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Epidemiological transition in a rural community of northern India: 18-year mortality surveillance using verbal autopsy
  1. Rajesh Kumar1,
  2. Dinesh Kumar1,
  3. J Jagnoor2,
  4. Arun K Aggarwal1,
  5. P V M Lakshmi1
  1. 1School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2George Institute for Global Health, Sydney, Australia
  1. Correspondence to Dr Rajesh Kumar, Prof. & Head, PGIMER School of Public Health, Chandigarh 160012, India; dr.rajeshkumar{at}


Background Information on causes of death is vital for planning of health services. However, vital events registration systems are weak in developing countries. Therefore, verbal autopsy (VA) tools were incorporated in a community-based surveillance system to track causes of death.

Method and Findings Trained fieldworker identified all deaths and interviewed a living relative of those who had died during 1992–2009, using VA, in eight villages of Haryana (11 864 populations). These field reports detailing events preceding death were reviewed by two trained physicians, who independently assigned an International Classification of Disease-10 code to each death. Discrepancies were resolved through reconciliation and, if necessary, adjudication. Non-communicable conditions were the leading causes of death (47.6%) followed by communicable diseases including maternal, perinatal and nutritional conditions (34.0%), and injuries (11.4%). Cause of death could not be determined in 6.9% cases. Deaths due to cardiovascular diseases showed a significant rise, whereas deaths due to diarrhoeal diseases have declined (p<0.01). Majority (90.0%) of the deceased had contacted a healthcare provider during illness but only 11.5% were admitted in hospital before death.

Conclusion Rising trend of cardiovascular diseases observed in a rural community of Haryana in India calls for reorientation of rural healthcare delivery system for prevention and control of chronic diseases.

  • Verbal autopsy
  • surveillance
  • cause of death
  • epidemiological transition
  • epidemiology
  • public health
  • preventive medicine

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  • Funding Post Graduate Institute of Medical Education and Research Chandigarh (India) had provided resources for conducting this study.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Institute Ethics Committee.

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