Multimodal Artificial Intelligence for Cause-of-Death Assignment From Verbal Autopsy Records: A National Benchmark Study in South Africa

BACKGROUND Timely cause-of-death (COD) information guides health policy, yet many deaths in low- and middle-income countries are not medically certified. In Africa, fewer than 10% of deaths are. Verbal autopsy (VA) yields a structured symptom questionnaire and a free-text narrative. Mortality surveillance increasingly records the narrative alongside the questionnaire, but the algorithms used to produce VA-based statistics were designed for structured responses only, so narratives inform physician COD assignment but do not contribute to algorithmic COD assignment. We evaluated whether supervise

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