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. 2023 Feb 15;12(2):328.
doi: 10.3390/pathogens12020328.

Value of Verbal Autopsy in a Fragile Setting: Reported versus Estimated Community Deaths Associated with COVID-19, Banadir, Somalia

Tahlil Abdi Afrah  1 , Lilly M Nyagah  2 , Asma Swaleh Ali  2 , Mary Karanja  2 , Hassan W Nor  1 , Solomon Abera  2 , Ali Sh Mohamed  1 , Mohamed Ahmed Yusuf Guled  1 , Mohamed Mohamud Hassan Biday  1 , Majdouline Obtel  3 , Sk Md Mamunur Rahman Malik  2
Affiliations

Value of Verbal Autopsy in a Fragile Setting: Reported versus Estimated Community Deaths Associated with COVID-19, Banadir, Somalia

Tahlil Abdi Afrah et al. Pathogens. .

Abstract

Background: Accurate mortality data associated with infectious diseases such as coronavirus disease 2019 (COVID-19) are often unavailable in countries with fragile health systems such as Somalia. We compared officially reported COVID-19 deaths in Somalia with COVID-19 deaths estimated using verbal autopsy.

Methods: We interviewed relatives of deceased persons to collect information on symptoms, cause, and place of death. We compared these data with officially reported data and estimated the positive and negative predictive values of verbal autopsy.

Results: We identified 530 deaths during March-October 2020. We classified 176 (33.2%) as probable COVID-19 deaths. Most deaths (78.5%; 416/530) occurred at home and 144 (34.6%) of these were attributed to COVID-19. The positive predictive value of verbal autopsy was lower for home deaths (22.3%; 95% CI: 15.7-30.1%) than for hospital deaths (32.3%; 95% CI: 16.7-51.4%). The negative predictive value was higher: 97.8% (95% CI: 95.0-99.3%) for home deaths and 98.4% (95% CI: 91.5-100%) for hospital deaths. Conclusions Verbal autopsy has acceptable predictive value to estimate COVID-19 deaths where disease prevalence is high and can provide data on the COVID-19 burden in countries with low testing and weak mortality surveillance where home deaths may be missed.

Keywords: COVID-19; Somalia; cause of death; mortality; verbal autopsy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Proportion of deaths likely caused by COVID-19 based on verbal autopsy, by district, Banadir, Somalia, 2020.
Figure 2
Figure 2
Trends in COVID-19 deaths reported in the verbal autopsy and official government reports.
See this image and copyright information in PMC

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