This document discusses the history and development of lay reporting systems for collecting health data in communities. Some key points:
- Lay reporting was first proposed by WHO in 1956 to aid reporting of morbidity and mortality where medical certification was not available. Various consultations and field trials were held from the 1970s onwards to develop standardized classification lists.
- India began utilizing lay reporting through the PHC network in the late 1970s to collect data on causes of death, treatment, and health service usage to aid planning. Verbal autopsy methods were also developed to ascertain probable causes of deaths.
- Over time, recommendations aimed to improve simplicity, usefulness of data, training of lay reporters, and ensuring reporting supported primary healthcare evaluation and
Although there is very less material in web ,I try to make the topic lucid . I also stuck in sampling part but i feel it helpful for readers .
Commends are welcome
National framework for malaria elimination in indiaAparna Chaudhary
outlines India’s strategy for elimination of the disease by 2030. The framework has been developed with a vision to eliminate malaria from the country and contribute to improved health and quality of life and alleviation of poverty.
The general shift from acute infectious and deficiency diseases characteristic of underdevelopment to chronic non-communicable diseases characteristic of modernization and advanced levels of development is usually referred to as the "epidemiological transition".
Although there is very less material in web ,I try to make the topic lucid . I also stuck in sampling part but i feel it helpful for readers .
Commends are welcome
National framework for malaria elimination in indiaAparna Chaudhary
outlines India’s strategy for elimination of the disease by 2030. The framework has been developed with a vision to eliminate malaria from the country and contribute to improved health and quality of life and alleviation of poverty.
The general shift from acute infectious and deficiency diseases characteristic of underdevelopment to chronic non-communicable diseases characteristic of modernization and advanced levels of development is usually referred to as the "epidemiological transition".
Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
An updated introduction to the PaRIS project, why it matters, how it works, its timeline, and the key issues it addresses. Contact us at paris_survey@oecd.org to learn more.
Management of Information and Evaluation system for B.Sc. Nursing 4th year students. Presented by M.Sc. Nursing 1st year student as a Practice Teaching class.
Assumptions of parametric and non-parametric tests
Testing the assumption of normality
Commonly used non-parametric tests
Applying tests in SPSS
Advantages of non-parametric tests
Limitations
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. CONTENTS
• Definition
• Time-line
• Feasibility and utility of lay reporting
• The Caveats
• Improvement and expansion of lay reporting
• Verbal autopsy
• Mortality reporting in India
• Community based MDR
• Morbidity reporting
• Recent developments
3. DEFINITION
• Lay report: The information provided (by a lay reporter) to monitor the
health situation in the community and to plan and manage the health
activities.
• Lay reporter: A person of sufficient maturity and intelligence to operate
a lay report and in a position to become aware of illness and death
occurring within his/her sphere of influence. He/she can be a local
government official, a health worker, a school teacher, community
worker, social worker or a house-wife with the appropriate education.
• While selecting the reporting personnel, one should take into their
official status in the community and responsibility in respect for defined
portions of the geographical area.
• Lay reporting system: Is a set of procedures for collecting, processing,
summarizing, analyzing and utilizing the data being gathered by the lay
or paramedical personnel.
4. TIME-LINE
• 1956: Lay reporting was for the first time proposed as a WHO
objective, mainly to aid for reporting morbidity and mortality.
• 1971: A consultation held, which considered problems inherent in
using the International Classification of Diseases (ICD) as a base for
lay reporting of diseases.
• 1973: Another consultation for development of the symptom and
disease classification lists, particularly in relation to the lay
reporting of maternal and infant deaths.
5. TIME-LINE
• 1975: A working party of the International Conference on the 9th
revision of ICD, recommended WHO:
1. Become increasingly involved in the attempts made by the
various developing countries for collection of morbidity and
mortality statistics through lay or paramedical personnel;
2. Organize meetings at regional level for facilitating exchange of
experiences between the countries currently facing this problem
so as to design suitable classification lists with due
consideration to national differences in terminology;
3. Assist countries in their endeavour to establish or expand the
system of collection of morbidity and mortality data through lay
or paramedical personnel.
