Verbal autopsy completion rate and factors associated with undetermined cause of death in a rural resource-poor setting of Tanzania

Population Health Metrics

Research

Mathew A Mwanyangala¹  Deodatus V Maliti¹  Chrisostom C Mahutanga¹  Honorathy M Urassa¹  Jensen C Rutashobya¹  Salim K Abdulla²  Rose N Lema²  Honorati M Masanja²  Angelina M Lutambi² 

[1] Ifakara Health Institute, Ifakara, Kilombero, P.o.Box 53, Morogoro, Tanzania;Ifakara Health Institute, Ifakara, Kilombero, P.o.Box 53, Morogoro, Tanzania;Ifakara Health Institute, P.o.Box 78373, Dar es Salaam, Tanzania;

关键词: Verbal autopsy (VA);    completion rate;    undetermined;    HDSS;   

DOI  :  10.1186/1478-7954-9-41

 received in 2011-03-09, accepted in 2011-08-05,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundVerbal autopsy (VA) is a widely used tool to assign probable cause of death in areas with inadequate vital registration systems. Its uses in priority setting and health planning are well documented in sub-Saharan Africa (SSA) and Asia. However, there is a lack of data related to VA processing and completion rates in assigning causes of death in a community. There is also a lack of data on factors associated with undetermined causes of death documented in SSA. There is a need for such information for understanding the gaps in VA processing and better estimating disease burden.ObjectiveThe study's intent was to determine the completion rate of VA and factors associated with assigning undetermined causes of death in rural Tanzania.MethodsA database of deaths reported from the Ifakara Health and Demographic Surveillance System from 2002 to 2007 was used. Completion rates were determined at the following stages of processing: 1) death identified; 2) VA interviews conducted; 3) VA forms submitted to physicians; 4) coding and assigning of cause of death. Logistic regression was used to determine factors associated with deaths coded as "undetermined."ResultsThe completion rate of VA after identification of death and the VA interview ranged from 83% in 2002 and 89% in 2007. Ninety-four percent of deaths submitted to physicians were assigned a specific cause, with 31% of the causes coded as undetermined. Neonates and child deaths that occurred outside health facilities were associated with a high rate of undetermined classification (33%, odds ratio [OR] = 1.33, 95% confidence interval [CI] (1.05, 1.67), p = 0.016). Respondents reporting high education levels were less likely to be associated with deaths that were classified as undetermined (24%, OR = 0.76, 95% CI (0.60, -0.96), p = 0.023). Being a child of the deceased compared to a partner (husband or wife) was more likely to be associated with undetermined cause of death classification (OR = 1.35, 95% CI (1.04, 1.75), p = 0.023).ConclusionEvery year, there is a high completion rate of VA in the initial stages of processing; however, a number of VAs are lost during the processing. Most of the losses occur at the final step, physicians' determination of cause of death. The type of respondent and place of death had a significant effect on final determination of the plausible cause of death. The finding provides some insight into the factors affecting full coverage of verbal autopsy diagnosis and the limitations of causes of death based on VA in SSA. Although physician review is the most commonly used method in ascertaining probable cause of death, we suggest further work needs to be done to address the challenges faced by physicians in interpreting VA forms. There is need for an alternative to or improvement of the methods of physician review.

【 授权许可】

Unknown   
© Mwanyangala et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.