Integrated multisource estimates of mortality for Thailand in 2005

This commentary relates to a set of four papers by Rao and colleagues that relate to a detailed investigation of cause-specific mortality in Thailand during 2005, integrating a number of different data sources. Paper I considers the rationale and methods for starting with routine death registration data, but complementing these with other data in order to arrive at more coherent overall estimates [1]. About one-third of registered deaths in Thailand occur in hospitals, and paper II looks into the validity of the registered causes of these deaths, using additional information from medical records and verbal autopsies, in order to attribute misclassification errors [2]. For the majority of deaths, which occur outside hospitals, registered causes can only be validated by carrying out verbal autopsies, and this process is covered in paper III [3], which also provides part of the validation comparisons for the hospital deaths in paper II. Paper IV then integrates the findings from papers II and III into a complete overview and estimate of mortality for Thailand in 2005, with a discussion of implications for practice and policy [4]. The somewhat complex inter-relationships between these four papers are illustrated conceptually in Figure 1, with paper I being an overview of the whole.Although paper I characterizes Thailand in terms of its record in documenting mortality in recent decades, it is also important to understand the position of Thailand in relation to other nations in terms of demographic, socioeconomic, and other contextual factors. The approach used in this whole series of papers is not uniquely applicable to Thailand, but at the same time would not be appropriate in appreciably more or less developed contexts.According to UNICEF [5], in 2005, Thailand was ranked 108 out of 190 of the world's countries in terms of under-5 mortality, putting it close to countries such as Saudi Arabia, Tunisia, Colombia, Jamaica, and Romania. Cumulative under-5 mortality was 21