Determining the cause of death through mortality surveillance using verbal autopsy in Karachi, Pakistan.

Background: In Pakistan, cultural and religious beliefs restrict autopsies, limiting their prevalence. Additionally, many deaths occur at home, outside of hospital systems, making cause-of-death (CoD) determination challenging. This study aims to overcome these challenges by using a community-based verbal autopsy approach in Karachi to identify CoD. Methods: The research was conducted in two peri-urban communities within the Health Demographic Site Surveillance catchment area. A total of 1500 deaths were investigated using the World Health Organization 2016 Verbal Autopsy Questionnaire. Interviewers received extensive training to ensure culturally sensitive data collection, and physicians analysed the data to determine CoD. The 10th edition of the International Classification of Diseases (ICD-10) was integrated with verbal autopsy data for a detailed analysis of mortality causes. Results: The study identified that 52.8% of deaths were male, and 47.1% female, with 51.2% occurring in hospitals and 48.7% at home. Among home deaths, 31.5% were children under five years and 55.4% were above 18 years. Analysis revealed that major CoD included non-communicable diseases: acute cardiac disease (12.6%), liver cirrhosis (7%), and stroke (4.3%), alongside communicable diseases like diarrheal disease (6.4%), pneumonia (4.1%), and sepsis (3.4%). In adults over 18, acute cardiac disease (25.0%) and liver cirrhosis (13.1%) were prevalent, whereas neonatal sepsis (12.8%) and perinatal asphyxia (11.7%) were the most common causes in children under five years. External causes included road traffic crashes (1.6%) and accidental drowning (0.7%). Conclusions: The study underscores the need for targeted health care strategies to address the diverse CoD and varying health-seeking behaviours observed. Improving access to health care, particularly for home-based deaths and vulnerable age groups, is essential for better health outcomes. Tailored interventions are crucial to address both communicable and non-communicable diseases effectively in resource-constrained settings.