Determining the Cause of Death: Mortality Surveillance Using Verbal Autopsy in Indonesia

Abdul Wahab Purworejo HDSS, Indonesia;
INDEPTH Network, Accra, Ghana;
Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia

Search for other papers by Abdul Wahab in
Current site
Google Scholar
PubMed
Close
,
Ifta Choiriyyah Purworejo HDSS, Indonesia;
Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia

Search for other papers by Ifta Choiriyyah in
Current site
Google Scholar
PubMed
Close
, and
Siswanto Agus Wilopo Purworejo HDSS, Indonesia;
INDEPTH Network, Accra, Ghana;
Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia

Search for other papers by Siswanto Agus Wilopo in
Current site
Google Scholar
PubMed
Close
Restricted access

In the absence of a vital registration and health information systems, Indonesia does not have complete, accurate, and continuous data to summarize the mortality statistics of the population, nor determine the exact cause of death. Verbal autopsies performed in a community-based mortality surveillance have been used to provide information on the cause of deaths in such context. However, physician review of verbal autopsy can be expensive, time-consuming, and give inconsistent results, raising concern about its reliability. We used the Purworejo Health and Demographic Surveillance System’s (HDSS) mortality data collected between 2000 and 2002 and assigned causes of death for all age groups using Interpreting Verbal Autopsy-4, analytic software that applies a probabilistic model. A total of 1,999 deaths were identified among 55,581 individuals surveyed in 14,409 households; 830 deaths were able to be recorded using the standardized World Health Organization (WHO) verbal autopsy questionnaire. We calculated the proportion of different causes of death and its incidence rate (IR) ratios with 95% confidence interval (CI) to compare the IR per person-years-observation (PYO). The IR of stroke was 126.7 per 100,000 PYO (95% CI: 109.7, 143.7); acute respiratory infection including pneumonia was 70.8 per 100,000 PYO (95% CI: 58.1, 83.5); and the IR of other and unspecified cardiac diseases was 57.7 per 100,000 PYO (95% CI: 46.2, 69.2). Stroke was indicated as the leading cause of death among elderly people aged 50 years and above. Meanwhile, pneumonia as a communicable disease was found to be the most common cause of death among both 0–14-year-old children and elderly people.

Author Notes

Address correspondence to Abdul Wahab, Department of Biostatistics, Epidemiology and Population Health (BEPH), Faculty of Medicine, Universitas Gadjah Mada, IKM Building 1st floor, Jl. Farmako 1 Sekip Utara, Yogyakarta 55281, Indonesia. E-mail: awahab@ugm.ac.id

Authors’ addresses: Abdul Wahab, Department of Biostatistics, Epidemiology and Population Health (BEPH), Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, E-mails: abiwahab@yahoo.com and awahab@ugm.ac.id. Ifta Choiriyyah and Siswanto Agus Wilopo, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, E-mails: ifta.choiriyyah@gmail.com and sawilopo@yahoo.com.

  • 1.

    CBS, NFPCB, MOH, 2003. Indonesia Demographic and Health Survey 2002–2003. Maryland: Macro International Inc.

    • PubMed
    • Export Citation
  • 2.

    Setel PW, Sankoh O, Rao C, Velkoff VA, Mathers C, Gonghuan Y, Hemed Y, Jha P, Lopez AD, 2005. Sample registration of vital events with verbal autopsy: a renewed commitment to measuring and monitoring vital statistics. Bull World Health Organ 83: 611617.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Chandramohan D, Setel P, Quigley MA, 2001. Effect of misclassification of causes of death in verbal autopsy: can it be adjusted? Int J Epidemiol 30: 509514.

  • 4.

    Quigley MA, Chandramohan D, Rodrigues LC, 1999. Diagnostic accuracy of physician review, expert algorithms, and data-derived algorithms in adult verbal autopsies. Int J Epidemiol 28: 10811087.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Leitao J et al. 2014. Comparison of physician-certified verbal autopsy with computer-coded verbal autopsy for cause of death assignment in hospitalized patients in low- and middle-income countries: systematic review. BMC Med 12: 22.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Leitao J et al. 2013. Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring. Pan Am Health 6: 21518.