6. TIME-LINE
• 1976: The South-East Asia Regional Office of WHO called for a
working group on lay reporting
– Here a detailed list, based on symptom associations, was devised
with the aim that it would be useful for primary health care
personnel in all parts of the world. From that detailed list, two
short lists were derived: one for causes of death and the other for
reasons for contact with primary health care services.
• 1977: Field trials of a pilot nature were carried out in Burma, India,
Maldives, Sri Lanka, Thailand as well as in several areas of the
Western Pacific Region.
7. TIME-LINE
• The results from these trials demonstrated that
– The International lists, when adapted to suit local and regional
needs, can be used to supply crude diagnostic data on death - or
medical services in areas where previously little or no
information was available.
– The quality of such data is obviously directly related to the level
of ability of the personnel involved with the responsibility for
operating the primary health care scheme at its lowest level.
– The experiment should involve larger areas in the country or
self-contained segment of the health care system - headed by an
official who is responsible for decision making at that segment
and could, after analysing the information, transmit it to the next
higher level.
8. TIME-LINE
• From the data provided, together with a complement of information
concerning their quality, the person with administrative
responsibility for the management of the primary health care system
should be able to obtain a reasonable picture about:
– Incidence of cases and their variations
– Relationship between cases and treatment (drug consumption)
– Uses of health services in general
– Management of emergencies and
– Handling of referrals.
• The administrator should be able to consider priorities in the
management of health care and prevention in the area under his
supervision and advice on short and long-term policies.
9. TIME-LINE
• 1978: Lay Reporting of Health Information booklet was published,
by WHO. The list was revised and published in a form in which they
could be readily adapted to suit the individual needs of countries.
• 1979: The Lay Reporting System was considered at an All-India
Workshop on Health Statistical Standards conducted in December.
The consensus was drawn that this tool be used for collecting data
on morbidity and mortality.
10. TIME-LINE
• 1980: Meeting on Lay Reporting of Health Information held in the
Regional Office for South-East Asia Region, New Delhi.
• The objectives of the meeting were:
– To assess the lay reporting system as it now operates in the
countries of the Region and the use being made of it by decision
makers, particularly those involved in the primary health care.
– To examine the potential range of health information which can
be collected at the peripheral level by the lay reporters having
regard to the difficulties of collecting and processing data at this
level.
– To suggest how the lay reporting system can be improved so as
to achieve a more effective monitoring and evaluation of the
primary health care at the peripheral level
11. TIME-LINE
• Recommendations in the meeting:
1. The lay reporting system be developed to cover the reporting of
primary health care activities by lay persons, including not only
morbidity and mortality but also information required to
monitor and evaluate the primary health care programme
within the community.
2. Countries developing lay reporting system continue to do so
and those currently not actively developing to do so at the
earliest.
3. Countries to provide realistic national support to lay reporting
in view of the potential benefits to the national interests in
promoting the health of the people.
12. TIME-LINE
4. Evaluation of primary health care activities ultimately must be
the responsibility of the community leader. The government can
assist with the development of an appropriate system but it is
the community who will assess the success of the primary
health care programme.
5. The lay reporters may best be employed within small
communities in collecting data on causes of mortality.
6. The lay reporting system be designed to meet the specific local
needs and must cover data collection, processing,
summarization, interpretation and presentation of results. In
addition, it is desirable that the system contains some
mechanism for assessing the quality of the data being gathered
and processed.
13. TIME-LINE
7. Emphasis must be on simplicity and on the potential usefulness of
the information to the primary health care worker, the community
leaders and the district health officers. Moreover the information
must pass into the national health information system and be used
for regional and national evaluation purpose.
8. Member countries of the South-East Asia region to use the
classification list for Lay Reporting of mortality and morbidity as
published by the WHO, making such changes as are necessary to
emphasize health problems which are of specific local interest.
9. WHO list for lay reporting of health information be revised
periodically jointly by WHO and the member countries in the
Region to determine, on the basis of interim experience in lay
reporting and primary health care, whether alterations should be
made.
14. TIME-LINE
10. Member countries should develop active programmes for the
initial and continued training of lay reporters. Special training
programmes and techniques will have to be developed,
particularly in the use of symptom-association lists, to
overcome the problem of the limited educational standard of
many of the reporters.
