Effects of recall time on cause-of-death findings using verbal autopsy: empirical evidence from rural South AfricaReport as inadecuate

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Emerging Themes in Epidemiology

, 13:10

First Online: 18 October 2016Received: 15 April 2016Accepted: 06 October 2016DOI: 10.1186-s12982-016-0051-1

Cite this article as: Hussain-Alkhateeb, L., Petzold, M., Collinson, M. et al. Emerg Themes Epidemiol 2016 13: 10. doi:10.1186-s12982-016-0051-1


BackgroundVerbal autopsy VA is a widely used technique for assigning causes to non-medically certified deaths using information gathered from a close caregiver. Both operational and cultural factors may cause delays in follow-up of deaths. The resulting time lag—from death to VA interview—can influence ways in which terminal events are remembered, and thus affect cause-of-death assignment. This study investigates the impact of recall period on causes of death determined by VA.

MethodsA total of 10,882 deaths from the Agincourt Health and Demographic Surveillance System HDSS with complete VAs, including recall period, were incorporated in this study. To measure seasonal effect, cause specific mortality fractions CSMFs were calculated and compared by every cause for VAs undertaken within six months of death and those undertaken from six to 12 months of death. All causes were classified into eight broad categories and entered in a multiple logistic regression to explore outcome by recall period in relation to covariates.

ResultsThe majority of deaths 83 % had VAs completed within 12 months. There was a tendency towards longer recall periods for deaths of those under one year or over 65 years of age. Only the acute respiratory, diarrhoeal and other unspecified non-communicable disease groups showed a CSMF ratio significantly different from unity at the 99 % confidence level between the two recall periods. Only neonatal deaths showed significantly different OR for recall exceeding 12 months OR 1.69; p value = 0.004 and this increased when adjusting for background factors OR 2.58; p value = 0.000.

ConclusionA recall period of up to one year between death and VA interview did not have any consequential effects on the cause-of-death patterns derived, with the exception of neonatal causes. This is an important operational consideration given the planned widespread use of the VA approach in civil registration, HDSS sites and occasional surveys.

KeywordsHDSS Verbal autopsy Cause of death Recall Time lapse South Africa  Download fulltext PDF

Author: Laith Hussain-Alkhateeb - Max Petzold - Mark Collinson - Stephen Tollman - Kathleen Kahn - Peter Byass

Source: https://link.springer.com/

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