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

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

doi:10.1186/s12982-016-0051-1

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

Emerg Themes Epidemiol. 2016 Oct 18:13:10. doi: 10.1186/s12982-016-0051-1. eCollection 2016.

Authors

Laith Hussain-Alkhateeb¹, Max Petzold², Mark Collinson³, Stephen Tollman³, Kathleen Kahn³, Peter Byass⁴

Affiliations

¹ Health Metrics, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden.
² Health Metrics, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden ; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Accra, Ghana ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: Verbal 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.

Methods: A 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.

Results: The 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).

Conclusion: A 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.

Keywords: Cause of death; HDSS; Recall; South Africa; Time lapse; Verbal autopsy.

Grants and funding

P01 AG041710/AG/NIA NIH HHS/United States