11. Regional Office to continue its role of stimulating the
development of lay health reporting within the context of
primary health care and compatible with the national health
information systems.
15. FEASIBILITY AND UTILITY
• Under Indian conditions the wide network of PHCs are a convenient
means for introducing lay reporting of morbidity and mortality as
part of the activities of health services.
• As a part of the routine activities, it seems feasible to extend the
survey to cover the whole countryside.
• The approach of lay reporting can give only the probable causes of
morbidity and mortality. It is not conceived as a substitute for the
medical certification of cause of death or the diagnosis given by the
treating physician. However, the resultant data can be utilized for
health planning.
16. FEASIBILITY AND UTILITY
• The percentage distribution of the major groups of diseases indicates
their relative importance. In major groups important specific
diseases can be identified. The data can also be utilized for
evaluating the impact of health services over a period of time
17. THE CAVEATS
• Caveat No. 1: Don't allow uncoordinated requests from sub-
agencies of the health bureaucracy to place on the primary health
care worker an overload of reporting responsibilities.
• Caveat No.2 Eliminate the concept and word of "Diagnosis" from
lay reporting processes. Diagnosis, in its classic medical sense, is the
business of personnel well trained in medical sciences and practice.
But for the purposes of reporting, documentation and treatment,
primary health care workers should be asked to classify or
categorize the conditions they see and treat, particularly upon the
basis of symptom-history models.
18. THE CAVEATS
• Caveat No. 3: Reporting format
– Design recording and reporting instruments (forms, etc.) according
to the general level of education and training of the lay workers
expected to use them.
– Do not use forms originally designed for highly trained
professional workers.
– Reduce form content to the minimum useful numbers of items
needed by management.
19. THE CAVEATS
• Caveat No. 3: Reporting format
– For example: The SOAP approach which was used (Subjective
symptoms, Objective symptoms, Assessment, Plan of Treatment),
in its original form, presumed that the user was a fully trained
practising physician. The only guides the lay workers had were the
medical standing orders for treatment. The result of imposing this
system on the lay workers was a disaster as far as case
documentation and reporting was concerned. The agency gained no
useful information on the categories and there were variety of
problems causing workload.
20. THE CAVEATS
• Caveat No.4:
– Wherever possible, make the case reporting form identical to, or part of,
the case recording form and, when economically possible, make the report
a copy of the record, to spare the time used in the documentation process
and to provide something useful at the local level.
– For example, a health agency simultaneously set two different medical care
reporting systems in operation.
• One system required that the health care worker extract the clinical
record and place the information on the reporting form.
• The other system used a duplicating record form which was structured
to simplify recording; the original became the local clinical record on
the patient, the copy was sent to the data centre as a report.
• In the first system, which required the server to prepare an additional
report, the error and omission rate was high. The reliability of data was
also dubious.
• In the second system, where recording and reporting happened
concurrently, the error problems had never been a cause for alarm.
21. THE CAVEATS
• Caveat No. 5:
– Make sure that simple, analysed information is routinely
provided to the primary health care workers which will assist
them in understanding the broader epidemiological and clinical
picture of their communities.
– Provide comparisons with other like communities.
– This type of feed-back promotes conscious attention to the
details of reporting.
• Caveat No. 6: Make sure that the reporting process services the
logistics needs of administration and that the administration uses the
output to plan, operate and evaluate health services. Reports that
only fill file cabinets are a dead loss to an agency.
• Caveat No. 7: Let the reporting bring beneficial results to the servers
and the utilizers of a system. People tire of a system of reporting if
there is no evident return in benefits.
22. THE CAVEATS
• Caveat No. 8:
– Do not presume that the data obtained represent, either
qualitatively or quantitatively, the actual epidemiological status of
the community served.
– The data represent only the disease experiences of the part of the
population which desired care and had access to it.
– A trained health worker would not be able to maintain a disease
index system but should be capable of recording the nature of the
symptoms being treated.
23. THE CAVEATS
• Caveat No. 8:
– As long as lay persons receive adequate initial and refresher
training and technical aids, their work commensurate with the
degree of performance expected
– And as long as they are motivated by good treatment in the system
and a sense of social responsibility, there is no basis for doubting
the validity of statistics derived from lay reports any more than
there is reason to doubt the validity of information from physician
reports.
