Adult mortality surveillance by routine health workers using a short verbal autopsy tool in rural north India

Most of the standard verbal autopsy tools are long and are used in a research setting. This study aims to compare a short verbal autopsy (VA) tool developed at Ballabgarh, India to be used by health workers for routine mortality surveillance with a standard tool.

A short VA tool was developed which was used by health workers during their routine house visits while a standard International Network of Field Sites with continuous Demographic Evaluation (INDEPTH) VA tool was filled by trained research workers for all adult deaths that occurred in 2008. The cause-specific mortality fraction using two tools, validity of the Comprehensive Rural Health Services Project (CRHSP) VA tool with INDEPTH VA tool as reference and agreement between the two tools, was compared.

The cause-specific mortality fraction was 11.6% and 12% for ischaemic heart disease (IHD), 10.6% and 11.8% for chronic pulmonary obstructive disease (COPD), and 9.4% and 7.3% for tuberculosis, using the INDEPTH and CRHSP VA tool, respectively. 16% and 21% of the deaths could not be classified using the INDEPTH and CRHSP VA tool respectively. The sensitivity of the CRHSP VA tool was 78.5% for IHD, 80% for COPD, 58.3% for tuberculosis, 92.8% for malignant neoplasm and 97.2% for intentional self harm. The kappa between two tools for IHD, COPD, tuberculosis, malignant neoplasm and intentional self harm was 0.754, 0.711, 0.628, 0.876 and 0.892 respectively.

The short VA tool had a good sensitivity and fair to excellent agreement with the standard tool in different age groups across the major causes of death. It can be used within the routine healthcare delivery framework and can fill the gap in mortality surveillance.