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

Author:

Afrah Tahlil Abdi1,Nyagah Lilly M.2ORCID,Ali Asma Swaleh2,Karanja Mary2ORCID,Nor Hassan W.1,Abera Solomon2,Mohamed Ali Sh1,Guled Mohamed Ahmed Yusuf1,Biday Mohamed Mohamud Hassan1,Obtel Majdouline3,Malik Sk Md Mamunur Rahman2ORCID

Affiliation:

1. College of Health Sciences, Benadir University, Mogadishu, Somalia

2. Somalia Country Office, World Health Organization (WHO), Mogadishu, Somalia

3. Department of Public Health, University Mohammed V of Rabat, Rabat, Morocco

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.

Funder

Alliance for Health Policy and Systems Research, World Health Organization

Publisher

MDPI AG

Subject

Infectious Diseases,Microbiology (medical),General Immunology and Microbiology,Molecular Biology,Immunology and Allergy

Reference33 articles.

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2. Ahmed, M., Fodjo, J.S., Gele, A., Farah, A., Osman, S., Guled, I., Ali, A., and Colebunders, R. (2020). COVID-19 in Somalia: Adherence to Preventive Measures and Evolution of the Disease Burden. Pathogens, 9.

3. Lockdowns, lives and livelihoods: The impact of COVID-19 and public health responses to conflict affected populations—A remote qualitative study in Baidoa and Mogadishu, Somalia;Braam;Confl. Health,2021

4. (2023). WHO Coronavirus (COVID-19) Dashboard [Internet], World Health Organization. Available online: https://covid19.who.int/?mapFilter=cases.

5. O’Callaghan, S., Abkiar Nur, F., Kesterton, A., and de Clercq, P. (2022). Beyond the Pandemic: Strengthening Somalia’s Health System, ODI. Available online: https://odi.org/en/insights/beyond-the-pandemic-strengthening-somalias-health-system/.

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