Table 2.

Strategies for Mortality Measurement Improvement

Problem	Strategy for Improvement	Advantages	Disadvantages
Inaccurate death certificate coding of cause of death	Education on death certificate completion	Inexpensive, Evidence based	Unclear what the long-term impact would be (studies have evaluated only short-term impact)
	Increased autopsy rate	Gold standard for cause-of-death accuracy	Expensive
			Requires buy-in from physicians who may fear litigation or believe that clinical cause of death is certain
Lack of vital registration system	Complete vital registration system using death certificates	Completely accounts for all deaths in a nation, Does not require projected estimates	Requires tremendous infrastructure that is difficult to implement in resource-poor settings, Subject to inaccuracies of death certificates
	Sample vital registration system using death certificates and verbal autopsy	Inexpensive compared with complete vital registration system, minimal infrastructure required	Difficult to assess the validity of projected estimates, Verbal autopsy methods need better validation (eg, with autopsy) and standardization across studies
		Verbal autopsy allows cause-of-death determination when death certificates are not available
	Epidemiological modeling	No infrastructure required	Relies on accuracy of underlying data, which can be awed
			Makes many assumptions to project estimates