Sample Vital Registration with Verbal Autopsy (SAVVY)Issue and BackgroundMajor U.S. and international initiatives in AIDS, malaria, newborn health and survival, maternal mortality, as well as several of the United Nation's eight Millennium Development Goals (MDGs), require representative, reliable, and routine sources of information on the levels, causes, and differentials of mortality at the national and sub-national levels in order to adequately measure population outcomes of the billions of dollars invested. Under the U.S. President's Emergency Plan for AIDS Relief (Emergency Plan), for example, the proportion of all deaths among 18-59 year-olds due to HIV/AIDS is one of just two outcome indicators of the impact of the Emergency Plan on population health. Yet, aside from South Africa (and possibly Kenya), no other focus countries currently have reliable sources of information on mortality rates at the national level, much less, on causes of death. Similarly, this information is lacking in all countries that receive funding under the President's Malaria Initiative which has, as its overall objective, a 50% reduction in malaria mortality among children under five years of age. How, then, can the necessary information on total deaths and deaths due specific causes best be collected? We recommend a system that registers vital events and attributes an underlying cause to registered deaths in a nationally representative sample. This system, called Sample Vital Registration with Verbal Autopsy, or SAVVY, has been developed by MEASURE Evaluation and the International Programs Center of the U.S. Census Bureau. SAVVY builds on decades of experience from both sentinel demographic surveillance and sample vital registration systems. Members of the SAVVY team participated in the development of the World Health Organization's (WHO) new international standard verbal autopsy procedures http://www.who.int/whosis/mort/verbalautopsystandards/en/. Implementation of these methods are an integral part of SAVVY, as is support for existing civil registration systems, and the appropriate application of the International Classification of Diseases (ICD).
Suggested MethodA SAVVY system establishes a community-based system to register births and deaths from a number of sites throughout a country using multi-stage probability sampling. All deaths are followed up at the household level using the new international standard verbal autopsy methods. Once fully implemented, SAVVY will provide nationally representative statistics on the number and causes of death. The population covered in a given country and the total number of SAVVY sites will depend on a number of factors including total population and available resources. The foundation of SAVVY is demographic surveillance. Following an initial census of SAVVY sites to determine resident populations, a network of supervised lay reporters would continue to enumerate all births, deaths, and migrations through annual or semi-annual census updates. An active death reporting would run in parallel to the census system in which all deaths will be followed up at the household with a verbal autopsy interview implemented by trained staff. Medically trained coders would review the interview forms and determine the probable causes of death. Ideally, a SAVVY system would be established using a phased-in approach in which sites are established over time, according to the capacity of the host country to implement, manage, and sustain them.
OutputsA reliable national estimate of all leading causes of death including HIV/AIDS, malaria, respiratory infection, diarrheal disease, and maternal mortality can be obtained from a fully functional SAVVY system. Data can be aggregated over multiple years to produce robust estimates for sub-national areas, age groups, or poverty groupings.
For Further Information, Contact: Dan Williams MEASURE Evaluation Carolina Population Center University of North Carolina at Chapel Hill Tel: 1-919-843-3772 Fax: 1-919-966-2319 Email: measure@unc.edu
Loraine West, Chief, Eurasia Branch International Programs Center, Population Division U.S. Census Bureau Washington, DC 20233 USA Tel: 1-301-763-1410 Fax: 1-301-763-6636 |
