Abstract
Objectives: This methodology paper outlines a mixed-methods study design to: (i) further validate the Child Health Epidemiology Reference Group (CHERG) Verbal-Social Autopsy (VASA) tool quantitatively on a larger representative sample in Karachi, (ii) gather qualitative feedback from users, and (iii) refine the tool accordingly to optimize its use investigating under-5 mortality in urban Pakistan.
 Methods: An explanatory sequential mixed methods design will be applied to revalidate the CHERG VASA tool in 7 districts of Karachi. The quantitative arm will validate the tool through analysis of data from under-5 deaths identified via stratified random sampling. Validation techniques will include assessment of criterion validity against hospital records, content validity, construct validity, reliability analysis. This will be followed by a qualitative component with cognitive interviews and focus group discussions with respondents to illicit feedback on user experiences with the tool. Qualitative data will undergo framework analysis. Tool refinement will occur integrating both quantitative and qualitative findings.
 Discussion: Combining robust statistical validation from a substantial representative sample with in-depth qualitative insights on tool design and functionality will lead to an enhanced context-specific instrument to reliably investigate determinants of under-5 mortality in the slums of Karachi, Pakistan’s largest city.
 Keywords: verbal autopsy, social autopsy, validity, reliability, scale validation, mixed-methods
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