Need to validate Verbal Autopsy/Social Autopsy (VASA) integrated tool for developing countries to assign biological and social reasoning of child mortalities

Letter to the Editor Need to validate Verbal Autopsy/Social Autopsy (VASA) integrated tool for developing countries to assign biological and social reasoning of child mortalities. Siddiqui MB, Ng. CW, Low WY Senior Lecturer, Department of Community Health Sciences, Hamdard University, Karachi Pakistan. Director, Child Health Registry of Pakistan (CHRoP). Head of “Centre of Maternal and Child Health Research” (CoMCHR) at Advanced Educational Institute of Research Centre (AEIRC). Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia. Health Research Development Unit, Faculty of Medicine, University of Malaya. Corresponding Author: drbilals@gmail.com

Over the time since 1990, as the world strive for reducing child mortality 1 , there has been a clustering of child mortality estimates in developing countries 2 . The most distinguished clusters have been found in countries belonging to Sub-Saharan African and South Asian regions 3,4 , especially in India, Nigeria, Pakistan, Democratic Republic of the Congo and China 2,3 . Most of the developing countries, in comparison to developed ones, lack comprehensive vital registration system (VRS) 5,6 . This system gathers data mostly on births and deaths of the population. The information extracted from such data facilitate and supports the health managers and planners during planning and allocation of scarce resources to the population.
Ascertaining the cause of death is crucially important for developing countries 7 . Most of the developing countries have weak VRS, due to which large number of deaths from non-accessible areas gets missed out and the cause of such deaths remain unknown. Verbal autopsy (VA) is the alternative way adopted by developing countries to capture data on child deaths and related variables 8 . With the use of VA, the biological cause of death (e.g. pneumonia, diarrhea, infections etc.) is ascertained. Similarly, Social Autopsy, which is relatively a newer technique than VA, focuses on capturing the non-biological determinants (mostly on the socioeconomic, cultural, healthy behaviors before and after birth, care seeking behavior of parents during the illness and all determinants linked with access to health care services during the childhood illness child) 9 . Such determinants can indirectly pinpoint the barriers in delivery of health care services to the ill child and helps in ascertaining the social cause of death 10  Since the CHERG'S (MCEE's) VASA tool captures and organizes data on biological and social determinants of child mortality and ultimately assign biological and social cause/s of any death incident, the gathered data should be valid and reliable.
Here lies the concept of validity of any instrument. Validity of an instrument tell us the instrument's ability and the measure to which its capacity can be able to measure what it is supposed to measure. Similarly, reliability tells us the degree to which a test consistently (on repeated trials) measure what it intends to measure. There are several techniques to identify the validity and reliability of any tool. Despite the fact that the CHERG (MCEE) VASA tool has been developed by a well-known agency with a team of experts, this tool has not been validated for use in developing countries, where its greatest need lies. There is a strong need that this tool should be tested on its validity and reliability so that the data (i.e. biological and social cause of death and biological and social determinants linked with child death) generated 19 from this tool should be valid and reliable to be used in policy and planning across developing countries.

Conclusion
We suggest that the CHERG (MCEE) VASA integrated tool should be tested on its validity and reliability to be use in developing countries to cater the upcoming need to identify the extended data on child mortality determinants.

Competing Interest
All the authors disclose that there are no competing interests in the preparation of this article.

Acknowledgment
I acknowledge all the researchers and healthcare professionals who strive and give their efforts in improving women and child survival of the developing countries. Their untiring efforts should be complemented by a strong governmental support to bring a