Death Analysis - ICMR to find out what kills Indians

With India having a very poor death record, the country's top medical research agency has begun to set up a process, which in future would inform the health authorities the cause of every death in India.

Indian Council of Medical Research would begin the pilot programme of the death analysis study in Tamil Nadu, Assam and Odisha from January 2018, Sanjay Mehendale, ICMR's additional deputy director general said.

The process, they would employ, is called verbal autopsy in which a trained health worker would visit every house with a set of questions, seeking answers from the relatives. On the basis of the responses, doctors would ascertain the cause of the death. This is used only for those cases where a person died without any medical record.

In the verbal autopsy process, scientific skills are utilised to frame the questions to bring out the correct answers.

"Verbal autopsy methods have improved significantly over the past decade, with validated questionnaires and automated cause-of-death analysis," said Rohina Joshi, a researcher at the Delhi-based George Institute for Global Health, who is not linked to the ICMR project.

“We need 10-15 outreach workers to cover the entire district. The workers will have to visit the houses within a month of the death. We intend to start the pilots by January 2018,” Soumya Swaminathan, ICMR director general said.

The same method was adopted for the Million Death Study – one of the world's largest mortality studies in the world conducted by Indian and Canadian public health experts in collaboration with the Registrar General of India.

“We want the system to improve our cause of death estimates. If we know the causes, we can plan the right medical intervention,” Soumya said.

On an average, nearly 55-60 lakh Indians die each year. ICMR's latest disease burden report showed in 1990 most of the death (53.6%) happened due to communicable, maternal, neonatal and nutritional diseases whereas, in 2016 non-communicable diseases like cancer, stroke and cardiovascular diseases cause most (61.8%) of deaths. There is also a marginal rise in deaths due to injury.

While such broad-picture scenario is available currently, a verbal autopsy would generate more area and disease-specific death data.

The disease burden report shows that life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males.

There were, however, continuing inequalities between states, with a range of 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and 63.6 years in Assam to 73.8 years in Kerala for males in 2016.