Assessing the feasibility and appropriateness of verbal autopsy using contact information of the deceased from burial records in urban Bangladesh

Background: Bangladesh faces significant challenges in accurately documenting causes of death (COD), largely due to incomplete vital registration systems, which lack COD reporting. A substantial number of deaths occur outside health facilities, often without medical certification, leading to further gaps in mortality data. Verbal autopsy (VA) has emerged as a viable method in low-resource settings to bridge this gap. We aimed to explore the feasibility and appropriateness of using VA by tracking burial records' contact information to enhance mortality documentation and inform health policies in the graveyards of urban Bangladesh. Methods: We employed an exploratory design using both quantitative and qualitative methods. We conducted VAs using the contact details from six graveyards' burial records of Dhaka North City Corporation in Bangladesh, identifying participants through random sampling. In-depth interviews with data collectors, graveyard managers, and study participants provided insights into the feasibility and challenges of this process. We collected the data using the World Health Organization VA tool and assigned CODs using the InSilicoVA algorithm, applying thematic analysis to qualitative findings. We compared mortality trends with national data sets. Results: We conducted 531 VAs using the contact information from burial site records in Dhaka North City Corporation graveyards, with sub-optimal consent rates varying by location. The leading CODs were acute respiratory infections (21%) and cardiac disease (19%), demonstrating the practicality of obtaining COD from the VA, and the feasibility of collecting burial records and contact details, if consent rates could be improved. Qualitative findings indicated that using burial records for such data collection faces obstacles, including low response rates, socioeconomic disparities in participation, difficulty finding contacts, and sampling inconsistencies. Conclusions: We are the first to explore VA using contact information from burial records in urban Bangladesh. While the approach shows promise, the current feasibility results are of limited value without substantially improving consent coverage, representativeness, and standardisation. Only with these improvements can this method meaningfully strengthen COD documentation and provide reliable insights into population-level mortality trends.