Assessment of the underlying causes of adult deaths using a short version of verbal autopsy in Xaiyabouli Province, Lao People’s Democratic Republic

(2023) 23:560 Thanavanh et al. BMC Public Health https://doi.org/10.1186/s12889-023-15469-2 BMC Public Health Open Access RESEARCH Assessment of the underlying causes of adult deaths using a short version of verbal autopsy in Xaiyabouli Province, Lao People’s Democratic Republic Bounbouly Thanavanh1,2, Nobuyuki Hamajima1, Kaiyason Sida2, Kene Duangdy2, Lasavong Latsamy2, Khounsavath Senaphane3, Viengsakhone Louangpradith4, Souphaphone Sadettan5, Souphalak Inthaphatha1, Kimihiro Nishino1 and Eiko Yamamoto1* Abstract Background In developing countries, it is difficult to collect the data of the underlying cause of death (UCOD), especially when a death does not occur in a health facility. This study aimed to develop a short version of verbal autopsy (VA) and identify the UCOD of adults in Lao People’s Democratic Republic (Lao PDR). Methods A short version of VA for deaths outside health facilities was developed. This study included all deaths of people aged 15 years old or older in Xaiyabouli Province in 2020. Socio-demographic factors, place of death, and UCOD of the deceased were collected from health facilities or from family members using a questionnaire including the short VA form. UCOD was compared between home deaths and hospital deaths, between the age group of 15–59 years old and the age group ≥ 60 years old, and between males and females. Results Of all the 1,235 deaths included in this study, 1,012 deaths (81.9%) occured at home and 223 deaths (18.1%) at hospitals. The most common UCOD was senility (13.3%), followed by heart/renal failure (10.5%), pneumonia (9.6%) and traffic accident (7.1%). Compared to hospital deaths, home deaths had more people who were females, 75 years old or older, and Lao-Tai. Home deaths had more deaths than hospital deaths due to accident/injury (16.0% vs. 8.1%), tumor (4.7% vs. 1.8%), and senility (16.2% vs. 0%); fewer deaths due to heart/renal disease (15.1% vs. 32.3%), respiratory disease (12.2% vs. 18.8%), liver/gastro-intestine disease (5.3% vs. 9.0%), and infection (3.1% vs. 14.3%). The age group of 15–59 years had more deaths in the categories of accident/injury (28.1% vs. 4.4%), liver/gastro-intestine disease (8.1% vs. 4.4%), infection (7.2% vs. 3.5%), and tumor (6.0% vs. 2.8%). Males had more deaths due to tumor (5.2% vs. 3.0%) and fewer natural deaths (11.2% vs. 15.9%) than females. Conclusions The major UCOD category was heart/renal disease in the adult generation in Xaiyabouli Province. Costeffective interventions based on the multisectoral noncommunicable disease prevention plan should be appropriately implemented. Mortality surveillance using the short VA tool should be conducted for all home deaths in Lao PDR. Keywords Lao PDR, Underlying cause of death, Verbal autopsy *Correspondence: Eiko Yamamoto Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Thanavanh et al. BMC Public Health (2023) 23:560 Background Information of deaths, such as the number of deaths, sex and age of the deceased persons, and causes of death, are essential information for policymakers and government officers to develop health policies and to implement appropriate interventions for improving public health in each country [1–3]. In most developed countries, the underlying cause of death (UCOD) is certified by medical doctors and reported to the government using the International Statistical Classification of Diseases and Related Health Problems (ICD), which is the standard medical classification list of the World Health Organization (WHO) [4]. However, many developing countries have no or limited mortality statistics because the systems of vital registration and death certificate by doctors are weak and many people die at home with no access to healthcare services. When a death occurs outside health facilities, the identification of UCOD is more difficult compared to a death at a health facility [4]. A verbal autopsy (VA) is a useful tool to determine the possible cause of death by interviewing family members or care givers regarding signs, symptoms, available medical history, treatment, and circumstances before a death [2, 3, 5]. The WHO started encouraging the use of VA in developing countries and developed reporting forms in the 1970s [2, 6]. The first WHO VA standard tools were developed in 2007, including a questionnaire for the three age groups, cause of death certification, and coding resources consistent with ICD-10, and they were revised in 2014, 2016, and 2022 [1, 3, 5, 7, 8]. There are four methods for VA, namely physician review without algorithmic diagnosis criteria, physician review using an algorithms, computer algorithms, and probabilistic approaches [7], but there is no method with universal advantages because the disease frequency, available personnel, and/or the social and cultural system are different in each country or region [9–11]. However, previous studies suggested that a VA method can provide a rough estimation of UCOD distribution close to that obtained at health facilities if the categories are not so detailed [1, 6]. Lao People’s Democratic Republic (Lao PDR) is a lower-middle income country in Southeast Asia with a population of 7,379,358 in 2021 [12]. It is suggested that deaths due to noncommunicable disease (NCD), such as ischemic heart disease, chronic kidney diseases, diabetes, and chronic respiratory diseases, are increasing in Lao PDR [13–15]. However, previous studies on causes of death in Lao PDR analyzed only deaths at hospitals [16– 18]. There have been no government reports on UCOD because the civil registration and death notification systems are weak and lack medical certification. When someone dies at a health facility, healthcare workers issue Page 2 of 13 a death notification that includes the cause of death and a representative of his/her household submits it to the village office and the district home af (...truncated)