Official websites use. Share sensitive information only on official, secure websites. Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy VA is increasingly used to provide population-level cause of death data. Here we use conventional autopsy as the gold standard to validate SmartVA methodology. VA was conducted with a relative of the deceased using an amended version of the SmartVA instrument to suit the local context.
Physician coded verbal autopsy PCVA , conducted on the same questionnaires, and Global Burden of Disease Study data were used as additional comparators. Cause of death data were grouped into 10 broad causes for the validation due to the real-world utility of VA lying in identifying broad population cause of death patterns. The cause specific mortality fractions CSMFs estimated using SmartVA were broadly similar to conventional autopsy for: cardiovascular diseases The results suggest that SmartVA can, with reasonable accuracy, predict the broad cause of death groups important to assess a population's epidemiological transition.
VA remains a useful tool for understanding causes of death where medical certification is not possible. Verbal autopsy VA is used increasingly in resource-limited settings to improve cause of death data. Prior to this study, to our knowledge, no research had been conducted to validate any of these tools using conventional autopsy as the gold standard.
This study provides researchers and countries implementing VA methods with a robust comparison of SmartVA and conventional autopsy diagnosis for the first time. We show that SmartVA can predict broad cause of death groups, that are important for health policy in resource-limited settings, with reasonable accuracy. Despite improvements in mortality surveillance and civil registration and vital statistics globally, verbal autopsy will remain an important tool for poorer countries to understand the causes of death in their populations for many years to come.
This research, further to the initial validation of SmartVA using hospital cause of death data, should provide confidence in the accuracy of SmartVA methodology for countries in which medical certification of cause of death is inadequate. Further validation studies using different VA methodologies would be useful for countries deciding whether to implement VA and what methods to use. These data are also required for evaluation and optimisation of health programs. Ideally, cause of death data are derived from complete and accurate medical certification of cause of death by trained physicians using the standard international form to identify the underlying cause of death.
