Free Content Validity of verbal autopsy procedures for determining cause of death in Tanzania

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Abstract:

Summary Objectives 

To validate verbal autopsy (VA) procedures for use in sample vital registration. Verbal autopsy is an important method for deriving cause-specific mortality estimates where disease burdens are greatest and routine cause-specific mortality data do not exist. Methods 

Verbal autopsies and medical records (MR) were collected for 3123 deaths in the perinatal/neonatal period, post-neonatal <5 age group, and for ages of 5 years and over in Tanzania. Causes of death were assigned by physician panels using the International Classification of Disease, revision 10. Validity was measured by: cause-specific mortality fractions (CSMF); sensitivity; specificity and positive predictive value. Medical record diagnoses were scored for degree of uncertainty, and sensitivity and specificity adjusted. Criteria for evaluating VA performance in generating true proportional mortality were applied. Results 

Verbal autopsy produced accurate CSMFs for nine causes in different age groups: birth asphyxia; intrauterine complications; pneumonia; HIV/AIDS; malaria (adults); tuberculosis; cerebrovascular diseases; injuries and direct maternal causes. Results for 20 other causes approached the threshold for good performance. Conclusions 

Verbal autopsy reliably estimated CSMFs for diseases of public health importance in all age groups. Further validation is needed to assess reasons for lack of positive results for some conditions.

Keywords: autopsy/methods; cause of death; child mortality; epidemiological measurements; epidemiological methods; vital statistics

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2006.01603.x

Affiliations: 1:  Department of Epidemiology and MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 2:  University of Newcastle upon Tyne School of Population and Health Sciences; Faculty of Medicine; Newcastle upon Tyne, UK 3:  SAVVY Regional Coordinator, MEASURE Evaluation and Tanzanian Ministry of Health, Dar es Salaam, Tanzania 4:  Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK 5:  Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland 6:  Department of Endocrinology and Metabolism, Imperial College, London, UK 7:  School of Population Health, University of Queensland, Herston, Australia

Publication date: May 1, 2006

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