24. IMPROVEMENT AND EXPANSION
• Improvement and expansion of Lay Reporting System: Each country
will have its own particular problems and the system developed will
have to be modified to overcome these problems.
• Factors to be considered are:
1. The degree of community participation:
This covers whether the village has its own administrative
infrastructure, how extensive and effective it is and its
relationship with the district and regional organization.
Awareness among the community of their health problems and
how far they are willing to take action to overcome these
problems.
25. IMPROVEMENT AND EXPANSION
2. The availability of suitable persons for recording information
relating to the health of the community. The person could be a local
government official, a health worker, a school teacher, or a house-
wife with the appropriate education.
3. The type of health services being provided- health activities such as
treatments, vaccinations, antenatal and postnatal care, water supply,
sanitation, food supplementation and health education, and also the
number of people benefiting from the services.
4. The frequency at which the reports are likely to be required.
Reports about conditions treated should be at short intervals for
epidemiological surveillance but more general information on
births, deaths, immunization, water supply, education etc., can be
gathered at long intervals of six months or one year.
26. IMPROVEMENT AND EXPANSION
5. Care should be taken that the data are useful. For example, for
epidemiological surveillance, it may be sufficient for a doctor at the
district level to maintain a graph/chart showing the number of cases
of a particular condition treated in the village during the month. If
the number exceeds a certain level then this could be taken as a
warning signal to arrange for an investigation to be made.
27. VERBAL AUTOPSY
• The term “verbal autopsy” was first proposed by Arnold Kielman and
co-workers in 1983.
• Defined as “a procedure to exploit the information provided by the
relatives of a deceased person to reconstruct the events and symptoms
that preceded the death so as to deduct a medically acceptable cause, or
causes, of the death”.
• The study of causes of deaths was first presented at a seminar on “New
Approaches to the Measurement and Analysis of Mortality” organized
in Sienna, Italy, in 1986 by the International Union for the Scientific
Study of Population (IUSSP) and published in French as part of the
proceedings.
• The First International Workshop on Verbal Autopsy was organized by
the Department of International Health of the Johns Hopkins School of
Public Health in March 1989.
28. VERBAL AUTOPSY
• 1994: First workshop focusing on maternal deaths was convened by
the London School of Tropical Medicine and Hygiene.
• Main conclusions were
– The collection of information to determine cause of death is
feasible “where there is no doctor”, provided there are well-
trained interviewers.
– Precisely the term “probable cause” suggests that it can be
probed.
• 1999: Verbal autopsy promoted as a part of sample registration of
vital events in communities with incomplete statistics.
29. Features of a verbal autopsy method
1. Data Collection
a) Questionnaire format
i. Unstructured (Open method)
ii. Structured (Closed method)
iii. Combined
b) Interviewer
i. Education
ii. Interviewing skills
iii. Knowledge of local language and dialect Validation of
iv. Training findings against a
c) Respondent gold standard :
i. Presence during illness and time of death
a. Post mortem
d) Recall period
b. Hospital
i. Greater than or less than5 years
record
2. Cause of death assignment
a) Cause of death assignment
i. Medical assessment (Physician review )
ii. Diagnostic algorithms or guidelines
b) Single or multiple causes of death
30. MORTALITY REPORTING IN INDIA
Registrar General of India
Vital statistics division of the
Directorate of Health Services
Civil Registration System Sample Registration System (SRS)
(CRS) Covers the entire Covers a representative sample of the
population urban and rural population
31. MORTALITY REPORTING IN INDIA
– Cause of death reports originate from lay reporters.
– The reports reach the State Vital Statistics office through the
primary health centre, in case of rural areas, and the municipal
health office for urban areas.
– Tabulation is usually done at the state level but the statistics are
published by the RGI.
– A health worker from the PHC is designated as the field agent
who undertakes the primary survey.
– For each death occurring, the field agent identifies one or more
persons having knowledge of the circumstances of death,
interviews them and records the symptoms and circumstances of
death in Form-7.