  • 7.

    Byass P, 2013. Combining the 2012 WHO Verbal Autopsy Instrument and the InterVA-4 Model into a Hand-Held VR Tool. Conference Presentation at the Global Summit on Civil Registration and Vital Statistics, Bangkok, Thailand, April 18–19, 2013.

    • PubMed
    • Export Citation
  • 8.

    Bauni E et al. 2011. Validating physician-certified verbal autopsy and probabilistic modeling (InterVA) approaches to verbal autopsy interpretation using hospital causes of adult deaths. Popul Health Metr 9: 112.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Barcus MJ, Laihad F, Sururi M, Sismadi P, Marwoto H, Bangs MJ, Baird JK, 2002. Epidemic malaria in the Menoreh hills of Central Java. Am J Trop Med Hyg 66: 287292.

  • 10.

    Murhandarwati EEH, Fuad A, Sulistyawati, Wijayanti MA, Bia MB, Widartono BS, Kuswantoro, Lobo NF, Supargiyono, Hawley WA, 2015. Change of strategy is required for malaria elimination: a case study in Purworejo district, Central Java province, Indonesia. Malar J 14: 318.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Kowal P et al. 2010. Ageing and adult health status in eight lower-income countries: the INDEPTH WHO-SAGE collaboration. Glob Health Action 3: 1112.

  • 12.

    Wahab A, Winkvist A, Stenlund H, Wilopo SA, 2001. Infant mortality among Indonesian boys and girls: effect of sibling status. Ann Trop Paediatr 21: 6671.

  • 13.

    Rao C, Soemantri S, Djaja S, Adair T, Wiryawan Y, Pangaribuan L, Irianto J, Kosen S, Lopez AD, 2010. Mortality in Central Java: results from the Indonesian mortality registration system strengthening project. BMC Res Notes 3: 325.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Finegold JA, Asaria P, Francis DP, 2012. Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organization and United Nations. Int J Cardiol 168: 934945.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Dans A, Ng N, Varghese C, Tai ES, Firestone R, Bonita R, 2011. The rise of chronic non-communicable diseases in southeast Asia: time for action. Lancet 377: 680689.

  • 16.

    CBS, NFPCB, MOH, 2012. Indonesia Demographic and Health Survey 2012. Maryland: Macro International Inc.

    • PubMed
    • Export Citation
  • 17.

    Ng N, Hakimi M, Van Minh H, Juvekar S, Razzaque A, Ashraf A, Masud Ahmed S, Kanungsukkasem U, Soonthornthada K, Huu Bich T, 2009. Prevalence of physical inactivity in nine rural INDEPTH health and demographic surveillance systems in five Asian countries. Glob Health Action 2. doi.org/10.3402/gha.v2i0.1985.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Montgomery AL, Morris SK, Bassani DG, Kumar R, Jotkar R, Jha P, 2012. Factors associated with physician agreement and coding choices of cause of death using verbal autopsies for 1130 maternal deaths in India. PLoS One 7: e33075.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Bauni E et al. 2011. Validating physician-certified verbal autopsy and probabilistic modeling (InterVA) approaches to verbal autopsy interpretation using hospital causes of adult deaths. Popul Health Metr 9: 49.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Byass P et al. 2015. Comparing verbal autopsy cause of death findings as determined by physician coding and probabilistic modelling: a public health analysis of 54000 deaths in Africa and Asia. J Glob Health 5: 010402.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Fantahun MW, Fottrell E, Berhane Y, Wall S, Hogberg U, Byass P, 2006. Assessing a new approach to verbal autopsy interpretation in a rural Ethiopian community: the InterVA model. Bull World Health Organ 84: 204210.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Oti SO, Kyobutungi C, 2010. Verbal autopsy interpretation: a comparative analysis of the InterVA model versus physician review in determining causes of death in the Nairobi DSS. Popul Health Metr 8: 21.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 471 384 37
Full Text Views 539 12 0
PDF Downloads 275 7 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save