Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool

Byass, Peter; Chandramohan, Daniel; Clark, Samuel J.; D’Ambruoso, Lucia; Fottrell, Edward; Graham, Wendy; Herbst, Abraham J; Hodgson, Abraham; Hounton, Sennen; Kahn, Kathleen; Krishnan, Anand; Leitao, Jordana; Odhiambo, Frank; Sankoh, Osman; Tollman, Stephen

doi:10.3402/gha.v5i0.19281

Cited by 192 publications

(250 citation statements)

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“…A detailed description of the InterVA-4 model has been given elsewhere [17]. In brief, the InterVA-4 model is a computer based logarithm which uses Bayes’ theorem in an attempt to overcome limitations of alternative methods [17–20], such as physician coding. InterVA-4 ascertains probable cause(s) of death for each VA case based on expert algorithms and relevant available medical data [21].…”

Section: Methodsmentioning

confidence: 99%

Cause-specific mortality in the Kombewa health and demographic surveillance systems site, rural Western Kenya from 2011–2015

Sifuna

Otieno

Ogwang

et al. 2018

Global Health Action

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Background: The vast majority of deaths in the health and Kombewa demographic surveillance system (HDSS) study area are not registered and reported through official systems of vital registration. As a result, few data are available regarding causes of death in this population. Objectives: To describe causes of death among residents of all ages in the Kombewa HDSS, located in rural Western Kenya. Methods: Verbal autopsy (VA) interviews at the site were conducted using the modified 2007 and later 2012 standardized WHO questionnaires. Assignment of causes of death was made using the InterVA-4 model version 4.02. Cox regression model, adjusted for sex, was built to evaluate the influence of age on mortality. Results: There were a total of 5196 deaths recorded between 2011 and 2015 at the site. VA interviews were successfully completed for 3903 of these deaths (75.1%). Mortality rates were highest among neonates HR = 38.54 (<0.001) and among Infants HR = 2.07 (<0.006) in the Kombewa HDSS. Among those deaths in which VA was performed, the top causes of death were HIV/AIDS (12.6%), Malaria (10.3%), Pneumonia (10.1%), Acute abdomen (7.0%), Stroke (5.2%) and TB (4.9%) for the whole population in general. Stroke, acute abdomen heart diseases and Pneumonia were common causes of death (CODs) among the elderly over the age of 65. Conclusions: The analysis established the main CODs among people of all ages within the area served by the Kombewa HDSS. We hope that information generated from this study will help better address preventable deaths in the surveyed community as well as help mitigate negative health impacts in other rural communities throughout the Western Kenya region.

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Section: Methodsmentioning

confidence: 99%

Cause-specific mortality in the Kombewa health and demographic surveillance systems site, rural Western Kenya from 2011–2015

Sifuna

Otieno

Ogwang

et al. 2018

Global Health Action

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“…In Mlomp, the illness history section of the VAs may include some information on the patient’s mobility before death that might influence the physician’s interpretation. But the illness history is not taken into account in the inter-VA-4 software [31]. Previous research has shown ‘a moderate agreement’ between causes of death derived from the inter-VA software and diagnosed by physicians [44,45].…”

Section: Discussionmentioning

confidence: 99%

“…Otherwise, the cause of death is categorized as ‘indeterminate’ [30]. The most widely used automated method on INDEPTH sites is the one based on Bayes’ theorem implemented in the InterVA-4 software [31]. …”