32. MORTALITY REPORTING IN INDIA
– The field agent arrives at a probable cause of death by applying
the questionnaire based on symptoms and circumstances
recorded.
– The cause of death thus arrived is reported.
– The PHC statistician is designated as the recorder of events
reported by the field agent.
– Half-yearly verification of the household list is done by the
recorder.
– Medical officer of the PHC is expected to check and certify the
correctness of cause of death assignment by the field agent.
33. MORTALITY REPORTING IN INDIA
– From January 1999 a cause of death component has been added
to the SRS (RGI, 1999). This is called as the SRS-COD
component.
– The SRS part-time enumerator (PTE) records cause of death in
column 16 and the code in column 17 of the revised Form-5.
– A departure from the Survey Cause of Death-Rural form (used
previously) in this format is the elimination of the structured
questionnaire.
– In case of the urban areas, a medical certification of cause of
death (MCCD) scheme is operational.
34. MORTALITY REPORTING IN INDIA
– All medically attended deaths are expected to be registered along
with cause of death reports in a format which is similar to what
is prescribed by the WHO for International Classification of
Cause of Death (ICD).
– The responsibility for reporting cause of death rests with the
doctor /health care provider who last attended on the deceased.
– Reports are sent to the municipal health authorities, who forward
them to the concerned state vital statistics office.
– SRS covers 7597 sample units in India covering a
population of 73 lakhs. Haryana – 210 sample units
covering a population of 2.15 lakhs.
35. MORTALITY REPORTING IN INDIA
Three stages in SRS-COD form:
Stage I: To isolate major groups of disease
Stage II: Tries to aggregate similar symptoms pertaining to specific
diseases in each major group
Stage III: Symptoms specific to a particular disease are collected
leading to the probable cause of death
36. SRS FORMS
• Baseline Survey Forms
• Form 1: House List
• Form 2: Household Schedule
• Form 3: Pregnancy Status of Women
• Continuous Enumeration Forms
• Form 4: Outcome of Pregnancy recorded by Enumerator (jan-june;july-dec)
• Form 5: Deaths recorded by Enumerator
• Form 6: Monthly report of Outcome of Pregnancy
• Form 7: Monthly report of Deaths
• Compilation Tabulation Forms
• Form 8: Consolidated monthly report on births and deaths
• Form 11: Finalized list of Outcome of Pregnancy (jan-june;july-dec)
• Form 12: Finalized list of Deaths (jan-june;july-dec)
• Form 13: Results of HYS for Outcome of Pregnancy (jan-june;july-dec)
• Form 14: Results of HYS for deaths (jan-june;july-dec)
37. SRS FORMS
• Half yearly Survey Forms
• Form 9: Outcome of Pregnancy recorded by Supervisor (jan-june; july-
dec)
• Form 10: Deaths recorded by Supervisor (jan-june; july-dec)
• Form 15: Distribution of usual resident population by age, sex &
marital status
• Form 16: Distribution of Female population by broad age groups and
levels of education (as on 1st July/1st January)
• Form 17: Number of females who got married by age at effective
marriage (jan-june; july-dec)
38. Base Line Survey
(By supervisor with the help of enumerator)
Houselist Household schedule List of pregnant women
(Form 1) (Form 2) (Form 3)
Continuous Enumeration by Retrospective Survey by supervisor
(Half Yearly Survey)
Part Time Enumerator (PTE)
Updating Forms
BIRTHS DEATHS 1,2 & 3
(Form 4) (Form 5) BIRTHS DEATHS
Monthly report Monthly report MATCHING (Form 9) (Form 10)
(Form 6) (Form 7) Births: Form 4 with
Form 9
Deaths: Form 5 with
Form 10
Completely matched
Partially matched or unmatched
Form 11: Finalised list of births
RE-VERIFICATION
Correct birth & death Form 12: Finalised list of deaths
(Independently to another
Form 13: Result of HYS for births
supervisor) Transmission of Form 11 to
Form 14: Result of HYS for deaths
17 to ORGI
39. MORTALITY REPORTING IN INDIA
• Major groups of diseases covered are:
1. Accidents and injuries
2. Child birth and pregnancy
3. Fevers
4. Digestive disorders
5. Disorders of respiratory system
6. Disorders of central nervous system
7. Diseases of circulatory system
8. Other clear symptoms
9. Causes peculiar to infancy
10. Senility and
11. The rest
40. MORTALITY REPORTING IN INDIA
Under each one of the broad groups provision is made to record
specific diseases which are important. Such as:
• Rabies • Pneumonia
• Suicide • Paralysis
• Toxemia • Heart disease
• Puerperal Sepsis • Measles
• Typhoid • Tetanus
• Malaria • Cancer
• Cholera • Diabetes
• Malnutrition • Pre-maturity
• Tuberculosis • Cord infection etc.
