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Research
Use of verbal autopsy and social autopsy in humanitarian crises
  1. Lisa-Marie Thomas1,
  2. Lucia D’Ambruoso1,2,3,
  3. Dina Balabanova4
  1. 1 Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  2. 2 Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
  3. 3 MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  4. 4 Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
  1. Correspondence to Lisa-Marie Thomas; lisamarie.thomas.16{at}aberdeen.ac.uk

Abstract

Introduction Two billion people live in countries affected by conflict, violence and fragility. These are exceptional situations in which mortality shifts dramatically and in which civil registration and vital statistics systems are often weakened or cease to function. Verbal autopsy and social autopsy (VA and SA) are methods used to assign causes of death and understand the contexts in which these occur, in settings where information is otherwise unavailable. This review sought to explore the use of VA and SA in humanitarian crises, with a focus on how these approaches are used to inform policy and programme responses.

Methods A rapid scoping review was conducted on the use of VA and SA in humanitarian crises in low and middle-income countries since 1991. Drawing on a maximum variation approach, two settings of application (‘application contexts’) were selected and investigated via nine semi-structured expert interviews.

Results VA can determine causes of death in crisis-affected populations where no other registration system is in place. Combined with SA and active community involvement, these methods can deliver a holistic view of obstacles to seeking and receiving essential healthcare, yielding context-specific information to inform appropriate responses. The contexts in which VA and SA are used require adaptations to standard tools, and new mobile developments in VA raise specific ethical considerations. Furthermore, collecting and sythesising data in a timely, continuous manner, and ensuring coordination and communication between agencies, is important to realise the potential of these approaches.

Conclusion VA and SA are valuable research methods to foster evidence-informed responses for populations affected by humanitarian crises. When coordinated and communicated effectively, data generated through these methods can help to identify levels, causes and circumstances of deaths among vulnerable groups, and can enable planning and allocating resources effectively, potentially improving health system resilience to future crises.

  • health systems
  • health Policy
  • public health
  • qualitative study
  • review

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjgh-2017-000640

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors LMT: conducted the literature review and interviews, performed the analysis, and prepared the manuscript. LD: conceived of the study and study design, designed the data collection, supervised the analysis, and prepared the manuscript. DB: conceived of the study and study design, designed the data collection, supervised the analysis, and prepared the manuscript. All three authors are guarantors of the study.

    • Funding The research presented in this paper is supported by a programme grant as part of the Health Systems Research Initiative from the Department for International Development (DFID)/Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/P014844/1).

    • Disclaimer The lead author (LMT) affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study protocol, information sheet and consent procedure were approved by the College Ethics Review Board (CERB), University of Aberdeen (CERB/2017/5/1469).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Qualitative information is stored at a University of Aberdeen managed file-space. Data can be available upon prior permission from the University and the corresponding author can be contacted for further communication. Participants gave informed consent for data sharing.

    • Author note In accordance to the EQUATOR Network there is no checklist for this study design in the research area.

    • Correction notice This article has been corrected since it first published. The author affiliations have been corrected.