Mortality measurement in transition: proof of principle for standardised multi-country comparisons.
OBJECTIVE
To demonstrate the viability and value of comparing cause-specific mortality across four socioeconomically and culturally diverse settings using a completely standardised approach to VA interpretation.


METHODS
Deaths occurring between 1999 and 2004 in Butajira (Ethiopia), Agincourt (South Africa), FilaBavi (Vietnam) and Purworejo (Indonesia) health and socio-demographic surveillance sites were identified. VA interviews were successfully conducted with the caregivers of the deceased to elicit information on signs and symptoms preceding death. The information gathered was interpreted using the InterVA method to derive population cause-specific mortality fractions for each of the four settings.


RESULTS
The mortality profiles derived from 4784 deaths using InterVA illustrate the potential of the method to characterise sub-national profiles well. The derived mortality patterns illustrate four populations with plausible, markedly different disease profiles, apparently at different stages of health transition.


CONCLUSIONS
Given the standardised method of VA interpretation, the observed differences in mortality cannot be because of local differences in assigning cause of death. Standardised, fit-for-purpose methods are needed to measure population health and changes in mortality patterns so that appropriate health policy and programmes can be designed, implemented and evaluated over time and place. The InterVA approach overcomes several longstanding limitations of existing methods and represents a valuable tool for health planners and researchers in resource-poor settings.
Fottrell
Edward
E
Department of Public Health and Clinical Medicine, Division of Epidemiology & Global Health, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden. Edward.Fottrell@epiph.umu.se
Kahn
Kathleen
K
Ng
Nawi
N
Sartorius
Benn
B
Huong
Dao Lan
DL
Van Minh
Hoang
H
Fantahun
Mesganaw
M
Byass
Peter
P
D017028:Caregivers / Q000523:psychology; D002423:Cause of Death; D005002:Ethiopia / Q000453:epidemiology; D014943:Global Health; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D015233:Models, Statistical; D009026:Mortality; D011159:Population Surveillance / Q000379:methods*; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014744:Vietnam / Q000453:epidemiology