TY - JOUR AU - Joshi Rohina AU - Dandona R. AU - Dandona L. AU - Serina P. AU - Stewart A. AU - Riley I. AU - Hernandez B. AU - Freeman M. AU - Sanvictores D. AU - Tallo V. AU - Kumar V. AU - Murray C. AU - Lozano R. AU - Flaxman A. AU - Phillips D. AU - James S. AU - Atkinson C. AU - Ohno S. AU - Black R. AU - Ali S. AU - Baqui A. AU - Dantzer E. AU - Das V. AU - Dhingra U. AU - Dutta A. AU - Fawzi W. AU - Gómez S. AU - Mehta S. AU - Lopez A. AU - Alam S. AU - Mooney M. AU - Kumar A. AU - Luning R. AU - Ahuja R. AU - Alam N. AU - Chowdhury H. AU - Darmstadt G. AU - Kalter H. AU - Lucero M. AU - Pierce K. AU - Prasad R. AU - Premji Z. AU - Ramirez-Villalobos D. AU - Remolador H. AU - Romero M. AU - Said M. AU - Sazawal S. AU - Streatfield P. AU - Vadhatpour A. AU - Gamage S. AU - Hensman D. AU - Rampatige R. AU - Wijesekara N. AU - Praveen Devarsetty AU - Neal Bruce AB -

BACKGROUND: Verbal autopsy (VA) is recognized as the only feasible alternative to comprehensive medical certification of deaths in settings with no or unreliable vital registration systems. However, a barrier to its use by national registration systems has been the amount of time and cost needed for data collection. Therefore, a short VA instrument (VAI) is needed. In this paper we describe a shortened version of the VAI developed for the Population Health Metrics Research Consortium (PHMRC) Gold Standard Verbal Autopsy Validation Study using a systematic approach. METHODS: We used data from the PHMRC validation study. Using the Tariff 2.0 method, we first established a rank order of individual questions in the PHMRC VAI according to their importance in predicting causes of death. Second, we reduced the size of the instrument by dropping questions in reverse order of their importance. We assessed the predictive performance of the instrument as questions were removed at the individual level by calculating chance-corrected concordance and at the population level with cause-specific mortality fraction (CSMF) accuracy. Finally, the optimum size of the shortened instrument was determined using a first derivative analysis of the decline in performance as the size of the VA instrument decreased for adults, children, and neonates. RESULTS: The full PHMRC VAI had 183, 127, and 149 questions for adult, child, and neonatal deaths, respectively. The shortened instrument developed had 109, 69, and 67 questions, respectively, representing a decrease in the total number of questions of 40-55%. The shortened instrument, with text, showed non-significant declines in CSMF accuracy from the full instrument with text of 0.4%, 0.0%, and 0.6% for the adult, child, and neonatal modules, respectively. CONCLUSIONS: We developed a shortened VAI using a systematic approach, and assessed its performance when administered using hand-held electronic tablets and analyzed using Tariff 2.0. The length of a VA questionnaire was shortened by almost 50% without a significant drop in performance. The shortened VAI developed reduces the burden of time and resources required for data collection and analysis of cause of death data in civil registration systems.

AD - Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. ptserina@uw.edu.
University of Queensland, School of Public Health, Level 2 Public Health Building School of Public Health, Herston Road, Herston, QLD, 4006, Australia. i.riley@sph.uq.edu.au.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. andrea.leigh.stewart@gmail.com.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. abie@uw.edu.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. rafael.lozano@insp.mx.
National Institute of Public Health, Av. Universidad 655, Buena Vista, 62100, Cuernavaca, Morelos, Mexico. rafael.lozano@insp.mx.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. megham2@uw.edu.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. rluning@uw.edu.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. bhp3@uw.edu.
Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. rblack1@jhu.edu.
Community Empowerment Lab, Shivgarh, India. kgmcice@sancharnet.in.
The INCLEN Trust International, New Delhi, India. kgmcice@sancharnet.in.
International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh. nalam@icddrb.org.
International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh. saidul@icddrb.org.
Public Health Laboratory-IdC, P.O.BOX 122, Wawi, Chake Chake, Pemba, Zanzibar, Tanzania. saidmali2003@yahoo.com.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. atkinsct@uw.edu.
Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. abaqui@jhsph.edu.
