A Verbal/Social Autopsy (VASA) Child Mortality Inquiry to Investigate Under-Five Mortality Determinants in Slums of Karachi, Pakistan:A Mix Methods Interventional Study

Abstract

Background Pakistan stands along top ten countries responsible for two-third of global child mortality burden. To improve Child Mortality (CM) estimates in Pakistan, there is an exigent need to understand the in-depth reasoning behind mortalities. In Pakistan, the data on cause-ofdeath (CoD) for a large number of child mortalities in Pakistan is either not available or not suitable for use. Pakistan uses an alternative technique called Verbal autopsy (VA). Since VA only determines the biological cause of death (BCoD), and does not capture multitude of other modifiable social, cultural and health system determinants, it has a limited importance. Such non-biological determinants are captured by another technique i.e. Social Autopsy (SA). Objective By integrating VA with SA, extended set of mortality related determinants will be explored, in addition to strengthening death notification coverage and assigning CoD in such missed out mortalities. Method Under the working group of Health Advocacy Council for Women and Children (HACWC) in collaboration with Child Registry of Pakistan (CROP), mixed method (QUAN-QUAL) interventional study will be carried out in urban-slums of Karachi city using VASA-integrated under-five mortality investigative technique. Parents of dead children will be interviewed. Second stage of study will be followed by qualitative interviews with different cadres of stakeholders. Expected Outcomes By focusing the specific determinants related to case-management and care-seeking process (identified by The Pathway to Survival Framework-TPtoSF) an in-depth understanding of related determinants can be achieved, which will help in crafting potential interventions required to limit the barriers that increase the chances of CM in developing nations.

Validation of CHERG’S Verbal Autopsy-Social Autopsy (VASA) tool for ascertaining determinants and causes of under-five child mortality in Pakistan

“…This validation study is a component of the Karachi VASA child mortality study [ 37 ] and is designed to objectively assess the validity and reliability estimates of the CHERG’s VASA questionnaire, which was later utilized in Karachi VASA child mortality study .…”

In-depth Validation of CHERG’S Verbal Autopsy-Social Autopsy (VASA) Tool for Ascertaining Determinants and Causes of Under-Five Child Mortalities in Karachi, Pakistan.

“…This validation study is a part of Karachi's VASA ICMI study (23) and objectively focuses assessing the validity and reliability estimates of the CHERG VASA questionnaire, which was later utilized in Karachi's VASA ICMI study.…”

Challenges and acceptance of the use of computer-assisted personal interviews technology for verbal autopsy/social autopsy child mortality survey in urban slums of Karachi, Pakistan.

“…Out of twenty (20), a total of eighteen (18) respondents showed acceptability for CAPI survey and only two (02) showed preference of PAPI (90%). All the interviewers (100%), and 80% of community members expressed acceptability.…”

“…The data collectors in the study were trained on how to improve this element during the interview. We also took specific measures to prevent such events, which are discussed in another paper in detail 18 . Additionally, CAPI questionnaire application was developed with shortened What this study has added to the literature:…”