Cause specific mortality and NCDs

Cause-specific mortality and non-communicable diseases

Professor Alan D. LopezExecutive Director,HIS Knowledge HubHead, School of Population HealthPresented by: Nicola Hodge

Health Information Systems Knowledge Hub | 2012

Pacific Health Information Network

Tonga, Fiji, Solomon Islands, Cook Islands, Papua New Guinea, Vanuatu, Kiribati

Federated States of Micronesia, Hawaii, Marshall Islands, Nauru, Palau, Samoa


Outline of presentation

• What is a health information system (HIS) and why is it important

• Why strengthening HIS is crucial for monitoring and evaluating responses to NCDs

• Opportunities for improving health information systems

• Current work on cause-specific mortality in the region


What are health information systems?

• ‘A system for the collection/processing of data from various sources, and using the information for policy making and management of health services’ (World Bank)

• ‘Integrated efforts to collect, process, report and use health information and knowledge to influence policy making, program action and research’ (WHO)

• A collection of components that work together to improve health services management through optimal information support (Sauerborn & Lippeveld)


Why are health information systems important?

• Without health information systems to inform decision-makers of where health problems are and if the health of the population is improving or getting worse – sound judgements cannot be made

• Accountability – to the population, to donors, to other organisations

• Evidence-based decisions

• Resource allocation


Components and standards of a health information system


Why is cause-specific mortality important to NCD prevention and control?

• Policy should be informed by accurate and timely data

• Provide information on patterns of leading diseases and trends

• Identify emerging health problems

• Monitor and evaluate the effectiveness of health programs and policies


Common issues with mortality data

Particularly problematic in countries where the majority of deaths occur outside health institutions:

• Not all deaths are medically certified

• High proportion of ill-defined deaths

• Frequent use of “garbage codes”

• Mode of death (i.e. the immediate cause) is reported instead of the underlying cause

• Not all births/deaths are registered – lack of resources, incentives, legislation

• Data quality issues


Monitoring NCDs

• HIS in the Pacific currently do not give Pacific decision makers enough information to address the information needs for NCD prevention and control

• Pacific NCD decision makers need information on:• The magnitude of the public health problem posed

by NCDs• Levels and trends in the prevalence of risk factors

and in NCD conditions/mortality• The impact of current policies and programs on

these trends


Indicators and targets for the global monitoring of NCDs


What is currently being done in the Pacific to improve mortality data?

• Capacity-building• Over 200 doctors from Asia and the Pacific have been trained in

correct cause-of-death certification practices• Three doctors from the Pacific have been trained as cause-of-

death instructors• Development of handbook for doctors• Over 100 health information professionals from the Pacific have

been trained in a HIS Short Course (being transferred to FNU)• Civil registration and vital statistics course in development

• Assistance to countries to investigate own data

• Pacific Vital Statistics Strategy• Training for all countries involved in strategy – late 2012• Comprehensive and rapid assessment of civil registration systems

• ICD-10 training offered by QUT and online via WHO


Cause of death certification in FijiDr Iris Wainiqolo, FNU

• Reviewed 500 death certificates in 2011

• 60% of death certificates gave information that was not useful for public planning and policy

• Clinically improbable sequence of death• Mode of death or immediate cause reported

• Lack of knowledge on how to complete death certificates correctly and poor understanding of ‘underlying cause-of-death’

• Training provided to doctors

• Handbook developed

• FNU are incorporating training on death certification to their medical students

Source: I Wainiqolo, R Rampitage, S Walker, A Aumua. 2012. Improving cause-of-death certification practices in the Pacific.


Cause of death certification in TongaMr Sione Hufanga, MoH

• Review of death certificates in 2011

• Analysis of Annual Report• High number of ‘ill-defined’ or ‘garbage’ codes

• Analysis of cause-of-death data• NCD-related deaths are three-times higher than previously estimated

• Training provided to doctors

• Agreement to modify death certificate to match international standards

• Agreement to promote online ICD-10 training to medical interns and refresher courses

Source: K Carter, S Hufanga, C Rao, S Akauola, A Lopez, R Rampitage, R Taylor. 2012. Causes of death in Tonga, quality of certification and implications for statistics


Thank you

Education

Cause specific mortality and NCDs