Under each major group a „non-classifiable‟ group is provided
41. MORTALITY REPORTING IN INDIA
• The medical officer in charge supervises the entire work and trains
the staff in the scheme.
• The cause of death in every case is scrutinized by him. Besides, he
himself investigates the cause of death independently for at least one
out of every ten of the total deaths, in a month, by personally
visiting households and following the questionnaire. In case there is
a difference in cause of death by the medical officer and the field
agent, the one given by the medical officer is taken as final.
• It is considered that this independent investigation will not only
improve the accuracy of data but also serve as a check on the quality
of work.
42. COMMUNITY BASED MDR
• INFORMATION
– In case any maternal death takes place, ASHA/AWW
telephonically informs BLOCK MO & ANM of the area
immediately.
– ANM ensures that every maternal death in her area is reported to
the BLOCK MO immediately telephonically within 24 hrs of its
occurrence, and simultaneously she also gives information to the
BLOCK MO in report.
– BLOCK MO informs this maternal death immediately within 24
hours of receipt of information from ASHA/AWW/ANM to the
Civil Surgeon.
43. COMMUNITY BASED MDR
• LINE LISTING OF ALL DEATHS OF WOMEN OF AGE 15‐49
YEARS
– ASHA/AWW line lists all deaths of women of age 15 to 49 years
during the month, irrespective of cause or pregnancy status, and
she submits the monthly report to ANM by 5th of the following
month.
– In addition, she informs every such death to the ANM
telephonically also within 24 hours of its occurrence.
– The ANM cross checks every death line listed by ASHA/AWW
and submits the final report to the BLOCK MO by 10th of the
following month.
44. COMMUNITY BASED MDR
• INVESTIGATION
– BLOCK MO on receipt of information of the maternal death
deputes the designated investigation team for Community
Based Investigation (Verbal Autopsy) to be completed within 3
weeks of the death.
– BLOCK MO discusses and analyses the findings of every
maternal death investigated with the Investigation Team,
completes the Case Summary Sheet in duplicate for every
confirmed maternal death during the month and sends the report
to the Civil Surgeon within four weeks of the occurrence of the
death while keeping one copy for record.
45. COMMUNITY BASED MDR
• KEEPING RECORD OF ALL DEATHS OF WOMEN OF AGE
15‐49 YEARS
– All the deaths of women of age 15‐49 yrs, irrespective of the
cause of death or pregnancy status be line listed by the
ASHA/AWW every month and submitted by ANMs after cross
checking, are serially recorded at PHC by the BLOCK MO in
the Community Based MDR Register ( including the
confirmed maternal deaths).
• PARTICIPATION IN THE MEETING OF DISTRICT MDR
COMMITTEE
– BLOCK MO participates in the monthly review meeting of the
District MDR Committee chaired by the Civil Surgeon in the
following month.
46. COMMUNITY BASED MDR
• DISTRICT LEVEL MATERNAL DEATH REVIEW BY CIVIL
SURGEON (FBMDR + CBMDR)
– Civil Surgeon will constitute the District MDR Committee
comprising of MO (Obs. & Gynae.), Anaesthetist, Officer I/c
blood bank/blood storage centre, a Senior Nurse and invited
members from Facilities/Block PHCs as Members, and District
Nodal Officer MDR as Member Secretary of the Committee.
– Monthly review meeting of the District MDR Committee chaired
by Civil Surgeon and convened by District Nodal Officer every
month on a prefixed date.
