Diagnostic accuracy of WHO verbal autopsy tool for ascertaining causes of neonatal deaths in the urban setting of Pakistan: a hospital-based prospective study

Abstract

BackgroundGlobally, clinical certification of the cause of neonatal death is not commonly available in developing countries. Under such circumstances it is imperative to use available WHO verbal autopsy tool to ascertain causes of death for strategic health planning in countries where resources are limited and the burden of neonatal death is high. The study explores the diagnostic accuracy of WHO revised verbal autopsy tool for ascertaining the causes of neonatal deaths against reference standard diagnosis obtained from standardized clinical and supportive hospital data.MethodsAll neonatal deaths were recruited between August 2006 –February 2008 from two tertiary teaching hospitals in Province Sindh, Pakistan. The reference standard cause of death was established by two senior pediatricians within 2 days of occurrence of death using the International Cause of Death coding system. For verbal autopsy, trained female community health worker interviewed mother or care taker of the deceased within 2–6 weeks of death using a modified WHO verbal autopsy tool. Cause of death was assigned by 2 trained pediatricians. The performance was assessed in terms of sensitivity and specificity.ResultsOut of 626 neonatal deaths, cause-specific mortality fractions for neonatal deaths were almost similar in both verbal autopsy and reference standard diagnosis. Sensitivity of verbal autopsy was more than 93 % for diagnosing prematurity and 83.5 % for birth asphyxia. However the verbal autopsy didn’t have acceptable accuracy for diagnosing the congenital malformation 57 %. The specificity for all five major causes of neonatal deaths was greater than 90 %.ConclusionThe WHO revised verbal autopsy tool had reasonable validity in determining causes of neonatal deaths. The tool can be used in resource limited community-based settings where neonatal mortality rate is high and death certificates from hospitals are not available.

In-depth Validation of CHERG’S Verbal Autopsy-Social Autopsy (VASA) Tool for Ascertaining Determinants and Causes of Under-Five Child Mortalities in Karachi, Pakistan.

“…Nausheen et al (18) undertook validation on 204 neonatal deaths; the sample size in Soo et al (19) was 626 neonatal deaths, and Marsha et al (14) used 137 neonatal deaths.…”

“…Events (or symptoms) with extraordinary severity (or implications) remain in the recall for a much more extended period compared to those with mild to moderate severity (28). Likewise all the other studies (14,18,19,29), our study undertook interviews within the six (06) weeks after the mortality event. In our sample size, none of the respondents had any di culty in recalling the events.…”

“…In order to obtain best possible data, many efforts have been undertaken globally in re ning the methodology of VA (13)(14)(15)(16)(17)(18)(19). In continuation of such efforts, a few of the validation studies have been undertaken globally as well as in Pakistan to assess the capacity of VA tool in providing precise and reliable evidence on the causes of child mortality (13,14,18,19). However, no attempts have been made in validating the SA, as well as the integrated VASA tool.…”

Pattern of all-causes and cause-specific mortality in an area with progressively declining malaria burden in Korogwe district, north-eastern Tanzania

“…This approach has increasingly become a useful alternative method for estimating cause-specific mortality in areas without vital registration systems [9], despite some technical limitations such as recall bias, questionnaire design, choice of interviewers and respondents, and mechanism for establishing causes of death [10]. The method has been extensively validated and adopted for estimating cause-specific mortality under different settings [11].…”

Opportunities and Challenges in Global Perinatal Research

“…For the past decade, the WHO verbal autopsy tool, a lengthy, structured interview with the next of kin, has become the primary method for ascertaining cause-of-death [25]. When compared to hospital data, verbal autopsy has been shown to have a specificity above 90% and a sensitivity greater than 75% for the top 3 causes of neonatal death [26]. Therefore, any implementation research aimed at reducing a specific cause-of-death must allocate sufficient resources and time to both collect and interpret verbal autopsies.…”