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Verbal autopsy: innovations, applications, opportunities - Improving cause of death measurement

Edited by Alan D Lopez, Rafael Lozano, Christopher JL Murray and Kenji Shibuya 
Population Health Metrics 

Identifying the causes of death in a population is critical to inform planning, resource allocation, program implementation, monitoring, and evaluation. Since many countries lack complete vital registration systems with medical certification of deaths, cause of death information is often missing. Verbal autopsy (VA) can be used to determine individuals' causes of death and cause-specific mortality fractions in areas without a vital registration system. A standard VA instrument paired with easy-to-implement and reliable analytic methods could help bridge significant gaps in information about causes of death, particularly in resource-poor settings. What has been missing from the VA field is a collection of the most up-to-date research to help decision-makers choose the best and most cost-effective techniques to identify causes of death in their populations. This thematic series, “Verbal autopsy: innovations, applications, opportunities,” was developed in response to this need. 

The research published in this collection emerged from the “Global Congress on Verbal Autopsy: State of the Science,” held in Bali, Indonesia, in February 2011. The conference was co-sponsored by the Institute for Health Metrics and Evaluation, the University of Queensland School of Population Health, and Population Health Metrics. The innovations in VA detailed in these papers represent a substantial increase in knowledge about the comparative performance of various methods to assign causes of death, from applications of methods used in current practice, including physician review, to a rigorous validation of new automated methods with significant potential for future application in routine national and research data collection platforms. 

We expect that this collection of Population Health Metrics will provide an opportunity for informed discussion and debate and hopefully will stimulate the widespread application of VA where it is needed.


  1. InterVA is a widely disseminated tool for cause of death attribution using information from verbal autopsies. Several studies have attempted to validate the concordance and accuracy of the tool, but the main l...

    Authors: Rafael Lozano, Michael K Freeman, Spencer L James, Benjamin Campbell, Alan D Lopez, Abraham D Flaxman and Christopher JL Murray
    Citation: Population Health Metrics 2011 9:50
    Content type: Research Published on:

  2. The most common method for determining cause of death is certification by physicians based either on available medical records, or where such data are not available, through verbal autopsy (VA). The physician-...

    Authors: Evasius Bauni, Carolyne Ndila, George Mochamah, Gideon Nyutu, Lena Matata, Charles Ondieki, Barbara Mambo, Maureen Mutinda, Benjamin Tsofa, Eric Maitha, Anthony Etyang and Thomas N Williams
    Citation: Population Health Metrics 2011 9:49
    Content type: Research Published on:

  3. Verbal autopsy (VA) is a widely used method for analyzing cause of death in absence of vital registration systems. We adapted the InterVA method to extrapolate causes of death for stillbirths and neonatal deat...

    Authors: Stefania Vergnano, Edward Fottrell, David Osrin, Peter N Kazembe, Charles Mwansambo, Dharma S Manandhar, Stephan P Munjanja, Peter Byass, Sonia Lewycka and Anthony Costello
    Citation: Population Health Metrics 2011 9:48
    Content type: Research Published on:

  4. The advent of the HIV pandemic and the more recent prevention and therapeutic interventions have resulted in extensive and rapid changes in cause-specific mortality rates in sub-Saharan Africa, and there is de...

    Authors: Abraham J Herbst, Tshepiso Mafojane and Marie-Louise Newell
    Citation: Population Health Metrics 2011 9:47
    Content type: Research Published on:

  5. Verbal autopsy (VA) has often been used for point estimates of cause-specific mortality, but seldom to characterize long-term changes in epidemic patterns. Monitoring emerging causes of death involves practiti...

    Authors: Peter Byass, Kathleen Kahn, Edward Fottrell, Paul Mee, Mark A Collinson and Stephen M Tollman
    Citation: Population Health Metrics 2011 9:46
    Content type: Research Published on:

  6. "Social autopsy" refers to an interview process aimed at identifying social, behavioral, and health systems contributors to maternal and child deaths. It is often combined with a verbal autopsy interview to es...

