Validation of verbal autopsy: determination of cause of deaths in Malaysia 2013

Shubash Shander Ganapathy,Mohd Azahadi Omar,Mohamad Fuad Mohamad Anuar,Khoo Yi Yi,Chandrika Jeevananthan,Chalapati Rao

doi:10.1186/s12889-017-4668-y

Shubash Shander Ganapathy, Mohd Azahadi Omar + Show 4 more

Open Access

https://doi.org/10.1186/s12889-017-4668-y

Copy DOI

Abstract

BackgroundMortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Verbal autopsy (VA) is a very useful tool in diagnosing broad causes of deaths for events that occur outside health facilities. This article reports the development of the VA methods and our principal finding from a validation study.MethodsA cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used. A VA questionnaire suitable for local use was developed. Trained field interviewers visited the family members of the deceased at their homes and conducted face to face interviews with the next of kin. Completed questionnaires were reviewed by trained physicians who assigned multiple and underlying causes. Reference diagnoses for validation were obtained from review of medical records (MR) available for a sample of the overall study deaths.ResultsCorresponding MR diagnosis with matched sample of the VA diagnosis were available in 2172 cases for the validation study. Sensitivity scores were good (>75%) for transport accidents and certain cancers. Moderate sensitivity (50% - 75%) was obtained for ischaemic heart disease (64%) and cerebrovascular disease (72%). The validation sample for deaths due to major causes such as ischaemic heart disease, pneumonia, breast cancer and transport accidents show low cause-specific mortality fraction (CSMF) changes. The scores obtained for the top 10 leading site-specific cancers ranged from average to good.ConclusionWe can conclude that VA is suitable for implementation for deaths outside the health facilities in Malaysia. This would reduce ill-defined mortality causes in vital registration data, and yield more accurate national mortality statistics.

Highlights

Mortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy
Study design and objectives A cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used to ascertain causes of death using Verbal Autopsy (VA) methods
To develop a VA method suitable for local use, we reviewed international VA questionnaires and adapted these to the Malaysian setting

Summary

Introduction

Sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Sex and cause are the foundation and the most basic health data of a country. With the advent of improved health policies and research, appropriate assignment of cause of death and a reliable death registration is vital for health status assessment, epidemiological research and formation of health policy. Certified deaths are deaths occurring in health facilities or attended by a medical officer. TOTAL ITEMS sections of the form, to ensure that all relevant clinical characteristics of the case are adequately documented and captured in the abstraction form to aid the determination of cause of death

Methods

Results

Discussion

Conclusion