MINErVA: Mortality in India established through Verbal Autopsy

Information about Cause of Deaths is one of the crucial factors in prolonging life expectancy by avoiding preventable causes of deaths. Reliable information on the number of deaths by age, and cause is the cornerstone of an effective health information system. Levels and trends in cause-specific mortality provide critical insights into emerging or neglected health problems and the effectiveness of current disease control priorities. Further, monitoring progress with national health development goals and global poverty reduction strategies enshrined in the Sustainable Development Goals requires a reliable understanding of how leading causes of death are changing in populations. Yet with the remarkably slow progress over the last 40 years or so in the development of vital registration systems built on medical certification of causes of death, India will be driving blind’. In India. The SRS (Sample Registration System) is the single most important source of data on annual demographic indicators including causes of death in India. Assigning most-probable underlying cause of death for nearly 50,000 deaths identified annually under the SRS all over the country is highly challenging. Though SRS is able to generate reliable vital statistics on the health of populations with accountability, but there is little prospect of it being able to do so if they continue to pursue current cause of death measurement strategies based on incrementally expanding coverage of physician certification of deaths. Therefore it is crucial to urgently improve the quality and availability of information on key mortality indicators, including patterns of disease in populations, and to exploit new measurement and data collection technologies. When deaths occur outside of a hospital or occur in facilities with limited diagnostic capability, verbal autopsy (VA) has increasingly been proposed and used to measure cause of death patterns. Recent studies suggest that VA can provide cause of death information that, at the population level, is similar to death certification in high-quality hospitals.. VA is thus a potential data collection option for low-resource settings to confidently monitor progress with their development strategies, provided it can be shown to be realistic, reliable and routinely applicable.   

In this respect the premier healthcare institute AIIMS Delhi has developed an online platform for the Registrar General of India Office, the Ministry of Home Affairs to provide data on the cause of deaths in the country which helps the government plan and monitor the effectiveness of its health programmes. The platform is called Minerva (Mortality in India established through Verbal Autopsies).The RGI office had signed an MoU with the AIIMS last year to provide technical support for its Sample Registration System-based verbal autopsy.

Under this system, close caregivers of the deceased identified under the SRS are interviewed and they fill up a pre-designed form used by trained physicians to arrive at the cause of death. This system has been necessitated by the fact that most deaths in India, especially rural areas are not medically certified. The platform enables physicians to review the verbal autopsy form and enter the cause of death in the form of a standard international code sitting at their office. It also has online training platform for doctors to learn about the system and on how to arrive at and code a cause of death.

About 24 partner institutes and 400 doctors have already registered with the system which will start coding of the verbal autopsy forms from next week. AIIMS will provide additional support in the form of training in conduct of verbal autopsy, training of physicians to code the cause of death and development of IT platform for training and coding.

Dr. U.K. Chattopadhyay,    DIRECTOR