    Authors: Henry D Kalter, Rene Salgado, Marzio Babille, Alain K Koffi and Robert E Black
    Citation: Population Health Metrics 2011 9:45
    Content type: Review Published on:

  7. Effective implementation of child survival interventions depends on improved understanding of cultural, social, and health system factors affecting utilization of health care. Never the less, no standardized i...

    Authors: Karin Källander, Daniel Kadobera, Thomas N Williams, Rikke Thoft Nielsen, Lucy Yevoo, Aloysius Mutebi, Jonas Akpakli, Clement Narh, Margaret Gyapong, Alberta Amu and Peter Waiswa
    Citation: Population Health Metrics 2011 9:44
    Content type: Research Published on:

  8. Trends in the causes of child mortality serve as important global health information to guide efforts to improve child survival. With child mortality declining in Bangladesh, the distribution of causes of deat...

    Authors: Li Liu, Qingfeng Li, Rose A Lee, Ingrid K Friberg, Jamie Perin, Neff Walker and Robert E Black
    Citation: Population Health Metrics 2011 9:43
    Content type: Research Published on:

  9. Because of a physician shortage in many low-income countries, the use of nonphysicians to classify perinatal mortality (stillbirth and early neonatal death) using verbal autopsy could be useful.

    Authors: Cyril Engmann, John Ditekemena, Imtiaz Jehan, Ana Garces, Mutinta Phiri, Vanessa Thorsten, Manolo Mazariegos, Elwyn Chomba, Omrana Pasha, Antoinette Tshefu, Elizabeth M McClure, Dennis Wallace, Robert L Goldenberg, Waldemar A Carlo, Linda L Wright and Carl Bose
    Citation: Population Health Metrics 2011 9:42
    Content type: Research Published on:

  10. Verbal autopsy (VA) is a widely used tool to assign probable cause of death in areas with inadequate vital registration systems. Its uses in priority setting and health planning are well documented in sub-Saha...

    Authors: Mathew A Mwanyangala, Honorathy M Urassa, Jensen C Rutashobya, Chrisostom C Mahutanga, Angelina M Lutambi, Deodatus V Maliti, Honorati M Masanja, Salim K Abdulla and Rose N Lema
    Citation: Population Health Metrics 2011 9:41
    Content type: Research Published on:

  11. Verbal autopsy (VA) can be used to describe leading causes of death in countries like Zambia where vital events registration does not produce usable data. The objectives of this study were to assess the feasib...

    Authors: Sheila S Mudenda, Stanley Kamocha, Robert Mswia, Martha Conkling, Palver Sikanyiti, Dara Potter, William C Mayaka and Melissa A Marx
    Citation: Population Health Metrics 2011 9:40
    Content type: Research Published on:

  12. The Mortality Information System (MIS) in Brazil records mortality data in hospitals and civil registries with the responsibility of compiling underlying cause of death. Despite continuous improvements in the ...

    Authors: Elisabeth França, Deise Campos, Mark DC Guimarães and Maria de Fátima M Souza
    Citation: Population Health Metrics 2011 9:39
    Content type: Research Published on:

  13. In Mexico, the vital registration system relies on information collected from death certificates to generate official mortality figures. Although the death certificate has high coverage across the country, the...

    Authors: Bernardo Hernández, Dolores Ramírez-Villalobos, Minerva Romero, Sara Gómez, Charles Atkinson and Rafael Lozano
    Citation: Population Health Metrics 2011 9:38
    Content type: Research Published on:

  14. In 2004, the media repeatedly reported water pollution and "cancer villages" along the Huai River in China. Due to the lack of death records for more than 30 years, a retrospective survey of causes of death us...

    Authors: Xia Wan, Maigeng Zhou, Zhuang Tao, Ding Ding and Gonghuan Yang
    Citation: Population Health Metrics 2011 9:37
    Content type: Research Published on:

  15. Verbal autopsy is important for detecting causes of death including HIV in areas with inadequate vital registration systems. Before antiretroviral therapy (ART) introduction, a verbal autopsy study in rural Ug...

