Validating the InterVA-5 cause of death analytical tool: using mortality data from the Comprehensive Health and Epidemiological Surveillance System in Papua New Guinea

Abstract

ObjectiveInterVA-5 is a new version of an analytical tool for cause of death (COD) analysis at the population level. This study validates the InterVA-5 against the medical review method, using mortality data in Papua New Guinea (PNG).Design and settingThis study used mortality data collected from January 2018 to December 2020 in eight surveillance sites of the Comprehensive Health and Epidemiological Surveillance System (CHESS), established by the PNG Institute of Medical Research in six major provinces.MethodsThe CHESS demographic team conducted verbal autopsy (VA) interviews with close relatives of the deceased, who died in communities within the catchment areas of CHESS, using the WHO 2016 VA instrument. COD of the deceased was assigned by InterVA-5 tool, and independently certified by the medical team. Consistency, difference and agreement between the InterVA-5 model and medical review were assessed. Sensitivity and positive predictive value (PPV) of the InterVA-5 tool were calculated with reference to the medical review method.ResultsSpecific COD of 926 deceased people was included in the validation. Agreement between the InterVA-5 tool and medical review was high (kappa test: 0.72; p<0.01). Sensitivity and PPV of the InterVA-5 were 93% and 72% for cardiovascular diseases, 84% and 86% for neoplasms, 65% and 100% for other chronic non-communicable diseases (NCDs), and 78% and 64% for maternal deaths, respectively. For infectious diseases and external CODs, sensitivity and PPV of the InterVA-5 were 94% and 90%, respectively, while the sensitivity and PPV of the medical review method were both 54% for classifying neonatal CODs.ConclusionThe InterVA-5 tool works well in the PNG context to assign specific CODs of infectious diseases, cardiovascular diseases, neoplasms and injuries. Further improvements with respect to chronic NCDs, maternal deaths and neonatal deaths are needed.

Causes of death among women of reproductive age during the war in Tigray, Ethiopia

“…While 10.2% of the women died of cardiovascular and circulatory disorders, other and unspecified cardiac diseases were the third leading CoD, comprising more than half of the cardiovascular and circulatory disorders. Although cardiac diseases in general are prevalent and among the leading top CoD in Ethiopia [ 37 , 38 ], report show that other and unspecified cardiac diseases may have low positive predictive value against medical review [ 39 ].…”

Assessing health impact of COVID-19 and associated household socioeconomic factors in Papua New Guinea: evidence from the Comprehensive Health and Epidemiological Surveillance System

“…As the data were collected in 2021, reflecting the household SES in 2020, the study's results may not fully represent the current COVID-19 situation in PNG, which might have evolved over time. [31][32][33][34][35][36][37][38][39][40][41] Lastly, the study's focus on household-level data may have limited the ability to explore individual-level factors and their associations with COVID-19 health issues comprehensively (online supplementary file 2). Future research may benefit from more representative sampling, improved data collection methods, and a broader scope of individual and community-level factors.…”