Section: Methodsmentioning

confidence: 99%

Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal

Lankoandé

Duthé

Soura

et al. 2018

Global Health Action

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Background: In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources. Little is known about population mobility at the end of life. Objective: To document the magnitude, motivations and associated factors of short-term mobility before death among adults over 15 years of age in Burkina Faso and Senegal. Methods: The study was based on deaths of adult residents reported in three Health and Demographic Surveillance System (HDSS) sites in urban (Ouagadougou) and semi-rural areas (Kaya) of Burkina Faso, and rural areas of Senegal (Mlomp). After excluding deaths from external causes, the analysis covered, respectively, 536 and 695 deaths recorded during the period 2012–2015 in Ouagadougou and Kaya. The period was extended to 2000–2015 in Mlomp, with a sample of 708 deaths. Binary logistic regressions were used to examine the effects of socio-demographic characteristics on place of death (health facility or not) and location of death (within or outside the HDSS). Results: In Mlomp, Kaya and Ouagadougou, respectively 20.6%, 5.3% and 5.9% of adults died outside the HDSS site. In Mlomp and Kaya, these deaths were more likely to occur in a health facility than deaths that occurred within the site. The reverse situation was found in Ouagadougou. Age is the strongest determinant of mobility before death in Mlomp and Kaya. In Mlomp, young adults (15–39) were 10 times more likely to die outside the site than adults in the 60–79 age group. In Ouagadougou, non-natives were three times more likely to die outside the city than natives. Conclusions: At the end of life, some rural residents move to urban areas for medical treatment while some urban dwellers return to their village for supportive care. These movements of dying individuals may affect the estimation of urban/rural mortality differentials.

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“…Further research  New developments in the use of standardised verbal autopsy instruments, [323][324][325][326] and refinements of automated methods for the interpretation of verbal autopsy data, 118,[327][328][329][330] offer easy-to-implement and reliable analytical methods that are less expensive and quicker than physician certification in traditional verbal autopsy methods. 325,326,331 Implementation and evaluation research related to these methods are necessary to ensure local applicability and community acceptance.…”

mentioning

confidence: 99%

“…325,326,331 Implementation and evaluation research related to these methods are necessary to ensure local applicability and community acceptance. suggests improved cause-of-death data at the district level, and that the linkage study results have been useful for developing adjustment factors.…”

mentioning

confidence: 99%

Availability and quality of vital registration mortality data in South Africa: a national and surveillance site perspective

Joubert¹

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The importance of valid and reliable mortality data as a key input for public and population health planning and research, and development programmes, is globally acknowledged.However, few low-and middle-income countries have such data. Even fewer have assessed the quality of their mortality data. Despite the particular utility of periodic, independent evaluations of national mortality statistics by countries themselves, such an evaluation has not yet been conducted for South Africa. Neither has a review been conducted of the sources of mortality data in South Africa since 1995. Regarding causes of death, a few small-scale studies assessed data quality in urban settings, but no study yet in civil registration mortality data in a rural setting. In addition, notwithstanding district health managers' critical need to know the health care needs of their district population current district mortality profiles are accompanied by strong warnings of invalid data.These gaps in essential public-and population-health intelligence present important reasons for research on the availability and quality of mortality data in South Africa.The primary aim of this body of research was to assess the quality of mortality data in the national CRVS system of South Africa. As alternative mortality data sources can complement or evaluate the quality of CRVS data, a secondary aim was to identify and review alternative mortality data sources, and assess the availability, strengths, and limitations of their data. A further aim was to conduct a field study to link and compare CRVS and Agincourt HDSS mortality data for the same individuals with the purpose of quantifying the level of completeness of death registration into the CRVS system, and assess the level of agreement between CRVS and verbal autopsy cause-of-death data. Seven research questions have been addressed towards achieving these aims. Different approaches were followed, including: (a) a mortality data source review and appraisal of the availability, strengths and limitations of different sources; (b) a comprehensive evaluation of national CRVS mortality data based on demographic and epidemiological principles; (c) a detailed record-linkage study applying both deterministic and probabilistic approaches; and (d) an application of adjustment factors from the linkage study to improve district-level cause-of-death data quality.iii The data source review found a rich and varied list of mortality data sources. Recent transformation in South Africa has enhanced mortality data availability from CRVS. Detailed cause-of-death data are available from civil registration and demographic surveillance.Additionally, a range of mortality data items are available in three population censuses, three demographic surveillance systems, and various national surveys, mortality audits and disease-notification programmes. Employing nine criteria to evaluate the quality of national CRVS mortality data, the data were rated satisfactory for coverage and completeness of death registration, temporal c...

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Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool

Cited by 192 publications

References 23 publications

Cause-specific mortality in the Kombewa health and demographic surveillance systems site, rural Western Kenya from 2011–2015

Cause-specific mortality in the Kombewa health and demographic surveillance systems site, rural Western Kenya from 2011–2015

Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal

Availability and quality of vital registration mortality data in South Africa: a national and surveillance site perspective

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