International Journal of Epidemiology, Vol 28, 1081-1087, Copyright © 1999 by International Epidemiological Association
MA Quigley, D Chandramohan and LC Rodrigues
BACKGROUND: The verbal autopsy (VA) is used to collect information on
cause-specific mortality from bereaved relatives. A cause of death may be
assigned by physician review of the questionnaires, or by an algorithm. We
compared the diagnostic accuracy of physician review, an expert algorithm,
and data-derived algorithms. METHODS: Data were drawn from a multicentre
validation study of 796 adult deaths that occurred in hospitals in
Tanzania, Ethiopia, and Ghana. A 'gold standard' cause of death was
assigned using hospital records and death certificates. The VA interviews
were carried out by trained fieldworkers 1-21 months after the subject's
death. A cause of death was assigned by physician review and an expert
algorithm. Data-derived algorithms that most accurately estimated the
cause-specific mortality fraction (CSMF) for each cause of death were
identified using logistic regression. RESULTS: The most common causes of
death were tuberculosis/AIDS (CSMF = 18.6%), malaria (CSMF = 10.7%),
meningitis (CSMF = 8.3%), and cardiovascular disorders (CSMF = 8.2%). The
CSMF obtained using physician review was within +/-20% of the gold standard
value for 12 causes of death including the four common causes. The CSMF
obtained using the expert algorithm was within +/-20% of the gold standard
for eight causes of death, including tuberculosis/AIDS, malaria, and
meningitis. The CSMF obtained using the data-derived algorithms was within
+/-20% of the gold standard for seven causes of death, including
tuberculosis/ AIDS, meningitis, and cardiovascular disorders. All three
methods yielded a specificity of at least 80% for all causes of death, and
a sensitivity of at least 80% for deaths due to injuries and rabies.
CONCLUSIONS: For those settings where physician review is not feasible,
expert and data- derived algorithms provide an alternative approach for
assigning many causes of death. We recommend that the algorithms proposed
herein are validated further.
Diagnostic accuracy of physician review, expert algorithms and data- derived algorithms in adult verbal autopsies
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
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