verbal autopsy, the research method used in recording mortality fractions of a population in countries with poor vital registration system

1. VERBAL AUTOPSY (VA)
KORAY HARUN MUNAWAR
10556095

2. OUTLINE OF PRESENTATION
• DEFINITION OF VERBAL AUTOPSY (VA)
• INTRODUCTION AND DEVELOPMENT OF VA
• THE USAGE OF VA
• METHODS OF INTERPRETING VA DATA
• IMPORTANCE OF VA
• INSTANCES OF VA WAS USED
• CONCLUSION
• REFERENCE

3. DEFINITION OF VERBAL AUTOPSY(VA)
• Verbal autopsy is a research method that helps determine
probable causes of death in cases where there is no medical
record or formal medical attention given.
• Verbal autopsy (VA) is a method of determining individuals’
causes of death and cause-specific mortality fractions in
populations without a complete vital registration system.

4. INTRODUCTION AND DEVELOPMENT OF VA
• The term verbal autopsy was first coined in research projects by the
Department of International Health of Johns Hopkins School of Hygiene
and Public Health which ran from 1965 to 1973 in Punjab, India.
• These two research projects were located in villages near Ludhiana,
with headquarters in Narangwal village.
• These projects were aimed at assessing the relationships between
nutrition, infection and child development,and
• the acceptance of family planning services by rural communities in
response to maternal and early child care service packages

5. INTRODUCTION AND DEVELOPMENT OF VA
• Feeding centers and health care for under-5s, and on maternal and
newborn health care services were created in various villages in the
Narangwal district.
• Early In 1971, results from the nutrition villages showed no significant
decrease in child mortality, and causes and circumstances of child
deaths had remained largely unknown
• In response, an information system was established, wherein all child
deaths in the villages had to be reported to the Narangwal Project
Office by the resident health worker within five days

6. INTRODUCTION AND DEVELOPMENT OF VA
• One of the project physicians then went to the concerned family and
through intense questioning of close relatives as to the signs and
symptoms of the process leading to death.
• Review of the child’s health records supplemented by visits to the
external health care provider if such was the case.
• These are all done to established possible reasons for, and a most likely
cause of death.
• Recommendations from the causes of death obtained through verbal
autopsy, were implemented. There was a significant reduction in child
morbidities and mortalities

7. INTRODUCTION AND DEVELOPMENT OF VA
• In 1972, results from the two projects were presented to the project
office in Narangwal
• The term Verbal Autopsy was used ‘in irony’ by a visiting medical
dignitary who not only questioned the results but also the method,
labelling it ‘’unscientific”.
• The term was retained by the then director of the two projects, Carl E.
Taylor, chairman of the Department of International Health and he also
chaired the conference.
• Seven years later (1980), the Ministry of Health of Egypt conducted an
investigation into prevention of child mortality from developmentally
disabled

8. INTRODUCTION AND DEVELOPMENT OF VA
• The verbal autopsy method as originally developed in Narangwal was
slightly modified to the Egyptian setting. It was used to identify
prevailing mortality patterns among preschoolers.
• Following implementation of different treatment schedules, child
mortality rates dropped significantly by 40% in specific input villages
over the period of study.
• The project site was re-visited six years following completion of the
investigation confirming utility and effectiveness of the V.A. method,
and applied intervention modalities respectively.

9. INTRODUCTION AND DEVELOPMENT OF VA
• As early as the 1950s forms of VA called lay reporting
were employed in countries with low coverage of
medical access.
• The World Health Organization (WHO) continued to
encourage lay reporting in such settings and in 1975
an official lay reporting form was established.

10. THE USAGE OF VERBAL AUTOPSY
• The past two decades have seen a proliferation of interest, research and
development in all aspects of the VA process, including data-collection
systems where VA is applied
• Needs and demands for standardization of VA, led to the 2007
publication of the WHO VA standards, which many researchers have
adopted.

