Abstract
Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and InterVA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making.
Highlights
Within the past few decades there has been a substantial progress in the reduction of child mortality globally
The result of this review clearly showed that Physician-Certified Verbal Autopsy (PCVA) is the most widely used Verbal Autopsy (VA) method to determine child mortality Cause of Death (COD) in sub-Saharan Africa
The outcome of this review clearly showed that none of the VA methods are a one-size-fits-all approach and like Leitao et al [42] reported, none of the methods consistently outperformed the others across selected CODs, for both individuals and population-level COD assignment
Summary
Within the past few decades there has been a substantial progress in the reduction of child mortality globally. Recent statistics from the World Health Organization (WHO) Global Health Observatory Data Repository showed that in sub-Saharan Africa, infant, neonatal and under-five mortality rates per 1000 live births reduced from 93.5, 40.9 and 154 in 2000 to 53.9, 27.7 and 79.5 in 2015 respectively [2]. Despite these appreciable reductions, the child mortality rate in sub-Saharan Africa remains unacceptably high. The sub-region, is still the home to all six countries (Central African Republic, Chad, Mali, Nigeria, Sierra Leone and Somalia) with an under-five mortality rate above 100 deaths per 1,000 live births [1, 2]. The probability that a child, aged 5 dies before reaching his or her fifteenth birthday in sub-Saharan Africa is 17 times higher than the average in high-income countries [1]
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