University of Melbourne, School of Population and Global Health, Building 379, 207 Bouverie St., Parkville, 3010, VIC, Australia. hafiz.chowdhury@unimelb.edu.au.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. dandona@uw.edu.
Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, National Capital Region, India. dandona@uw.edu.
Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, National Capital Region, India. Rakhi.dandona@phfi.org.
Malaria Consortium Cambodia, 113 Mao Tse Toung, Phnom Penh, Cambodia. emilydantzer@gmail.com.
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94304, USA. gdarmsta@stanford.edu.
CSM Medical University, Shah Mina Road, Chowk Lucknow, Uttar Pradesh, 226003, India. das_lko@yahoo.com.
Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. udhingra@jhu.edu.
Public Health Laboratory-IdC, P.O.BOX 122, Wawi, Chake Chake, Pemba, Zanzibar, Tanzania. udhingra@jhu.edu.
Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. adutta@cphealthkinetics.org.
Public Health Laboratory-IdC, P.O.BOX 122, Wawi, Chake Chake, Pemba, Zanzibar, Tanzania. adutta@cphealthkinetics.org.
Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA. mina@hsph.harvard.edu.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. mikefree@uw.edu.
WHO Collaborating Centre for Public Health Workforce Development, National Institute of Health Sciences, Kalutara, Sri Lanka. samanhattotuwa@yahoo.com.
Iipas, Chapel Hill, NC, USA. saraegomez@gmail.com.
WHO Collaborating Centre for Public Health Workforce Development, National Institute of Health Sciences, Kalutara, Sri Lanka. hensmand@SEARO.WHO.INT.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. spencj@gmail.com.
The George Institute for Global Health, Sydney, Australia. rjoshi@george.org.au.
Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. hkalter1@jhu.edu.
Community Empowerment Lab, Shivgarh, India. aarti.kumar@shivgarh.org.
The INCLEN Trust International, New Delhi, India. aarti.kumar@shivgarh.org.
Community Empowerment Lab, Shivgarh, India. vishwajeet.kumar@shivgarh.org.
The INCLEN Trust International, New Delhi, India. vishwajeet.kumar@shivgarh.org.
Research Institute for Tropical Medicine, Corporate Ave., Muntinlupa City, 1781, Philippines. grandchallenge13@yahoo.com.
Cornell University, Division of Nutritional Sciences, 314 Savage Hall, Ithaca, NY, 14853, USA. smehta@cornell.edu.
The George Institute for Global Health, University of Sydney and Royal Prince Albert Hospital, Sydney, Australia. bneal@georgeinstitute.org.au.
Imperial college, London, London, UK. bneal@georgeinstitute.org.au.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. summerlockett9@yahoo.com.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. davidp6@uw.edu.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. kpierce2@uw.edu.
CSM Medical University, Shah Mina Road, Chowk Lucknow, Uttar Pradesh, 226003, India. rprasad2@sancharnet.in.
The George Institute for Global Health, Hyderabad, India. dpraveen@georgeinstitute.org.in.
Muhimbili University of Health and Allied Sciences, United Nations Rd., Dar es Salaam, Tanzania. zulpremji688@gmail.com.
National Institute of Public Health, Av. Universidad 655, Buena Vista, 62100, Cuernavaca, Morelos, Mexico. mdolores@insp.mx.
University of Queensland, School of Public Health, Level 2 Public Health Building School of Public Health, Herston Road, Herston, QLD, 4006, Australia. rampatige@gmail.com.
Research Institute for Tropical Medicine, Corporate Ave., Muntinlupa City, 1781, Philippines. britt_ph11@yahoo.com.
National Institute of Public Health, Av. Universidad 655, Buena Vista, 62100, Cuernavaca, Morelos, Mexico. mpromero@insp.mx.
Muhimbili University of Health and Allied Sciences, United Nations Rd., Dar es Salaam, Tanzania. mwana77@gmail.com.
Research Institute for Tropical Medicine, Corporate Ave., Muntinlupa City, 1781, Philippines. diozele_sanvictores@yahoo.com.
Institute for International Programs, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. sazawal@jhu.edu.
Public Health Laboratory-IdC, P.O.BOX 122, Wawi, Chake Chake, Pemba, Zanzibar, Tanzania. sazawal@jhu.edu.
International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh. pkstreatfield@icddrb.org.
Research Institute for Tropical Medicine, Corporate Ave., Muntinlupa City, 1781, Philippines. veronica.tallo2015@gmail.com.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. alvahdat@microsoft.com.