11. THE USAGE OF VERBAL AUTOPSY
• The standards included:
1. Verbal autopsy questionnaires for three age groups (under
four weeks; four weeks to14 years; and 15 years and above);
2. Cause of death certification and coding resources consistent
with the International Classification of Diseases and Related
Health Problems, tenth revision (ICD-10); and
3. A cause-of-death list for verbal autopsy prepared according
to the ICD-10

12. THE USAGE OF VERBAL AUTOPSY
• However, the WHO 2007 instrument was modified in several
projects to accommodate the local needs.
• 2012, a new VA instrument was created as a modified version
of the 2007 instrument.
• The 2012 instrument eliminated unreported causes and focus
on useful questions.
• It was designed to facilitate VA use in routine vital registration
systems to improve national cause-specific mortality data.

13. THE USAGE OF VERBAL AUTOPSY
• The full set of questions and the resulting full questionnaire of
the 2012 instrument included
1) Personal information
a) Information on the deceased
b) Vital registration
2) Information on the respondent

14. THE USAGE OF VERBAL AUTOPSY
3) Cause of death
• a) Medical history
• b) General signs and symptoms
• c) Signs and symptoms associated with pregnancy
• d) Neonatal and child history, signs and symptoms
• e) History of injuries and accidents
• f) Risk factors
• g) Health service utilization

15. THE USAGE OF VERBAL AUTOPSY
4) Background and context
5) Recommended optional open narrative text field

16. THE USAGE OF VERBAL AUTOPSY
• Also, the following are indicated on the questionnaire form;
1. A unique ID, control or reference number for the VA
questionnaire being completed;
2. The date, place and time of the interview and identity of the
interviewer;
3. Key characteristics of the respondent;
4. The time, place and date of death;
5. The name, sex and age of the deceased

17. THE USAGE OF VERBAL AUTOPSY
• Interviewers should be trained on the instrument
and on conducting interviews with persons that
may still be in mourning.
• Interviewers should be given enough time to
carry out their task in VA.

18. THE USAGE OF VERBAL AUTOPSY
• Interviewers involved in the application of the VA should have
the following minimum qualifications:
1. Have completed at least secondary school and have good
working knowledge in the relevant local language(s)
2. Be acceptable to the local community; where possible,
selected by the local community;
3. Have good training in conducting VA interviews;
4. Know very well the content and uses of the VA instrument

19. Methods of interpreting VA data
• Three or more Physicians review of the questionnaires, and the
signs and symptoms and then classify the cause of death
without any validation sample
• This approach can be expensive as it involves approximately
three or more physicians, each taking 20–30 minutes to
review symptoms and classify each death.
• Judgments by these doctors are highly sensitive to their socio-
demographic location. So physicians need to come from local
areas.

20. Methods of interpreting VA data
• Another method of VA data analysis which is currently and
mostly in use is using computer algorithm.
• Database is created for all the causes and risk factors related to
death are encrypted.
• When the data from the questionnaire is inputted into the
computer, the data is analyzed and possible cause of death is
displayed.
• It is more easier and less time consuming.

21. Importance of Verbal Autopsy
• First, it has been primarily used as a research tool in population studies,
intervention research or epidemiological studies.
• Second, it has become a source of cause of death statistics to meet the
demand for population cause-specific mortality data to be used in
policy, planning, priority setting and benchmarking.
• Third, VA data are gaining acceptance as a source of cause of death
statistics because vital registration coverage has not significantly
improved in developing countries.

22. Importance of Verbal Autopsy
• VA methods have been used in the following data collection
systems: clinical trials and large-scale epidemiological studies;
demographic surveillance systems; national sample
surveillance systems; and household surveys

23. INSTANCES VERBAL AUTOPSY WAS USED
• Noteworthy uses of the verbal autopsy method include the
Million Death Study in India.
• China's national program to document causes of death in rural
areas.
• And the Global Burden of Disease Study 2010

24. CONCLUSION
• Verbal autopsy is a method used in determining the cause
specific mortality.
• It is used mostly in developing countries where vital
registration is poor.
• It has undergone modifications since it inception and
currently, the WHO 2012 verbal autopsy standard instrument
is used.

25. REFERENCE
1. Verbal Autopsy (VA) | Institute for Health Metrics and
• www.healthdata.org/verbal-autopsy
2. Verbal Autopsy Methods with Multiple Causes of - Gary King
• gking.harvard.edu/files/vamc.pdf
3. What is Verbal Autopsy? www.cghr.org
4. Verbal autopsy standards – WHO
www.who.int/healthinfo/statistics/verbal_autopsy