Browsing by Author "Chalapati Rao"
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- PublicationCause-specific mortality estimates for Malaysia in 2013: results from a national sample verification study using medical record review and verbal autopsy(2019)
;Azahadi Omar ;Shubash Shander Ganapathy ;Mohamad Fuad Mohamad Anuar ;Yi Yi Khoo ;Chandrika Jeevananthan ;S. Maria Awaluddin ;Jane Ling Miaw YnChalapati RaoBackground: Mortality indicators are essential for monitoring population health. Although Malaysia has a functional death registration system, the quality of information on causes of death still needs improvement, since approximately 30% of deaths are classified to poorly defined causes. This study was conducted to verify registered causes in a sample of deaths in 2013 and utilise the findings to estimate cause-specific mortality indicators for Malaysia in 2013. Methods: This is a cross-sectional study involving a nationally representative sample of 14,497 deaths distributed across 19 districts. Registered causes of deaths were verified using standard medical record review protocols for hospital deaths, and locally adapted international standard verbal autopsy procedures for deaths outside hospitals. The findings were used to measure the validity and reliability of the registration data, as well as to establish plausible cause-specific mortality fractions for hospital and non-hospital deaths, which were subsequently used as the basis for estimating national cause-specific mortality indicators. Results: The overall response rate for the study was 67%. Verified causes of 5041 hospital deaths and 3724 deaths outside hospitals were used to derive national mortality estimates for 2013 by age, sex and cause. The study was able to reclassify most of the ill-defined deaths to a specific cause. The leading causes of deaths for males were Ischaemic Heart Disease (15.4%), Cerebrovascular diseases (13.7%), Chronic Obstructive Pulmonary Disease (8.5%) and Road Traffic Accident (8.0%). Among females, the leading causes were Cerebrovascular diseases (18.3%), Ischaemic Heart Disease (12.7%), Lower Respiratory Infections (11.5%) and Diabetes Mellitus (7.2%). Conclusions: Investigation of registered causes of death using verbal autopsy and medical record review yielded adequate information to enable estimation of cause-specific mortality indicators in Malaysia. Strengthening the national mortality statistics system must be made a priority as it is a core data source for policy and evaluation of the public health and healthcare sectors in Malaysia. - PublicationStrengthening Mortality Statistics for Health Programs in Malaysia: Lessons from the Field(Atlantis Press International B.V., 2019)
;Chalapati Rao ;Mohammad Azahadi Omar ;Shubash Shander GanapathyNor Saleha Ibrahim TaminReliable information on causes of death is essential for an evidence-based health policy. There is a challenge in ascertaining the cause for deaths occurring without medical attention. This has been a persistent problem for Malaysia, where 50% of deaths are registered as “nonmedically certified” deaths mostly with ill-defined causes. During 2014–2016, a research study was conducted in a nationally representative sample of 15,000 deaths in Malaysia, to verify their registered causes and develop cause-specific mortality estimates. Standard Verbal Autopsy (VA) methods were used to ascertain causes for the nonmedically certified deaths in the sample. VA methods were successful in assigning specific causes for most cases with ill-defined causes of death, resulting in plausible mortality patterns. The Malaysian government issued official instructions for routine implementation of VA methods for nonmedically certified deaths. Nationwide capacity development was implemented to improve data quality. These activities provide several lessons for strengthening the national mortality statistics programs. - PublicationValidation of verbal autopsy: determination of cause of deaths in Malaysia 2013(2017)
;Shubash Shander Ganapathy ;Khoo Yi Yi ;Mohd Azahadi Omar ;Mohamad Fuad Mohamad Anuar ;Chandrika JeevananthanChalapati RaoBackground: Mortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Verbal autopsy (VA) is a very useful tool in diagnosing broad causes of deaths for events that occur outside health facilities. This article reports the development of the VA methods and our principal finding from a validation study. Methods: A cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used. A VA questionnaire suitable for local use was developed. Trained field interviewers visited the family members of the deceased at their homes and conducted face to face interviews with the next of kin. Completed questionnaires were reviewed by trained physicians who assigned multiple and underlying causes. Reference diagnoses for validation were obtained from review of medical records (MR) available for a sample of the overall study deaths. Results: Corresponding MR diagnosis with matched sample of the VA diagnosis were available in 2172 cases for the validation study. Sensitivity scores were good (>75%) for transport accidents and certain cancers. Moderate sensitivity (50% - 75%) was obtained for ischaemic heart disease (64%) and cerebrovascular disease (72%). The validation sample for deaths due to major causes such as ischaemic heart disease, pneumonia, breast cancer and transport accidents show low cause-specific mortality fraction (CSMF) changes. The scores obtained for the top 10 leading site-specific cancers ranged from average to good. Conclusion: We can conclude that VA is suitable for implementation for deaths outside the health facilities in Malaysia. This would reduce ill-defined mortality causes in vital registration data, and yield more accurate national mortality statistics.