The verbal autopsy based cause of death reporting systems in rural areas of India.

Valid and reliable statistics on cause of death is an essential input for setting of priorities in the health sector. An overview of the cause of death reporting system in India has been published elsewhere. In the rural areas medical certification of cause of death is usually not feasible since many deaths occur without any prior medical attendance. Thus the country depends on a system of lay reporting of cause of death using what is called a verbal autopsy methodology. Until December 1998 cause of death data for the rural areas used to be collected under the Survey of Cause of Death (SCD) Rural scheme. SCD-Rural data used to be collected from a sample of primary health center (PHC) headquarter villages by a lay diagnosis and reporting system in accordance with guidelines issued by the Registrar General of India (1991 1993). The SCD-Rural scheme was discontinued from beginning of 1999 (Registrar General of India 1999). Instead a cause of death component has been added to the sample registration scheme (SRS). The SRS is designed to register births and deaths in another set of sample rural and urban areas. The cause of death (SRS-COD) component is also based on verbal autopsy. The verbal autopsy guidelines were developed in the 1960s when the Model Registration Survey (MRS) of cause of death scheme first came into existence. The MRS later came to be known as the SCD-Rural scheme. The verbal autopsy introduced in India in 1965 was the first verbal autopsy based cause of death reporting system in the world. The concept of verbal autopsy as a source of cause of death information has been used in many developing areas that have poorly developed facilities for medical certification of cause of death it will be useful to review the content validity of the Verbal autopsy-based cause of death reporting system in the light of research findings and field experiences gained over the last four decades. Design characteristics of the SCD-Rural system are reviewed first and followed by the SRS-COD component. (excerpt)