    Authors: Billy N Mayanja, Kathy Baisley, Norah Nalweyiso, Freddie M Kibengo, Joseph O Mugisha, Lieve Van der Paal, Dermot Maher and Pontiano Kaleebu
    Citation: Population Health Metrics 2011 9:36
    Content type: Research Published on:

  16. Verbal autopsy (VA) is used to estimate the causes of death in areas with incomplete vital registration systems. The King and Lu method (KL) for direct estimation of cause-specific mortality fractions (CSMFs) ...

    Authors: Abraham D Flaxman, Alireza Vahdatpour, Spencer L James, Jeanette K Birnbaum and Christopher JL Murray
    Citation: Population Health Metrics 2011 9:35
    Content type: Research Published on:

  17. Through application of the verbal autopsy (VA) approach, trained fieldworkers collect information about the probable cause of death (COD) by using a standardized questionnaire to interview family members who w...

    Authors: Maurice Yé, Eric Diboulo, Louis Niamba, Ali Sié, Boubacar Coulibaly, Cheik Bagagnan, Jonas Dembélé and Heribert Ramroth
    Citation: Population Health Metrics 2011 9:34
    Content type: Research Published on:

  18. The process of data collection and the methods used to assign the cause of death vary significantly among different verbal autopsy protocols, but there are few data to describe the consequences of the choices ...

    Authors: Rohina Joshi, Devarsetty Praveen, Clara Chow and Bruce Neal
    Citation: Population Health Metrics 2011 9:33
    Content type: Research Published on:

  19. Physician review of a verbal autopsy (VA) and completion of a death certificate remains the most widely used approach for VA analysis. This study provides new evidence about the performance of physician-certif...

    Authors: Rafael Lozano, Alan D Lopez, Charles Atkinson, Mohsen Naghavi, Abraham D Flaxman and Christopher JL Murray
    Citation: Population Health Metrics 2011 9:32
    Content type: Research Published on:

  20. Verbal autopsies provide valuable information for studying mortality patterns in populations that lack reliable vital registration data. Methods for transforming verbal autopsy results into meaningful informat...

    Authors: Spencer L James, Abraham D Flaxman and Christopher JL Murray
    Citation: Population Health Metrics 2011 9:31
    Content type: Research Published on:

  21. Verbal autopsy can be a useful tool for generating cause of death data in data-sparse regions around the world. The Symptom Pattern (SP) Method is one promising approach to analyzing verbal autopsy data, but i...

    Authors: Christopher JL Murray, Spencer L James, Jeanette K Birnbaum, Michael K Freeman, Rafael Lozano and Alan D Lopez
    Citation: Population Health Metrics 2011 9:30
    Content type: Research Published on:

  22. Computer-coded verbal autopsy (CCVA) is a promising alternative to the standard approach of physician-certified verbal autopsy (PCVA), because of its high speed, low cost, and reliability. This study introduce...

    Authors: Abraham D Flaxman, Alireza Vahdatpour, Sean Green, Spencer L James and Christopher JL Murray
    Citation: Population Health Metrics 2011 9:29
    Content type: Research Published on:

  23. Verbal autopsy (VA) is an important method for obtaining cause of death information in settings without vital registration and medical certification of causes of death. An array of methods, including physician...

    Authors: Christopher JL Murray, Rafael Lozano, Abraham D Flaxman, Alireza Vahdatpour and Alan D Lopez
    Citation: Population Health Metrics 2011 9:28
    Content type: Research Published on:

    The Erratum to this article has been published in Population Health Metrics 2014 12:7

  24. Verbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches...

    Authors: Christopher JL Murray, Alan D Lopez, Robert Black, Ramesh Ahuja, Said Mohd Ali, Abdullah Baqui, Lalit Dandona, Emily Dantzer, Vinita Das, Usha Dhingra, Arup Dutta, Wafaie Fawzi, Abraham D Flaxman, Sara Gómez, Bernardo Hernández, Rohina Joshi…
    Citation: Population Health Metrics 2011 9:27
    Content type: Research Published on: