Abstract
BackgroundIn resource- poor settings, verbal autopsy data are often reviewed by physicians in order to assign the probable cause of death. But in addition to being time and energy consuming, the method is liable to produce inconsistent results. The aim of this study is to evaluate the performance of the InterVA 3.2 model for establishing pulmonary tuberculosis as a cause of death in comparison with physician review of verbal autopsy data.MethodsA population-based cross-sectional study was conducted from March to April, 2012. All adults aged ≥14 years and died between 01 January 2010 and 15 February 2012 were included in the study. Data were collected by using a pre-tested and modified WHO designed verbal autopsy questionnaire. The verbal autopsy interviews were reviewed by the InterVA model and the physicians. Cohen’s kappa statistic, receiver operating characteristic curves, sensitivity, and specificity values were applied to compare the agreement between the InterVA model and the physician review.ResultsA total of 408 adult deaths were studied. The proportion of tuberculosis-specific mortality was established to be 36.0% and 23.0% by the InterVA model and the physicians, respectively. The InterVA model predicted pulmonary tuberculosis as a cause of death with the probability of 0.80 (95% CI: 0.75-0.85). In classifying all deaths as tuberculosis and non-tuberculosis, the sensitivity and specificity values were 0.82 and 0.78, respectively. A moderate agreement was found between the model and physicians in assigning pulmonary tuberculosis as a cause of deaths [kappa= 0.5; 95% CI: (0.4-0.6)].ConclusionsThis study has revealed that the InterVA model showed a more promising result as a community-level tool for generating pulmonary tuberculosis-specific mortality data from verbal autopsy. The conclusion is believed to provide policymakers with a highly needed piece of information for allocating resources for health intervention.
Highlights
In resource- poor settings, verbal autopsy data are often reviewed by physicians in order to assign the probable cause of death
There have been various attempts at validating physician reviews [4,5], but there appears several concerns that arise from using this methodology to interpret Verbal autopsy (VA) data
There may be inter- and intra-reviewer variability among physicians that may lead to inconsistencies in causes of death (COD) data hindering reliable temporal and spatial comparisons of mortality [6,7]
Summary
In resource- poor settings, verbal autopsy data are often reviewed by physicians in order to assign the probable cause of death. The aim of this study is to evaluate the performance of the InterVA 3.2 model for establishing pulmonary tuberculosis as a cause of death in comparison with physician review of verbal autopsy data. Developing countries generally lack consistent, timely, and reliable information on pulmonary tuberculosis (PTB)-specific causes of death (COD) in their populations [1]. Physicians may differ systematically in their methods of interpreting VA data owing to their training, experience, and/or perceptions of local epidemiology. There may be inter- and intra-reviewer variability among physicians that may lead to inconsistencies in COD data hindering reliable temporal and spatial comparisons of mortality [6,7]. The physician review process often demands a considerable amount of physician time and can incur remunerative costs [8]
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