ArticleGlobal health action2021
Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making.
Article in Global health action, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Patterns and determinants of COVID-19 mortality in Bangladesh: insights from three health and demographic surveillance systems across diverse socio-environmental settings.Population health metrics · 2026Article
- Evaluating the implementation of the vignettes-based injury care process assessment tool in low- and middle-income countries settings.BMC health services research · 2026Article
- Community-based health screening and all-cause mortality in rural South Africa: a longitudinal cohort study.BMJ public health · 2026Article
- Mortality in children and adolescents in Western Democratic Republic of Congo: retrospective analysis of verbal autopsy and demographic data from the Kimpese Health and Demographic Surveillance System.BMJ paediatrics open · 2025Article
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- Synthesizing a pragmatic and systemized measure of universal health coverage: verifying the circumstances of mortality CATegories of death investigated by verbal autopsy.Frontiers in public health · 2025Article
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- Realising radical potential: building community power in primary health care through Participatory Action Research.International journal for equity in health · 2023Article
- Community perception of causes of death using verbal autopsy for diabetes mellitus in Saudi Arabia.PLOS global public health · 2023Article
- A life in death: reflections of Peter.Global health action · 2021Article
- Article
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Authors and funding
10 authors.
Funding
Abstract
backgroundRecognising that the causes of over half the world's deaths pass unrecorded, the World Health Organization (WHO) leads development of Verbal Autopsy (VA): a method to understand causes of death in otherwise unregistered populations. Recently, VA has been developed for use outside research environments, supporting countries and communities to recognise and act on their own health priorities. We developed the Circumstances of Mortality Categories (COMCATs) system within VA to provide complementary circumstantial categorisations of deaths.
objectivesRefine the COMCAT system to (a) support large-scale population assessment and (b) inform public health decision-making.
methodsWe analysed VA data for 7,980 deaths from two South African Health and Socio-Demographic Surveillance Systems (HDSS) from 2012 to 2019: the Agincourt HDSS in Mpumalanga and the Africa Health Research Institute HDSS in KwaZulu-Natal. We assessed the COMCAT system's reliability (consistency over time and similar conditions), validity (the extent to which COMCATs capture a sufficient range of key circumstances and events at and around time of death) and relevance (for public health decision-making).
resultsPlausible results were reliably produced, with 'emergencies', 'recognition, 'accessing care' and 'perceived quality' characterising the majority of avoidable deaths. We identified gaps and developed an additional COMCAT 'referral', which accounted for a significant proportion of deaths in sub-group analysis. To support decision-making, data that establish an impetus for action, that can be operationalised into interventions and that capture deaths outside facilities are important.
conclusionsCOMCAT is a pragmatic, scalable approach enhancing functionality of VA providing basic information, not available from other sources, on care seeking and utilisation at and around time of death. Continued development with stakeholders in health systems, civil registration, community and research environments will further strengthen the tool to capture social and health systems drivers of avoidable deaths and promote use in practice settings.
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