaire, such as the World Health Organization (WHO) instrument, can improve the consistency and reliability of the data it collects. Systematically revising a questionnaire, however, requires evidence about the performance of its questions. The purpose of this investigation was to use a mixed methods approach to evaluate the performance of questions related to 14 previously reported issues in the 2016 version of the WHO questionnaire, where there were concerns of potential confusion, redundancy, or inability of the respondent to answer the question. The results from this mixed methods analysis are discussed across common themes that may have contributed to the underperformance of questions and have been compiled to inform decisions around the revision of the current VA instrument. METHODS: Quantitative analysis of 19,150 VAs for neonates, children, and adults from five project teams implementing VAs predominately in Sub-Saharan Africa included frequency distributions and cross-tabulations to evaluate response patterns among related questions. The association of respondent characteristics and response patterns was evaluated using prevalence ratios. Qualitative analysis included results from cognitive interviewing, an approach that provides a detailed understanding of the meanings and processes that respondents use to answer interview questions. Cognitive interviews were conducted among 149 participants in Morocco and Zambia. Findings from the qualitative and quantitative analyses were triangulated to identify common themes. RESULTS: Four broad themes contributing to the underperformance or redundancy within the instrument were identified: question sequence, overlap within the question series, questions outside the frame of reference of the respondent, and questions needing clarification. The series of questions associated with one of the 14 identified issues (the series of questions on injuries) related to question sequence; seven (tobacco use, sores, breast swelling, abdominal problem, vomiting, vaccination, and baby size) demonstrated similar response patterns among questions within each series capturing overlapping information. Respondent characteristics, including relationship to the deceased and whether or not the respondent lived with the deceased, were associated with differing frequencies of non-substantive responses in three question series (female health related issues, tobacco use, and baby size). An inconsistent understanding of related constructs was observed between questions related to sores/ulcers, birth weight/baby size, and diagnosis of dementia/presence of mental confusion. An incorrect association of the intended construct with that which was interpreted by the respondent was observed in the medical diagnosis question series. CONCLUSIONS: In this mixed methods analysis, we identified series of questions which could be shortened through elimination of redundancy, series of questions requiring clarification due to unclear constructs, and the impact of respondent characteristics on the quality of responses. These changes can lead to a better understanding of the question constructs by the respondents, increase the acceptance of the tool, and improve the overall accuracy of the VA instrument. |
Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations
de Savigny D , Riley I , Chandramohan D , Odhiambo F , Nichols E , Notzon S , AbouZahr C , Mitra R , Cobos Munoz D , Firth S , Maire N , Sankoh O , Bronson G , Setel P , Byass P , Jakob R , Boerma T , Lopez AD . Glob Health Action 2017 10 (1) 1272882 BACKGROUND: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death. Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance. CONCLUSIONS: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems. |
Improving mortality data in Jordan: a 10 year review
Dababneh F , Nichols EK , Asad M , Haddad Y , Notzon F , Anderson R . Bull World Health Organ 2015 93 (10) 727-731 PROBLEM: Before 2003 there was substantial underreporting of deaths in Jordan. The death notification form did not comply with World Health Organization (WHO) guidelines and information on the cause of death was often missing, incomplete or inaccurate. APPROACH: A new mortality surveillance system to determine the causes of death was implemented in 2003 and a unit for coding causes of death was established at the ministry of health. LOCAL SETTING: Jordan is a middle-income country with a population of 6.4 million people. Approximately 20 000 deaths were registered per year between 2005 and 2011. RELEVANT CHANGES: In 2001, the ministry of health organized the first meeting on Jordan’s mortality system, which yielded a five-point plan to improve mortality statistics. Using the recommendations produced from this meeting, in 2003 the ministry of health initiated a mortality statistics improvement project in collaboration with international partners. Jordan has continued to improve its mortality reporting system, with annual reporting since 2004. Reports are based on more than 70% of reported deaths. The quality of cause-of-death information has improved, with only about 6% of deaths allocated to symptoms and ill-defined conditions – a substantial decrease from the percentage before 2001 (40%). Mortality information is now submitted to WHO following international standards. LESSONS LEARNT: After 10 years of mortality surveillance in Jordan, the reporting has improved and the information has been used by various health programmes throughout Jordan. |
Rapid assessment of Malawi's civil registration and vital statistics system
Nichols EK , Giles D , Kang'oma S , Mwalwanda L , Onaka A , Notzon F . Public Health Action 2015 5 (3) 162-4 In 2010, Malawi adopted a National Registration Act, making the registration of births and deaths compulsory, and efforts to improve Malawi's civil registration and vital statistics (CRVS) system are underway. During a participatory-style workshop, stakeholders completed a rapid assessment of the national civil registration and vital statistics systems. While participants discussed and scored each item in a standard tool, the workshop focused on sharing of partners' roles and challenges. The workshop has enhanced receptiveness in collaboration, and an inter-ministerial technical working group has now been formed to develop a strategic plan and conduct a comprehensive assessment to guide future improvements. |
Civil registration and vital statistics: progress in the data revolution for counting and accountability
AbouZahr C , de Savigny D , Mikkelsen L , Setel PW , Lozano R , Nichols E , Notzon F , Lopez AD . Lancet 2015 386 (10001) 1373-1385 New momentum for civil registration and vital statistics (CRVS) is building, driven by the confluence of growing demands for accountability and results in health, improved equity, and rights-based approaches to development challenges, and by the immense potential of innovation and new technologies to accelerate CRVS improvement. Examples of country successes in strengthening of hitherto weak systems are emerging. The key to success has been to build collaborative partnerships involving local ownership by several sectors that span registration, justice, health, statistics, and civil society. Regional partners can be important to raise awareness, set regional goals and targets, foster country-to-country exchange and mutual learning, and build high-level political commitment. These regional partners continue to provide a platform through which country stakeholders, development partners, and technical experts can share experiences, develop and document good practices, and propose innovative approaches to tackle CRVS challenges. This country and regional momentum would benefit from global leadership, commitment, and support. |
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