Academic journal article Bulletin of the World Health Organization

Verbal Autopsy Coding: Are Multiple Coders Better Than one?/Codage Des Autopsies Verbales : Est-Il Preferable Qu'il Soit Effectue Par Plusieurs Codeurs Au Lieu D'un ?/Codificacion De Las Autopsias Verbales: ?Varios Codificadores Mejor Que Uno?

Academic journal article Bulletin of the World Health Organization

Verbal Autopsy Coding: Are Multiple Coders Better Than one?/Codage Des Autopsies Verbales : Est-Il Preferable Qu'il Soit Effectue Par Plusieurs Codeurs Au Lieu D'un ?/Codificacion De Las Autopsias Verbales: ?Varios Codificadores Mejor Que Uno?

Article excerpt

Introduction

Most high-income countries have well-established mortality reporting systems with complete recording of deaths and medical certification for more than 90% of them. (1) The information about the pattern of death in the population that is provided by these systems is important for planning health service provision. (2,3) However, most low-income countries lack systems to document mortality rates and causes of death. Most deaths occur at home, (4) many go unreported and information about the cause of death is typically absent of unreliable. (5-8) In India, about 7 million of the 9.5 million deaths that occur annually happen at home and fewer than half have a medically certified cause of death. (9)

Mortality surveillance systems based on verbal autopsy are a key source of data about causes of death in less developed countries such as India where limited resources are available for the vital registration process. (7,9-13) The verbal autopsy method relies on information gathered from a standardized interview with a relative or caretaker; trained coders review the data and apply standardized diagnostic algorithms to arrive at a cause of death. (14-17)

The usual practice for cause of death assignment has been to either use a panel of expert physicians or to have two or more physician coders independently review the data and arrive at a diagnosis. (9,18,19) In the latter case, any discrepancies between the two diagnoses are resolved by consultation or through review of the verbal autopsy questionnaire by a third physician. (19) There has been debate about the impact of different methods of cause of death assignment, but in the absence of empirical data no consensus has been reached. (14)

In this paper we compare verbal autopsy strategies using a single coder versus multiple coders and report on the impact of each method on the reported patterns of death in an Indian community.

Methods

This study was conducted as part of a research collaboration (the Andhra Pradesh Rural Health Initiative) between five Australian and Indian institutions (see the acknowledgements section). The data were collected between 1 October 2003 and 30 September 2004, and the main causes of death have been reported previously. (20) Ethics approval for the project was received from the ethics committees of the CARE Hospital, Hyderabad, India, and the University of Sydney, Australia. Written informed consent was obtained from each respondent before the collection of any data, and the project was designed and conducted in line with the Declaration of Helsinki and its subsequent amendments. For participants who could not read or write, the participant information sheet and consent form were explained by a multipurpose primary healthcare worker (MPHW), and a thumb impression was taken instead of a signature. An MPHW is a female non-physician health worker who provides basic health care to the community served by a village health centre. Her role is to collect vital statistics, provide primary health care to the villagers and assist the visiting doctor during clinic hours in the village health centre. In this study, the MPHW carried out the mortality surveillance work in addition to regular clinic activities.

Population

This project was conducted in 45 villages in East and West Godavari districts in the state of Andhra Pradesh in southern India. The population (N = 180 162) age and sex structure was defined by a population census conducted in 2002-2003. The age distribution of the population in the villages is characteristic of that found in places where fertility has recently decreased, with relatively low proportions of the population in the very young and very old age groups. A quarter of the population is below 15 years of age, and a tenth is older than 60 years. Most people are engaged in work related to agriculture or aquaculture, and the average household income is 2000. …

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