Publication: Estimation of Causes of Death in Suburban Nepal Using Verbal Autopsy
Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Nepal is in the midst of a disease transition, including a rapid increase of non-
communicable diseases. In order for health policy makers and planners to make
informed programmatic and funding decisions, they need up to date and accurate
data regarding cause of death throughout the country. Methods of improving cause
of death reporting in Nepal are urgently required.
Objective
We sought to validate SmartVA-Analyze, an application which computer certifies
verbal autopsies, to evaluate it as a method for collecting mortality data in Nepal.
Method
We conducted a medical record review of mortality cases at Dhulikhel Hospital,
Kathmandu University Hospital. Cases with a verifiable underlying cause of death
were used as gold standard reference cases. Verbal autopsies were conducted with
caregivers of 48 gold standard cases.
Result
Of the 66 adult gold standard mortality cases reviewed, 76% were caused by cancer,
cirrhosis, cardiovascular disease, COPD or injury. When assessing concordance
between cause of death from verbal autopsy vs. gold standards, we found an overall
agreement (Kappa) of 0.50. Kappa based on broader ICD-10 categories was 0.69.
Cause-Specific Mortality Fraction Accuracy was 0.625, and disease specific measures
of concordance varied widely, with sensitivities ranging from 0-100%.
Conclusion
Ongoing, countrywide mortality data collection is crucial for evidence-based priority
setting in Nepal. Though not valid for all causes, we found SmartVA-Analyze to
provide useful general cause of death data, particularly in settings where death
certification is unavailable.
KEY WORDS
Cause of death, death certification, Nepal, SmartVA, verbal autopsy
Description
Ide N,1 Fitzpatrick AL,2 Flaxman AD,3 Koju R,4 Tamrakar D,4 Hernandez B3
1Department of Global Health
University of Washington
Box 357965 Seattle, WA 98195 USA.
2Departments of Family Medicine,
Epidemiology, and Global Health,
Box 354696 Seattle, WA 98195 USA.
3Institute for Health Metrics and Evaluation
2301 5th Ave. Suite 600, Seattle, WA 98121, USA.
4Dhulikhel Hospital-Kathmandu University Hospital
Dhulikhel, Kavre, Nepal
Keywords
Cause of death, Death certification, Nepal, SmartVA, Verbal autopsy