Abstract
BackgroundVerbal autopsy (VA) is an established tool for assessing cause-specific mortality patterns in communities where deaths are not routinely medically certified, and is an important source of data on deaths among the poorer half of the world's population. However, the repeatability of the VA process has never been investigated, even though it is an important factor in its overall validity. This study analyses repeatability in terms of the overall VA process (from interview to cause-specific mortality fractions (CSMF)), as well as specifically for interview material and individual causes of death, using data from Burkina Faso and Indonesia.MethodsTwo series of repeated VA interviews relating to women of reproductive age in Burkina Faso (n = 91) and Indonesia (n = 116) were analysed for repeatability in terms of interview material, individual causes of death and CSMFs. All the VA data were interpreted using the InterVA-M model, which provides 100% intrinsic repeatability for interpretation, and thus eliminated the need to consider variations or repeatability in physician coding.ResultsThe repeatability of the overall VA process from interview to CSMFs was good in both countries. Repeatability was moderate in the interview material, and lower in terms of individual causes of death. Burkinabé data were less repeatable than Indonesian, and repeatability also declined with longer recall periods between the death and interview, particularly after two years.ConclusionWhile these analyses do not address the validity of the VA process in absolute terms, repeatability is a prerequisite for intrinsic validity. This study thus adds new understanding to the quest for reliable cause of death assessment in communities lacking routine medical certification of deaths, and confirms the status of VA as an important and reliable tool at the community level, but perhaps less so at the individual level.
Highlights
Verbal autopsy (VA) is an established tool for assessing cause-specific mortality patterns in communities where deaths are not routinely medically certified, and is an important source of data on deaths among the poorer half of the world's population
None of this work has objectively assessed the repeatability of the overall VA process, nor of its constituent parts
Educational levels among both the deceased women and the VA respondents were much lower in Burkina Faso than in Indonesia, as were the availability of amenities such as piped water and television
Summary
Verbal autopsy (VA) is an established tool for assessing cause-specific mortality patterns in communities where deaths are not routinely medically certified, and is an important source of data on deaths among the poorer half of the world's population. Following early VA work in West Africa [2], there have been a number of efforts towards standardisation of VA procedures Much of this has concentrated on the standardisation of interview questionnaires, culminating in WHO's recently published standards [3]. Other studies have made comparisons between VAderived cause of death and arguably "harder" evidence, such as hospital records for deaths occurring in institutions [9,10,11,12,13] Some of these have been described as "validation" studies for VA, they have generally only considered selected parts of the overall VA process. None of this work has objectively assessed the repeatability of the overall VA process (from individual interviews to aggregated mortality patterns), nor of its constituent parts (interviews, interpretations, individual causes of death, aggregated mortality patterns)
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