Research
Population Health Metrics Research Consortium gold standard verbal autopsy validation study: design, implementation, and development of analysis datasets
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* Corresponding author: Christopher JL Murray cjlm@uw.edu
1 Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Suite 600, Seattle, WA 98121, USA
2 University of Queensland, School of Population Health, Brisbane, Australia
3 Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
4 Community Empowerment Lab, Shivgarh, India, and The INCLEN Trust International, New Delhi, India
5 Public Health Laboratory-IdC, Pemba, Tanzania
6 Public Health Foundation of India, New Delhi, India
7 Brigham and Women's Hospital, Boston, MA, USA
8 CSM Medical University, Lucknow, India
9 Harvard University, School of Public Health, Boston, MA, USA
10 National Institute of Public Health, Cuernavaca, Mexico
11 The George Institute for Global Health, Camperdown, Australia
12 Research Institute for Tropical Medicine, Manila, Philippines
13 Cornell University, Division of Nutritional Sciences, Ithaca, NY, USA
14 The George Institute for Global Health, India, Hyderabad, India
15 Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Population Health Metrics 2011, 9:27 doi:10.1186/1478-7954-9-27
Published: 4 August 2011Abstract
Background
Verbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches, it is essential to create a high quality validation dataset from different populations to evaluate comparative method performance and make recommendations for future verbal autopsy implementation. This study was undertaken to compile a set of strictly defined gold standard deaths for which verbal autopsies were collected to validate the accuracy of different methods of verbal autopsy cause of death assignment.
Methods
Data collection was implemented in six sites in four countries: Andhra Pradesh, India; Bohol, Philippines; Dar es Salaam, Tanzania; Mexico City, Mexico; Pemba Island, Tanzania; and Uttar Pradesh, India. The Population Health Metrics Research Consortium (PHMRC) developed stringent diagnostic criteria including laboratory, pathology, and medical imaging findings to identify gold standard deaths in health facilities as well as an enhanced verbal autopsy instrument based on World Health Organization (WHO) standards. A cause list was constructed based on the WHO Global Burden of Disease estimates of the leading causes of death, potential to identify unique signs and symptoms, and the likely existence of sufficient medical technology to ascertain gold standard cases. Blinded verbal autopsies were collected on all gold standard deaths.
Results
Over 12,000 verbal autopsies on deaths with gold standard diagnoses were collected (7,836 adults, 2,075 children, 1,629 neonates, and 1,002 stillbirths). Difficulties in finding sufficient cases to meet gold standard criteria as well as problems with misclassification for certain causes meant that the target list of causes for analysis was reduced to 34 for adults, 21 for children, and 10 for neonates, excluding stillbirths. To ensure strict independence for the validation of methods and assessment of comparative performance, 500 test-train datasets were created from the universe of cases, covering a range of cause-specific compositions.
Conclusions
This unique, robust validation dataset will allow scholars to evaluate the performance of different verbal autopsy analytic methods as well as instrument design. This dataset can be used to inform the implementation of verbal autopsies to more reliably ascertain cause of death in national health information systems.