THE EFFECT OF MISCLASSIFICATION ERROR ON REPORTED CAUSE-SPECIFIC MORTALITY FRACTIONS FROM VERBAL AUTOPSY

Background. Verbal autopsy (VA) studies are important for measuring ca use-specific mortality in areas where medical certification of cause o f death is uncommon. This paper explores the effects of misclassificat ion errors on the results of Verbal autopsy studies, and recommends wa ys to take misclassification errors into account in the interpretation of results. Methods. Mathematical formulae are derived for determinin g the size and direction of the error in cause-specific mortality esti mates based on VA studies caused by misclassification. The levels of s ensitivity and specificity found in currently available validation stu dies for childhood VA are examined, Results. There can be substantial errors in the estimates of the cause-specific mortality fraction deriv ed from VA studies. The cause-specific mortality fraction itself has a n important influence on the size of the error forgiven levels of sens itivity and specificity, and when the cause-specific mortality fractio n is small, the size of the error depends more on specificity than on sensitivity. Conclusion. Despite its drawbacks VA seems to be the most promising way of establishing cause of death when most deaths take pl ace at home without medical attention. However, more validation studie s an standardized instruments are required in order to collect informa tion about sensitivity and specificity and subsequently improve the de sign of the instrument. At the same time, analysts need to take miscla ssification errors into consideration in ways outlined in this paper.