Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and Zimbabwe

<p>Abstract</p> <p>Background</p> <p>Verbal autopsy (VA) is a widely used method for analyzing cause of death in absence of vital registration systems. We adapted the InterVA method to extrapolate causes of death for stillbirths and neonatal deaths from verbal autopsy q...

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Main Authors: Munjanja Stephan P, Manandhar Dharma S, Mwansambo Charles, Kazembe Peter N, Osrin David, Fottrell Edward, Vergnano Stefania, Byass Peter, Lewycka Sonia, Costello Anthony
Format: Article
Language:English
Published: BMC 2011-08-01
Series:Population Health Metrics
Online Access:http://www.pophealthmetrics.com/content/9/1/48
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spelling doaj-c7292245039543aba4515a9f37b2cb772020-11-25T00:21:03ZengBMCPopulation Health Metrics1478-79542011-08-01914810.1186/1478-7954-9-48Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and ZimbabweMunjanja Stephan PManandhar Dharma SMwansambo CharlesKazembe Peter NOsrin DavidFottrell EdwardVergnano StefaniaByass PeterLewycka SoniaCostello Anthony<p>Abstract</p> <p>Background</p> <p>Verbal autopsy (VA) is a widely used method for analyzing cause of death in absence of vital registration systems. We adapted the InterVA method to extrapolate causes of death for stillbirths and neonatal deaths from verbal autopsy questionnaires, using data from Malawi, Zimbabwe, and Nepal.</p> <p>Methods</p> <p>We obtained 734 stillbirth and neonatal VAs from recent community studies in rural areas: 169 from Malawi, 385 from Nepal, and 180 from Zimbabwe. Initial refinement of the InterVA model was based on 100 physician-reviewed VAs from Malawi. InterVA indicators and matrix probabilities for cause of death were reviewed for clinical and epidemiological coherence by a pediatrician-researcher and an epidemiologist involved in the development of InterVA. The modified InterVA model was evaluated by comparing population-level cause-specific mortality fractions and individual agreement from two methods of interpretation (physician review and InterVA) for a further 69 VAs from Malawi, 385 from Nepal, and 180 from Zimbabwe.</p> <p>Results</p> <p>Case-by-case agreement between InterVA and reviewing physician diagnoses for 69 cases from Malawi, 180 cases from Zimbabwe, and 385 cases from Nepal were 83% (kappa 0.76 (0.75 - 0.80)), 71% (kappa 0.41(0.32-0.51)), and 74% (kappa 0.63 (0.60-0.63)), respectively. The proportion of stillbirths identified as fresh or macerated by the different methods of VA interpretation was similar in all three settings. Comparing across countries, the modified InterVA method found that proportions of preterm births and deaths due to infection were higher in Zimbabwe (44%) than in Malawi (28%) or Nepal (20%).</p> <p>Conclusion</p> <p>The modified InterVA method provides plausible results for stillbirths and newborn deaths, broadly comparable to physician review but with the advantage of internal consistency. The method allows standardized cross-country comparisons and eliminates the inconsistencies of physician review in such comparisons.</p> http://www.pophealthmetrics.com/content/9/1/48
collection DOAJ
language English
format Article
sources DOAJ
author Munjanja Stephan P
Manandhar Dharma S
Mwansambo Charles
Kazembe Peter N
Osrin David
Fottrell Edward
Vergnano Stefania
Byass Peter
Lewycka Sonia
Costello Anthony
spellingShingle Munjanja Stephan P
Manandhar Dharma S
Mwansambo Charles
Kazembe Peter N
Osrin David
Fottrell Edward
Vergnano Stefania
Byass Peter
Lewycka Sonia
Costello Anthony
Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and Zimbabwe
Population Health Metrics
author_facet Munjanja Stephan P
Manandhar Dharma S
Mwansambo Charles
Kazembe Peter N
Osrin David
Fottrell Edward
Vergnano Stefania
Byass Peter
Lewycka Sonia
Costello Anthony
author_sort Munjanja Stephan P
title Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and Zimbabwe
title_short Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and Zimbabwe
title_full Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and Zimbabwe
title_fullStr Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and Zimbabwe
title_full_unstemmed Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and Zimbabwe
title_sort adaptation of a probabilistic method (interva) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in malawi, nepal, and zimbabwe
publisher BMC
series Population Health Metrics
issn 1478-7954
publishDate 2011-08-01
description <p>Abstract</p> <p>Background</p> <p>Verbal autopsy (VA) is a widely used method for analyzing cause of death in absence of vital registration systems. We adapted the InterVA method to extrapolate causes of death for stillbirths and neonatal deaths from verbal autopsy questionnaires, using data from Malawi, Zimbabwe, and Nepal.</p> <p>Methods</p> <p>We obtained 734 stillbirth and neonatal VAs from recent community studies in rural areas: 169 from Malawi, 385 from Nepal, and 180 from Zimbabwe. Initial refinement of the InterVA model was based on 100 physician-reviewed VAs from Malawi. InterVA indicators and matrix probabilities for cause of death were reviewed for clinical and epidemiological coherence by a pediatrician-researcher and an epidemiologist involved in the development of InterVA. The modified InterVA model was evaluated by comparing population-level cause-specific mortality fractions and individual agreement from two methods of interpretation (physician review and InterVA) for a further 69 VAs from Malawi, 385 from Nepal, and 180 from Zimbabwe.</p> <p>Results</p> <p>Case-by-case agreement between InterVA and reviewing physician diagnoses for 69 cases from Malawi, 180 cases from Zimbabwe, and 385 cases from Nepal were 83% (kappa 0.76 (0.75 - 0.80)), 71% (kappa 0.41(0.32-0.51)), and 74% (kappa 0.63 (0.60-0.63)), respectively. The proportion of stillbirths identified as fresh or macerated by the different methods of VA interpretation was similar in all three settings. Comparing across countries, the modified InterVA method found that proportions of preterm births and deaths due to infection were higher in Zimbabwe (44%) than in Malawi (28%) or Nepal (20%).</p> <p>Conclusion</p> <p>The modified InterVA method provides plausible results for stillbirths and newborn deaths, broadly comparable to physician review but with the advantage of internal consistency. The method allows standardized cross-country comparisons and eliminates the inconsistencies of physician review in such comparisons.</p>
url http://www.pophealthmetrics.com/content/9/1/48
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