KUMJ | VOL. 14 | NO. 2 | ISSUE 54 | APR-JUN. 2016
Estimation of Causes of Death in Suburban Nepal Using Verbal AutopsyAbstract:
Ide N, Fitzpatrick AL, Flaxman AD, Koju R, Tamrakar D, Hernandez B
Nepal is in the midst of a disease transition, including a rapid increase of noncommunicable
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.
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.
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.
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%.
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.Keyword :
Cause of death, death certification, Nepal, SmartVA, verbal autopsy