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Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries

BACKGROUND: Verbal autopsy is the main method used in countries with weak civil registration systems for estimating community causes of neonatal and 1–59-month-old deaths. However, validation studies of verbal autopsy methods are limited and assessment has been dependent on hospital-based studies, w...

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Autores principales: Kalter, Henry D., Perin, Jamie, Amouzou, Agbessi, Kwamdera, Gift, Adewemimo, Wasilat Adeyinka, Nguefack, Félicitée, Roubanatou, Abdoulaye-Mamadou, Black, Robert E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291588/
https://www.ncbi.nlm.nih.gov/pubmed/32527253
http://dx.doi.org/10.1186/s12916-020-01639-1
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author Kalter, Henry D.
Perin, Jamie
Amouzou, Agbessi
Kwamdera, Gift
Adewemimo, Wasilat Adeyinka
Nguefack, Félicitée
Roubanatou, Abdoulaye-Mamadou
Black, Robert E.
author_facet Kalter, Henry D.
Perin, Jamie
Amouzou, Agbessi
Kwamdera, Gift
Adewemimo, Wasilat Adeyinka
Nguefack, Félicitée
Roubanatou, Abdoulaye-Mamadou
Black, Robert E.
author_sort Kalter, Henry D.
collection PubMed
description BACKGROUND: Verbal autopsy is the main method used in countries with weak civil registration systems for estimating community causes of neonatal and 1–59-month-old deaths. However, validation studies of verbal autopsy methods are limited and assessment has been dependent on hospital-based studies, with uncertain implications for its validity in community settings. If the distribution of community deaths by cause was similar to that of facility deaths, or could be adjusted according to related demographic factors, then the causes of facility deaths could be used to estimate population causes. METHODS: Causes of neonatal and 1–59-month-old deaths from verbal/social autopsy (VASA) surveys in four African countries were estimated using expert algorithms (EAVA) and physician coding (PCVA). Differences between facility and community deaths in individual causes and cause distributions were examined using chi-square and cause-specific mortality fractions (CSMF) accuracy, respectively. Multinomial logistic regression and random forest models including factors from the VASA studies that are commonly available in Demographic and Health Surveys were built to predict population causes from facility deaths. RESULTS: Levels of facility and community deaths in the four countries differed for one to four of 10 EAVA or PCVA neonatal causes and zero to three of 12 child causes. CSMF accuracy for facility compared to community deaths in the four countries ranged from 0.74 to 0.87 for neonates and 0.85 to 0.95 for 1–59-month-olds. Crude CSMF accuracy in the prediction models averaged 0.86 to 0.88 for neonates and 0.93 for 1–59-month-olds. Adjusted random forest prediction models increased average CSMF accuracy for neonates to, at most, 0.90, based on small increases in all countries. CONCLUSIONS: There were few differences in facility and community causes of neonatal and 1–59-month-old deaths in the four countries, and it was possible to project the population CSMF from facility deaths with accuracy greater than the validity of verbal autopsy diagnoses. Confirmation of these findings in additional settings would warrant research into how medical causes of deaths in a representative sample of health facilities can be utilized to estimate the population causes of child death.
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spelling pubmed-72915882020-06-12 Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries Kalter, Henry D. Perin, Jamie Amouzou, Agbessi Kwamdera, Gift Adewemimo, Wasilat Adeyinka Nguefack, Félicitée Roubanatou, Abdoulaye-Mamadou Black, Robert E. BMC Med Research Article BACKGROUND: Verbal autopsy is the main method used in countries with weak civil registration systems for estimating community causes of neonatal and 1–59-month-old deaths. However, validation studies of verbal autopsy methods are limited and assessment has been dependent on hospital-based studies, with uncertain implications for its validity in community settings. If the distribution of community deaths by cause was similar to that of facility deaths, or could be adjusted according to related demographic factors, then the causes of facility deaths could be used to estimate population causes. METHODS: Causes of neonatal and 1–59-month-old deaths from verbal/social autopsy (VASA) surveys in four African countries were estimated using expert algorithms (EAVA) and physician coding (PCVA). Differences between facility and community deaths in individual causes and cause distributions were examined using chi-square and cause-specific mortality fractions (CSMF) accuracy, respectively. Multinomial logistic regression and random forest models including factors from the VASA studies that are commonly available in Demographic and Health Surveys were built to predict population causes from facility deaths. RESULTS: Levels of facility and community deaths in the four countries differed for one to four of 10 EAVA or PCVA neonatal causes and zero to three of 12 child causes. CSMF accuracy for facility compared to community deaths in the four countries ranged from 0.74 to 0.87 for neonates and 0.85 to 0.95 for 1–59-month-olds. Crude CSMF accuracy in the prediction models averaged 0.86 to 0.88 for neonates and 0.93 for 1–59-month-olds. Adjusted random forest prediction models increased average CSMF accuracy for neonates to, at most, 0.90, based on small increases in all countries. CONCLUSIONS: There were few differences in facility and community causes of neonatal and 1–59-month-old deaths in the four countries, and it was possible to project the population CSMF from facility deaths with accuracy greater than the validity of verbal autopsy diagnoses. Confirmation of these findings in additional settings would warrant research into how medical causes of deaths in a representative sample of health facilities can be utilized to estimate the population causes of child death. BioMed Central 2020-06-12 /pmc/articles/PMC7291588/ /pubmed/32527253 http://dx.doi.org/10.1186/s12916-020-01639-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Kalter, Henry D.
Perin, Jamie
Amouzou, Agbessi
Kwamdera, Gift
Adewemimo, Wasilat Adeyinka
Nguefack, Félicitée
Roubanatou, Abdoulaye-Mamadou
Black, Robert E.
Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries
title Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries
title_full Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries
title_fullStr Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries
title_full_unstemmed Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries
title_short Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries
title_sort using health facility deaths to estimate population causes of neonatal and child mortality in four african countries
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291588/
https://www.ncbi.nlm.nih.gov/pubmed/32527253
http://dx.doi.org/10.1186/s12916-020-01639-1
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