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Verbal Autopsy

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Verbal Autopsy: BACKGROUND

Verbal Autopsy (VA) is an approach used to obtain cause of death by interviewing lay respondents on the signs and symptoms experienced by the deceased before death. It is used where vital registration systems are weak or the proportion of a population under medical care is low, and involves three steps:

  1. data collection by interviewing bereaved relatives or others familiar with the circumstances of the death and who ideally were with the deceased during the events leading to death
  2. assignment of cause of death using either individual or multiple physician reviews, expert algorithms or data driven algorithms (regression or neural networks, Bayesian approaches with probabilities of various diagnoses)
  3. coding and tabulation of causes, ideally using the ICD

VAs aim to:

VA is often used as part of community-based maternal death reviews or Confidential Enquiries and is coupled with questions to ascertain both the medical and non-medical factors that precipitated a maternal death via in-depth interviews and questionnaires (including open ended verbatim accounts, symptom checklists or checklists with filter questions).

These are then used to:

VA can be done on a one-off basis or routinely as part of SAVVY, DSS, or Active Surveillance of Pregnancy-Related deaths. VA has been used to measure cause specific mortality in populations (e.g. as part of SAVVY in India, China, and Tanzania) and to investigate cause of death in specific age, sex, or cause groups such as women of reproductive age, maternal, neonatal, infant, child or injury related deaths. They have also been used to investigate epidemics and to assess the effectiveness of disease specific interventions.

Identification of death:

Ascertainment of maternal/pregnancy related status

This is done by asking pregnancy-related questions (Please see Decennial Census for information on pregnancy-related questions), followed by questions to ascertain sub-causes of maternal death.

For example relatives of women who died postpartum can be asked:

Responses to these questions would them be used to determine if the woman died of post partum haemorrhage.

Advantages:

Limitations:

Measurement issues:

Can be supplemented with information from medical documents if available in the household or from health facilities.

Measurement requirements:

InterVA-M

InterVA-M provides a computer-based model for interpreting verbal autopsy information. For further details, please see Additional Resources.

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World Health Organisation WHO (2007) Verbal autopsy standards: ascertaining and attributing cause of death. Geneva: World Health Organization.

World HEalth Organisation Campbell O, Ronsmans C. Verbal autopsies for maternal deaths: report of a WHO workshop, London, 10-13 January 1994. Geneva, World Health Organization, 1995

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Scandinavian Journal of Public Health Byass P, Huong DL, Minh HV. (2003) A probabilistic approach to interpreting verbal autopsies: methodology and preliminary validation in Vietnam. Scandinavian Journal of Public Health, 31(Suppl.62):32-37

Scandinavian Journal of Public Health Byass P, Fottrell E, Dao LH, Berhane Y, Corrah T, Kahn K, Muhe L et al (2006) Refining a probabilistic model for interpreting verbal autopsy data. Scandinavian Journal of Public Health, 34: 26-31

Oxford Journals - International Journal of Epidemiology Chandramohan D et al. Verbal autopsies for adult deaths: issues in their development and validation. International Journal of Epidemiology 1994; 23:213-222.

Studies in Family Planning Chandramohan D et al. The validity of verbal autopsies for assessing the causes of institutional maternal death. Studies in Family Planning 1998; 29:414-422.

Bulletin of the World Health Organisation Fantahun M, Fottrell E, Berhane Y, Wall S, Högberg U, Byass P. (2006) Assessing a new approach to verbal autopsy interpretation in a rural Ethiopian community: the InterVA model. Bulletin of the World Health Organization, 84:204-210

Population Health Metrics Fottrell E, Byass P, Ouedraogo TW, Tamini C, Gbangou A, Sombie I, Hogberg U, Witten KH, Bhattacharya S, Desta T, Deganus S, Tornui J, Fitzmaurice AE, Meda N, Graham WJ (2007) Revealing the burden of maternal mortality: a probabilistic model for determining pregnancy-related causes of death from verbal autopsies. Population Health Metrics, 5:1

Oxford Journals - International Journal of Epidemiology Høj L, Stensballe J, Aaby P. Maternal mortality in Guinea-Bissau: the use of verbal autopsy in a multi-ethnic population. International Journal of Epidemiology 1999; 28:70-76.

Oxford Journals - International Journal of Epidemiology Ronsmans C et al. A comparison of three verbal autopsy methods to ascertain levels and causes of maternal deaths in Matlab, Bangladesh. International Journal of Epidemiology 1998; 27:660-666.

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World Health Organisation Verbal Autopsy Standards: Ascertaining and attributing causes of death

Immpact InterVA-M:
A collection of computer-based models designed to assist in the interpretation of Verbal Autopsy interviews. Umeå University, Sweden and Immpact, University of Aberdeen, United Kingdom.
Umea University, Sweden

Immpact InterVA-M User Guide
Umea University, Sweden

Berkeley, University of California General presentation on verbal autopsy

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