47. COMMUNITY BASED MDR
• MATERNAL DEATH REVIEW BY DISTRICT HEALTH
SOCIETY UNDER THE CHAIRMANSHIP OF DEPUTY
COMMISSIONER (FBMDR + CBMDR)
– The review meeting will be attended by all the members of the
District Health Society or a selected group of DHS members as
deemed fit by the Deputy Commissioner.
– The other members to attend will be the District MDR
Committee members and any other member
incorporated/suggested by the DC which may include the family
members of the deceased who were present with the mother
during the treatment of complications or at the time of death.
– Monthly review meeting chaired by DC, convened by the
Civil Surgeon and assisted by the District Nodal Officer (2
relatives of the deceased to attend).
48. COMMUNITY BASED MDR
• STATE LEVEL MATERNAL DEATH REVIEW BY STATE
LEVEL TASK FORCE (SLTF). (FBMDR + CBMDR)
– Review meeting once in 3 months chaired by Principal
Secretary Health & Family Welfare (PSHFW).
49.
50.
51.
52.
53.
54. Table : Countries where verbal autopsy studies have been conducted
WHO Countries
Region
South- Afghanistan, Bangladesh, India, Nepal,
East Asia Pakistan, Indonesia
Africa Angola, Benin, Cameroon, Egypt, Ethiopia,
Gambia, Ghana, Guinea-Bissau, Kenya,
Malawi, Namibia, Nigeria, Senegal, South
Africa, Sudan, Tanzania, Uganda
South Mexico, Bolivia, Nicaragua
America
Western Papua New Guinea
Pacific
region
Eastern Syria, Jordan, Lebanon, Yemen
Mediterr
anean
Region
55. RECENT DEVELOPMENTS
• Currently, 36 Demographic Surveillance Sites (DSS) in 20
countries, the Sample Registration System (SRS) sites in India, and
the Disease Surveillance Points (DSP) in China regularly use VA on
a large scale, primarily to assess the causes-of-death structure of a
defined population.
• Despite such a widespread use of verbal autopsy, its difficult to
assess how consistent and reliable the data are.
• Another drawback: unable to replicate procedures used to assign
cause of death as verbal autopsy data sets are not widely shared, and
it is impossible to independently assess the quality of the
assignment.
56. RECENT DEVELOPMENTS
• WHO has now published (2012) : Verbal autopsy standards:
ascertaining and attributing cause of death.
• The new standards include:
– Verbal autopsy questionnaires for three age groups (under four
weeks; four weeks to 14 years; and 15 years and above);
– A cause-of-death list for verbal autopsy prepared according to
the ICD-10.
58. REFERENCES
• Lay reporting of health information for Primary health care. SEARO 1980
• Setting international standards for verbal autopsy. Available from:
www.who.int/bulletin/volumes/85/8/07-043745/en/index.html
• A Standard Verbal Autopsy Method for Investigating Causes of Death in
Infants and Children. World Health Organization Department of
Communicable Disease Surveillance and Response. Available from:
http://www.who.int/emc
• Causes of death in Rural Andhra Pradesh, India, Central Clinical School
Faculty of Medicine, University of Sydney June 2006.
• Framework and standards for country health information systems / Health
Metrics Network, World Health Organization. Available from:
http://www.healthmetricsnetwork.org.
• Guidelines for HMIS Reporting Format. 8th July, 2010
• SRS 2012. Available from:
http://www.censusindia.gov.in/vital_statistics/srs/Chap_1_-_2010.pdf
59. REFERENCES
• SRS flowchart. Available from:
http://www.censusindia.gov.in/vital_statistics/srs/Executive_Summary_201
0.pdf
• Status of Mortality Statistics Reporting in India A Report March 2007.
Central Bureau of Health Intelligence (CBHI). Available from:
www.cbhidghs.nic.in
• Lay reporting of health information. Geneva: World Health Organization;
1978
• Beyond the numbers: reviewing maternal deaths and complications to make
pregnancy safer. Geneva: World Health Organization; 2004.
• World Health Organization. International Statistical Classification of
Diseases and Related Health Problems (ICD). 10th Revision, Second
Edition. Geneva, World Health Organization, 2005. Available from:
http://www.who.int/classifications/icd/en/
• Applying ICD-10 to Verbal Autopsy. Available from:
9789241547215_part3_eng.pdf