Abstract
BackgroundVerbal autopsy (VA) is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS) systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed.Methods and findingsIn 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future.ConclusionsDespite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable.The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality.
Highlights
Introduction of an international standardVerbal autopsy (VA) instrumentIn 2007, WHO introduced the first international technical standards and guidelines for VA, following recommendations from a 2005 systematic review of the most widely used instruments and procedures [8]
Inadequate data on cause-specific mortality patterns impede the development of sound health policy, planning, monitoring, and evaluation [4]
This paper describes key developments of the WHO 2016 VA instrument as a harmonized international standard
Summary
Introduction of an international standardVA instrumentIn 2007, WHO introduced the first international technical standards and guidelines for VA, following recommendations from a 2005 systematic review of the most widely used instruments and procedures [8]. Compared to the 2007 instrument, questions were modified to facilitate a dichotomous yes/no response (or some multiple select values) and to capture continuous variables with their value, and the overall number of conditions and questions was reduced. This process marked a significant shift from the previous uses of VA, which were generally limited to small-scale research and surveillance settings. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS) systems, have developed rapidly in the last decade These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed
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