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Refining a probabilistic model for interpreting verbal autopsy data

Umeå International School of Public Health, Umeå University, Umeå, Sweden, peterbyass{at}aol.com

Edward Fottrell

Umeå International School of Public Health, Umeå University, Umeå, Sweden

Dao Lan Huong

Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam

Yemane Berhane

Department of Community Health, Addis Ababa University, Addis Ababa, Ethiopia

Tumani Corrah

Medical Research Council Laboratories, Banjul, The Gambia

Kathleen Kahn

School of Public Health, University of the Witswatersrand, Johannesburg, South Africa

Lulu Muhe

World Health Organization, Geneva, Switzerland

Do Duc Van

Viet Duc Surgical Hospital, Hanoi, Vietnam

Objective: To build on the previously reported development of a Bayesian probabilistic model for interpreting verbal autopsy (VA) data, attempting to improve the model's performance in determining cause of death and to reassess it. Design: An expert group of clinicians, coming from a wide range geographically and in terms of specialization, was convened. Over a four-day period the content of the previous probabilistic model was reviewed in detail and adjusted as necessary to reflect the group consensus. The revised model was tested with the same 189 VA cases from Vietnam, assessed by two local clinicians, that were used to test the preliminary model. Results: The revised model contained a total of 104 indicators that could be derived from VA data and 34 possible causes of death. When applied to the 189 Vietnamese cases, 142 (75.1%) achieved concordance between the model's output and the previous clinical consensus. The remaining 47 cases (24.9%) were presented to a further independent clinician for reassessment. As a result, consensus between clinical reassessment and the model's output was achieved in 28 cases (14.8%); clinical reassessment and the original clinical opinion agreed in 8 cases (4.2%), and in the remaining 11 cases (5.8%) clinical reassessment, the model, and the original clinical opinion all differed. Thus overall the model was considered to have performed well in 170 cases (89.9%). Conclusions: This approach to interpreting VA data continues to show promise. The next steps will be to evaluate it against other sources of VA data. The expert group approach to determining the required probability base seems to have been a productive one in improving the performance of the model.

Key Words: verbal autopsy • Bayes' theorem • mortality surveillance • probability • cause of death

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