The majority of low- and middle-income countries (LMICs) do not have adequate civil registration and vital statistics (CRVS) systems to properly support health policy formulation. Verbal autopsy (VA), long used in research, can provide useful information on the cause of death (COD) in populations where physicians are not available to complete medical certificates of COD. Here, we report on the application of the SmartVA tool for the collection and analysis of data in several countries as part of routine CRVS activities. Data from VA interviews conducted in 4 of 12 countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative, and at different stages of health statistical development, were analysed and assessed for plausibility: Myanmar, Papua New Guinea (PNG), Bangladesh and the Philippines. Analyses by age- and cause-specific mortality fractions were compared to the Global Burden of Disease (GBD) study data by country. VA interviews were analysed using SmartVA-Analyze-automated software that was designed for use in CRVS systems. The method in the Philippines differed from the other sites in that the VA output was used as a decision support tool for health officers. Country strategies for VA implementation are described in detail. Comparisons between VA data and country GBD estimates by age and cause revealed generally similar patterns and distributions. The main discrepancy was higher infectious disease mortality and lower non-communicable disease mortality at the PNG VA sites, compared to the GBD country models, which critical appraisal suggests may highlight real differences rather than implausible VA results. Automated VA is the only feasible method for generating COD data for many populations. The results of implementation in four countries, reported here under the D4H Initiative, confirm that these methods are acceptable for wide-scale implementation and can produce reliable COD information on community deaths for which little was previously known.

中文翻译：

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自动化的语言尸检：从研究到在民事登记和生命统计系统中的常规使用。

大多数低收入和中等收入国家（LMIC）没有足够的民事登记和生命统计（CRVS）系统来适当地支持卫生政策的制定。长期用于研究的言语尸检（VA）可为无法提供完整的COD医学证明的人群中的死因（COD）提供有用的信息。在此，我们报告了SmartVA工具在例行CRVS活动中在多个国家/地区收集和分析数据的应用情况。在彭博慈善数据促进健康（D4H）计划的支持下，在12个国家中的4个国家进行了弗吉尼亚州采访，并在健康统计发展的不同阶段对这些数据进行了分析和评估，包括缅甸，巴布亚新几内亚（PNG），孟加拉国和菲律宾人。将按年龄和特定原因造成的死亡率进行的分析按国家与全球疾病负担（GBD）研究数据进行了比较。使用专为CRVS系统设计的SmartVA-Analyze自动化软件对VA访谈进行了分析。菲律宾的方法与其他站点的不同之处在于，VA输出被用作卫生官员的决策支持工具。详细介绍了VA实施的国家策略。VA数据与国家GBD估算值之间的比较（按年龄和原因）显示出大致相似的模式和分布。与GBD国家模型相比，PNG VA站点的主要差异是传染病死亡率较高，PNG VA站点的非传染性疾病死亡率较低，关键评估表明，这可能会突出真实差异而不是令人难以置信的VA结果。自动化的VA是为许多人群生成COD数据的唯一可行方法。根据D4H计划在此报告的四个国家的实施结果证实，这些方法对于大规模实施是可以接受的，并且可以产生关于社区死亡的可靠COD信息，而此前鲜为人知。