Structure of CHERG’s VASA questionnaire.

The majority (40%) of the world’s under-five mortality burden is concentrated in nations like Nigeria (16.5%), India (16%), Pakistan (8%), and the Democratic Republic of the Congo (6%), where an undetermined number of under-five deaths go unrecorded. In low-resource settings throughout the world, the Verbal Autopsy-Social Autopsy (VASA) technique may assist assess under-five mortality estimates, assigning medical and social causes of death, and identifying relevant determinants. Uncertainty regarding missing data in high-burden nations like Pakistan necessitates a valid and reliable VASA instrument. This is the first study to validate Child Health Epidemiology Reference Group-CHERG’s VASA tool globally. In Pakistan, data from such a valid and reliable tool is vital for policy. This paper reports on the VASA tool in Karachi, Pakistan. Validity and reliability of the CHERG VASA tool were tested using face, content, discriminant validation, and reliability tests on one hundred randomly selected mothers who had recently experienced an under-five child death event. Data were computed on SPSS (version-21) and R software. Testing revealed high Item-content Validity Index (I-CVI) (>81.43%); high Cronbach’s Alpha (0.843); the accuracy of between 75–100% of the discriminants classifying births to live and stillbirths; and I-CVI (>82.07% and 88.98% respectively) with high accuracy (92% and 97% respectively) for assigning biological and social causes of child deaths, respectively. The CHERG VASA questionnaire was found relevant to the conceptual framework and valid in Pakistan. This valid tool can assign accurate medical and non-medical causes of child mortality cases occurring in Pakistan.全球5岁以下儿童死亡总负担的40%集中于尼日利亚（16.5%）、印度（16%）、巴基斯坦（8%）及刚果民主共和国（6%）等国，这些国家有数量未明的5岁以下儿童死亡病例未被记录在案。在全球各类低资源环境中，口述尸检-社会尸检（Verbal Autopsy-Social Autopsy, VASA）技术可辅助开展5岁以下儿童死亡估算，明确死亡的医学与社会归因，并识别相关影响因素。在巴基斯坦这类高负担国家，因死亡数据缺失存在不确定性，亟需一款有效且可靠的VASA工具。本研究为首个在全球范围内验证儿童健康流行病学参考组（Child Health Epidemiology Reference Group, CHERG）VASA工具的研究。在巴基斯坦，该经验证的可靠工具所产生的数据对政策制定至关重要。本文报告了巴基斯坦卡拉奇地区VASA工具的应用验证情况。研究选取100名近期经历5岁以下儿童死亡的母亲作为随机抽样对象，通过表面效度、内容效度、区分效度检验及信度检验，对CHERG VASA工具的效度与信度进行评估。数据采用SPSS（21.0版本）与R软件进行统计分析。检验结果显示：条目内容效度指数（Item-content Validity Index, I-CVI）达81.43%以上；克朗巴赫α系数为0.843；区分活产与死产的分类准确率为75%~100%；在判定儿童死亡的生物学归因与社会归因时，条目内容效度指数分别达82.07%与88.98%以上，对应分类准确率分别为92%与97%。研究证实，CHERG VASA问卷符合研究的概念框架，且在巴基斯坦境内具有良好效度。该有效工具可精准判定巴基斯坦境内儿童死亡病例的医学与非医学归因。