Health statistics and information systems

Verbal autopsy standards: ascertaining and attributing causes of death

The 2012 WHO verbal autopsy instrument

In 2012, WHO published a revised shortened verbal autopsy (VA) questionnaire (called Release Candidate 1). The instrument has now been used in several field settings. In addition, other instruments have been developed based on validation studies. The Institute of Health Metrics and Evaluation at the University of Washington and its partners are also promoting a shortened VA questionnaire.

The WHO verbal autopsy (VA) working group

At the first meeting of the WHO Reference Group on Global Health Statistics, 9-10 December, a VA working group was established. This group will be chaired by Daniel Chandramohan of the London School of Hygiene and Tropical Medicine. It will bring together experts in this field, and its first goal is to agree upon a single VA instrument for data collection in countries, based on the recent experiences. This instrument should then be the basis for multiple analytical methods including physician-based diagnosis, InterVA, Tariff and others. The group will further address data sharing, the development of standardized data sets, methods for validation of VA analysis, and reference definitions for causes of death of interest to ensure consistency with ICD classification rules.

Release Candidate 1

The WHO verbal autopsy instrument 2012 is designed to be suitable for routine use. It can be used for physician assessment as much as with software that assigns the cause of death. It is designed primarily for use with electronic data collection tools. Traditional paper based questionnaires can be derived. Sample questionnaires are provided with the instrument.

Compared to the 2007 instrument the numbers of conditions and questions have been reduced, based on evidence from the field. The questions have been reformulated to allow for responses with a simple yes or no answer, or a duration in some instances.

The instrument is designed for all age groups, including maternal and perinatal deaths, and also deaths caused by injuries.

The tool will evolve based on users’ feedback and further evidence from the field. The users are asked to share the information collected in their verbal autopsy (VA) in a way that allows assessment of validity and feasibility of the questions in the field.

In order to facilitate its dissemination, translators are asked to share their translated files for reuse in the same language region.

The manual includes:
  • Background on VA;
  • Sample VA questionnaires for three age groups (under four weeks; 4weeks-14 years,15 years and above);
  • The full matrix of questions, definitions and related skip patterns;
  • Instructions on how to use the matrix of questions;
  • Criteria for setting up a data collection infrastructure and the related databases;
  • Information about available software for assessing a cause of death;
  • Instructions on how to design a localized questionnaire;
  • A simplified cause of death list for VA with corresponding ICD-10 codes.
  • Data input instrument under development.

A separate document (to be published) reports in detail about the steps and the evidence that led to this new version of the WHO VA tool, and gives the rationale for inclusion or exclusion of indicators.

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