WHO Collaborating Centre for Public Health Workforce Development, National Institute of Health Sciences, Kalutara, Sri Lanka. nmwijesekara@yahoo.com.
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. cjlm@u.washington.edu.
University of Melbourne, School of Population and Global Health, Building 379, 207 Bouverie St., Parkville, 3010, VIC, Australia. alan.lopez@unimelb.edu.au. AN - 26670275 BT - BMC Medicine C2 - PMC4681088 DP - NLM ET - 2015/12/17 LA - eng LB - AUS
INDIA
FP
OCS
FY16 N1 - Serina, Peter
Riley, Ian
Stewart, Andrea
Flaxman, Abraham D
Lozano, Rafael
Mooney, Meghan D
Luning, Richard
Hernandez, Bernardo
Black, Robert
Ahuja, Ramesh
Alam, Nurul
Alam, Sayed Saidul
Ali, Said Mohammed
Atkinson, Charles
Baqui, Abdulla H
Chowdhury, Hafizur R
Dandona, Lalit
Dandona, Rakhi
Dantzer, Emily
Darmstadt, Gary L
Das, Vinita
Dhingra, Usha
Dutta, Arup
Fawzi, Wafaie
Freeman, Michael
Gamage, Saman
Gomez, Sara
Hensman, Dilip
James, Spencer L
Joshi, Rohina
Kalter, Henry D
Kumar, Aarti
Kumar, Vishwajeet
Lucero, Marilla
Mehta, Saurabh
Neal, Bruce
Ohno, Summer Lockett
Phillips, David
Pierce, Kelsey
Prasad, Rajendra
Praveen, Devarsetty
Premji, Zul
Ramirez-Villalobos, Dolores
Rampatige, Rasika
Remolador, Hazel
Romero, Minerva
Said, Mwanaidi
Sanvictores, Diozele
Sazawal, Sunil
Streatfield, Peter K
Tallo, Veronica
Vadhatpour, Alireza
Wijesekara, Nandalal
Murray, Christopher J L
Lopez, Alan D
Research Support, Non-U.S. Gov't
England
BMC Med. 2015 Dec 16;13:302. doi: 10.1186/s12916-015-0528-8. N2 -

BACKGROUND: Verbal autopsy (VA) is recognized as the only feasible alternative to comprehensive medical certification of deaths in settings with no or unreliable vital registration systems. However, a barrier to its use by national registration systems has been the amount of time and cost needed for data collection. Therefore, a short VA instrument (VAI) is needed. In this paper we describe a shortened version of the VAI developed for the Population Health Metrics Research Consortium (PHMRC) Gold Standard Verbal Autopsy Validation Study using a systematic approach. METHODS: We used data from the PHMRC validation study. Using the Tariff 2.0 method, we first established a rank order of individual questions in the PHMRC VAI according to their importance in predicting causes of death. Second, we reduced the size of the instrument by dropping questions in reverse order of their importance. We assessed the predictive performance of the instrument as questions were removed at the individual level by calculating chance-corrected concordance and at the population level with cause-specific mortality fraction (CSMF) accuracy. Finally, the optimum size of the shortened instrument was determined using a first derivative analysis of the decline in performance as the size of the VA instrument decreased for adults, children, and neonates. RESULTS: The full PHMRC VAI had 183, 127, and 149 questions for adult, child, and neonatal deaths, respectively. The shortened instrument developed had 109, 69, and 67 questions, respectively, representing a decrease in the total number of questions of 40-55%. The shortened instrument, with text, showed non-significant declines in CSMF accuracy from the full instrument with text of 0.4%, 0.0%, and 0.6% for the adult, child, and neonatal modules, respectively. CONCLUSIONS: We developed a shortened VAI using a systematic approach, and assessed its performance when administered using hand-held electronic tablets and analyzed using Tariff 2.0. The length of a VA questionnaire was shortened by almost 50% without a significant drop in performance. The shortened VAI developed reduces the burden of time and resources required for data collection and analysis of cause of death data in civil registration systems.

PY - 2015 SN - 1741-7015 (Electronic)
1741-7015 (Linking) EP - 302 T2 - BMC Medicine TI - A shortened verbal autopsy instrument for use in routine mortality surveillance systems VL - 13 Y2 - FY16 ER -