Core Verbal Autopsy Procedures with Comparative Validation Results from Two Countries

Kathleen Kahn,Philip W Setel,Daniel Chandramohan,K G M M Alberti,Yusuf Hemed,Alan D Lopez,Chalapati Rao,David R Whiting,Gonghuan Yang

doi:10.1371/journal.pmed.0030268

Abstract

BackgroundCause-specific mortality statistics remain scarce for the majority of low-income countries, where the highest disease burdens are experienced. Neither facility-based information systems nor vital registration provide adequate or representative data. The expansion of sample vital registration with verbal autopsy procedures represents the most promising interim solution for this problem. The development and validation of core verbal autopsy forms and suitable coding and tabulation procedures are an essential first step to extending the benefits of this method.Methods and FindingsCore forms for peri- and neonatal, child, and adult deaths were developed and revised over 12 y through a project of the Tanzanian Ministry of Health and were applied to over 50,000 deaths. The contents of the core forms draw upon and are generally comparable with previously proposed verbal autopsy procedures. The core forms and coding procedures based on the International Statistical Classification of Diseases (ICD) were further adapted for use in China. These forms, the ICD tabulation list, the summary validation protocol, and the summary validation results from Tanzania and China are presented here.ConclusionsThe procedures are capable of providing reasonable mortality estimates as adjudged against stated performance criteria for several common causes of death in two countries with radically different cause structures of mortality. However, the specific causes for which the procedures perform well varied between the two settings because of differences in the underlying prevalence of the main causes of death. These differences serve to emphasize the need to undertake validation studies of verbal autopsy procedures when they are applied in new epidemiological settings.

Highlights

Only about a third of all deaths are registered with age, sex, and cause [1]
The specific causes for which the procedures perform well varied between the two settings because of differences in the underlying prevalence of the main causes of death
These differences serve to emphasize the need to undertake validation studies of verbal autopsy procedures when they are applied in new epidemiological settings

Summary

Introduction

Only about a third of all deaths are registered with age, sex, and cause [1]. Cause-specific mortality statistics remain scarce for the majority of low-income countries, where the highest disease burdens are experienced. People living in developed countries take it for granted that when a loved one dies an accurate cause-of-death certificate will be issued. Detailed information about what people die from is unavailable for more than 50% of countries, many of which have high death rates. This information is badly needed for public-health planning, for using scarce health resources wisely, and for monitoring the effect of new health initiatives. One way to improve knowledge about what people die from is a procedure called verbal autopsy (VA). Doctors review the completed VA forms and assign a specific cause of death from a short version of the International Classifications of Diseases, or ICD, an internationally agreed on list of codes for hundreds of diseases

Methods

Results

Discussion

Conclusion