New app Helps Monitor Disease and Injury Trends

The app, developed by an international consortium of researchers led by the Institute for Health Metrics and Evaluation (IHME; Seattle, WA, USA) at the University of Washington (Seattle, WA, USA), and the University of Melbourne (VIC, Australia), is basically a shortened verbal autopsy instrument (VAI) for recording mortality data in settings with no or unreliable vital registration systems.

The researchers first established a rank order of individual questions based on the Population Health Metrics Research Consortium (PHMRC) gold standard VAI according to their importance in predicting causes of death. Second, they reduced the size of the instrument by dropping questions in reverse order of importance. They then assessed the predictive performance of the instrument as questions were removed at the individual level by calculating chance-corrected concordance, and at the population level with cause-specific mortality fraction (CSMF) accuracy.

The final result was an app that shortened the full PHMRC VAI by almost 50%, without a significant drop in performance. While the full PHMRC VAI had 183, 127, and 149 questions for adult, child, and neonatal deaths (respectively), the shortened instrument developed had 109, 69, and 67 questions, respectively, representing a decrease in the total number of questions of 40%–55%. App performance was then validated using hand-held electronic tablets. A study describing the development and testing of the app was published on December 16, 2015, in BMC Medicine.

“Without accurate cause of death information, we can't monitor disease and injury trends, we can't keep track of emerging health problems, and we don't have any markers to show us whether programs and policies are actually working,” said senior author Professor Laureate Alan Lopez, PhD, of the University of Melbourne. “Up-to-date, reliable information on what people are dying from and at what age is really important for policies to prevent premature death.

“Our app provides a way to do this, quickly, simply, cheaply and effectively, in real time, with the power of technology. Our method involves data collection by health workers, registrars and village officials, who use the app to administer the surveys,” concluded Prof. Lopez. “It requires very minimal training. The data is fed into a computer, which makes a diagnosis. This way doctors are free to do what they do best, which is providing essential medical care to their communities.”

Worldwide, two in three deaths—about 35 million deaths each year—are unregistered. In addition, around 180 countries that are home to 80% of the world's population do not collect reliable cause of death statistics. Another problem is that in many regions around the world that do collect data, only registered doctors are qualified to determine a cause of death, but the process is expensive, time-consuming, and can be unreliable.

Related Links:
Institute for Health Metrics and Evaluation
University of Washington
University of Melbourne