A shortened verbal autopsy instrument for use in routine mortality surveillance systems

Serina, Peter, Riley, Ian, Stewart, Andrea, Flaxman, Abraham D., Lozano, Rafael, Mooney, Meghan D., Luning, Richard, Hernandez, Bernardo, Black, Robert, Ahuja, Ramesh, Alam, Nurul, Alam, Sayed Saidul, Ali, Said Mohammed, Atkinson, Charles, Baqui, Abdulla H., Chowdhury, Hafizur R., Dandona, Lalit, Dandona, Rakhi, Dantzer, Emily, Darmstadt, Gary L., Das, Vinita, Dhingra, Usha, Dutta, Arup, Fawzi, Wafaie, Freeman, Michael, Gamage, Saman, Gomez, Sara, Hensman, Dilip, James, Spencer L., Joshi, Rohina, Kalter, Henry D., Kumar, Aarti, Kumar, Vinita, Lucero, Marilla, Mehta, Saurabh, Neal, Bruce, Ohno, Summer Lockett, Phillips, David, Pierce, Kelsey, Prasad, Rajendra, Praveen, Devarsetty, Premji, Zul, Ramirez-Villalobos, Dolores, Rampatige, Rasika, Remolador, Hazel, Romero, Minerva, Said, Mwanaidi, Sanvictores, Diozele, Sazawal, Sunil, Streatfield, Peter K., Tallo, Veronica, Vadhatpour, Alireza, Wijesekara, Nandalal, Murray, Christopher J.L. and Lopez, Alan D. (2015) A shortened verbal autopsy instrument for use in routine mortality surveillance systems. BMC Medicine, 13 1: . doi:10.1186/s12916-015-0528-8


Author Serina, Peter
Riley, Ian
Stewart, Andrea
Flaxman, Abraham D.
Lozano, Rafael
Mooney, Meghan D.
Luning, Richard
Hernandez, Bernardo
Black, Robert
Ahuja, Ramesh
Alam, Nurul
Alam, Sayed Saidul
Ali, Said Mohammed
Atkinson, Charles
Baqui, Abdulla H.
Chowdhury, Hafizur R.
Dandona, Lalit
Dandona, Rakhi
Dantzer, Emily
Darmstadt, Gary L.
Das, Vinita
Dhingra, Usha
Dutta, Arup
Fawzi, Wafaie
Freeman, Michael
Gamage, Saman
Gomez, Sara
Hensman, Dilip
James, Spencer L.
Joshi, Rohina
Kalter, Henry D.
Kumar, Aarti
Kumar, Vinita
Lucero, Marilla
Mehta, Saurabh
Neal, Bruce
Ohno, Summer Lockett
Phillips, David
Pierce, Kelsey
Prasad, Rajendra
Praveen, Devarsetty
Premji, Zul
Ramirez-Villalobos, Dolores
Rampatige, Rasika
Remolador, Hazel
Romero, Minerva
Said, Mwanaidi
Sanvictores, Diozele
Sazawal, Sunil
Streatfield, Peter K.
Tallo, Veronica
Vadhatpour, Alireza
Wijesekara, Nandalal
Murray, Christopher J.L.
Lopez, Alan D.
Title A shortened verbal autopsy instrument for use in routine mortality surveillance systems
Journal name BMC Medicine   Check publisher's open access policy
ISSN 1741-7015
Publication date 2015-12-16
Sub-type Article (original research)
DOI 10.1186/s12916-015-0528-8
Open Access Status DOI
Volume 13
Issue 1
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Subject 2700 Medicine
Abstract Background: Verbal autopsy (VA) is recognized as the only feasible alternative to comprehensive medical certification of deaths in settings with no or unreliable vital registration systems. However, a barrier to its use by national registration systems has been the amount of time and cost needed for data collection. Therefore, a short VA instrument (VAI) is needed. In this paper we describe a shortened version of the VAI developed for the Population Health Metrics Research Consortium (PHMRC) Gold Standard Verbal Autopsy Validation Study using a systematic approach. Methods: We used data from the PHMRC validation study. Using the Tariff 2.0 method, we first established a rank order of individual questions in the PHMRC VAI according to their importance in predicting causes of death. Second, we reduced the size of the instrument by dropping questions in reverse order of their importance. We assessed the predictive performance of the instrument as questions were removed at the individual level by calculating chance-corrected concordance and at the population level with cause-specific mortality fraction (CSMF) accuracy. Finally, the optimum size of the shortened instrument was determined using a first derivative analysis of the decline in performance as the size of the VA instrument decreased for adults, children, and neonates. Results: The full PHMRC VAI had 183, 127, and 149 questions for adult, child, and neonatal deaths, respectively. The shortened instrument developed had 109, 69, and 67 questions, respectively, representing a decrease in the total number of questions of 40-55 %. The shortened instrument, with text, showed non-significant declines in CSMF accuracy from the full instrument with text of 0.4 %, 0.0 %, and 0.6 % for the adult, child, and neonatal modules, respectively. Conclusions: We developed a shortened VAI using a systematic approach, and assessed its performance when administered using hand-held electronic tablets and analyzed using Tariff 2.0. The length of a VA questionnaire was shortened by almost 50 % without a significant drop in performance. The shortened VAI developed reduces the burden of time and resources required for data collection and analysis of cause of death data in civil registration systems.
Formatted abstract
Background: Verbal autopsy (VA) is recognized as the only feasible alternative to comprehensive medical certification of deaths in settings with no or unreliable vital registration systems. However, a barrier to its use by national registration systems has been the amount of time and cost needed for data collection. Therefore, a short VA instrument (VAI) is needed. In this paper we describe a shortened version of the VAI developed for the Population Health Metrics Research Consortium (PHMRC) Gold Standard Verbal Autopsy Validation Study using a systematic approach.

Methods: We used data from the PHMRC validation study. Using the Tariff 2.0 method, we first established a rank order of individual questions in the PHMRC VAI according to their importance in predicting causes of death. Second, we reduced the size of the instrument by dropping questions in reverse order of their importance. We assessed the predictive performance of the instrument as questions were removed at the individual level by calculating chance-corrected concordance and at the population level with cause-specific mortality fraction (CSMF) accuracy. Finally, the optimum size of the shortened instrument was determined using a first derivative analysis of the decline in performance as the size of the VA instrument decreased for adults, children, and neonates.

Results: The full PHMRC VAI had 183, 127, and 149 questions for adult, child, and neonatal deaths, respectively. The shortened instrument developed had 109, 69, and 67 questions, respectively, representing a decrease in the total number of questions of 40-55 %. The shortened instrument, with text, showed non-significant declines in CSMF accuracy from the full instrument with text of 0.4 %, 0.0 %, and 0.6 % for the adult, child, and neonatal modules, respectively.

Conclusions: 
We developed a shortened VAI using a systematic approach, and assessed its performance when administered using hand-held electronic tablets and analyzed using Tariff 2.0. The length of a VA questionnaire was shortened by almost 50 % without a significant drop in performance. The shortened VAI developed reduces the burden of time and resources required for data collection and analysis of cause of death data in civil registration systems.
Keyword Verbal autopsy questionnaire
Mortality surveillance
Causes of death
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Public Health Publications
 
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