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

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 series 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 thematic series 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. Research

    Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and Zimbabwe

    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...

    Stefania Vergnano, Edward Fottrell, David Osrin, Peter N Kazembe, Charles Mwansambo, Dharma S Manandhar, Stephan P Munjanja, Peter Byass, Sonia Lewycka and Anthony Costello

    Population Health Metrics 2011 9:48

    Published on: 5 August 2011

  2. Research

    Performance of InterVA for assigning causes of death to verbal autopsies: multisite validation study using clinical diagnostic gold standards

    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...

    Rafael Lozano, Michael K Freeman, Spencer L James, Benjamin Campbell, Alan D Lopez, Abraham D Flaxman and Christopher JL Murray

    Population Health Metrics 2011 9:50

    Published on: 5 August 2011

  3. Research

    Social autopsy: INDEPTH Network experiences of utility, process, practices, and challenges in investigating causes and contributors to mortality

    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...

    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

    Population Health Metrics 2011 9:44

    Published on: 5 August 2011

  4. Research

    Classifying perinatal mortality using verbal autopsy: is there a role for nonphysicians?

    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.

    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

    Population Health Metrics 2011 9:42

    Published on: 5 August 2011

  5. Research

    Feasibility of using a World Health Organization-standard methodology for Sample Vital Registration with Verbal Autopsy (SAVVY) to report leading causes of death in Zambia: results of a pilot in four provinces, 2010

    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...

    Sheila S Mudenda, Stanley Kamocha, Robert Mswia, Martha Conkling, Palver Sikanyiti, Dara Potter, William C Mayaka and Melissa A Marx

    Population Health Metrics 2011 9:40

    Published on: 5 August 2011

  6. Research

    Validating physician-certified verbal autopsy and probabilistic modeling (InterVA) approaches to verbal autopsy interpretation using hospital causes of adult deaths

    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-...

    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

    Population Health Metrics 2011 9:49

    Published on: 5 August 2011

  7. Review

    Social autopsy for maternal and child deaths: a comprehensive literature review to examine the concept and the development of the method

    "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...

    Henry D Kalter, Rene Salgado, Marzio Babille, Alain K Koffi and Robert E Black

    Population Health Metrics 2011 9:45

    Published on: 5 August 2011

  8. Research

    Trends in causes of death among children under 5 in Bangladesh, 1993-2004: an exercise applying a standardized computer algorithm to assign causes of death using verbal autopsy data

    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...

    Li Liu, Qingfeng Li, Rose A Lee, Ingrid K Friberg, Jamie Perin, Neff Walker and Robert E Black

    Population Health Metrics 2011 9:43

    Published on: 5 August 2011

  9. Research

    Verbal autopsy completion rate and factors associated with undetermined cause of death in a rural resource-poor setting of Tanzania

    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...

    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

    Population Health Metrics 2011 9:41

    Published on: 5 August 2011

  10. Research

    Assessing quality of medical death certification: Concordance between gold standard diagnosis and underlying cause of death in selected Mexican hospitals

    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...

    Bernardo Hernández, Dolores Ramírez-Villalobos, Minerva Romero, Sara Gómez, Charles Atkinson and Rafael Lozano

    Population Health Metrics 2011 9:38

    Published on: 4 August 2011

  11. Research

    Performance of physician-certified verbal autopsies: multisite validation study using clinical diagnostic gold standards

    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...

    Rafael Lozano, Alan D Lopez, Charles Atkinson, Mohsen Naghavi, Abraham D Flaxman and Christopher JL Murray

    Population Health Metrics 2011 9:32

    Published on: 4 August 2011

  12. Research

    Robust metrics for assessing the performance of different verbal autopsy cause assignment methods in validation studies

    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...

    Christopher JL Murray, Rafael Lozano, Abraham D Flaxman, Alireza Vahdatpour and Alan D Lopez

    Population Health Metrics 2011 9:28

    Published on: 4 August 2011

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

  13. Research

    Simplified Symptom Pattern Method for verbal autopsy analysis: multisite validation study using clinical diagnostic gold standards

    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...

    Christopher JL Murray, Spencer L James, Jeanette K Birnbaum, Michael K Freeman, Rafael Lozano and Alan D Lopez

    Population Health Metrics 2011 9:30

    Published on: 4 August 2011

  14. Research

    Use of verbal autopsy in a national health information system: Effects of the investigation of ill-defined causes of death on proportional mortality due to injury in small municipalities in Brazil

    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 ...

    Elisabeth França, Deise Campos, Mark DC Guimarães and Maria de Fátima M Souza

    Population Health Metrics 2011 9:39

    Published on: 4 August 2011

  15. Research

    Random forests for verbal autopsy analysis: multisite validation study using clinical diagnostic gold standards

    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...

    Abraham D Flaxman, Alireza Vahdatpour, Sean Green, Spencer L James and Christopher JL Murray

    Population Health Metrics 2011 9:29

    Published on: 4 August 2011

  16. Research

    Population Health Metrics Research Consortium gold standard verbal autopsy validation study: design, implementation, and development of analysis datasets

    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...

    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…

    Population Health Metrics 2011 9:27

    Published on: 4 August 2011

  17. Research

    Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008

    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...

    Billy N Mayanja, Kathy Baisley, Norah Nalweyiso, Freddie M Kibengo, Joseph O Mugisha, Lieve Van der Paal, Dermot Maher and Pontiano Kaleebu

    Population Health Metrics 2011 9:36

    Published on: 4 August 2011

  18. Research

    An improved method for physician-certified verbal autopsy reduces the rate of discrepancy: experiences in the Nouna Health and Demographic Surveillance Site (NHDSS), Burkina Faso

    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...

    Maurice Yé, Eric Diboulo, Louis Niamba, Ali Sié, Boubacar Coulibaly, Cheik Bagagnan, Jonas Dembélé and Heribert Ramroth

    Population Health Metrics 2011 9:34

    Published on: 4 August 2011

  19. Research

    Direct estimation of cause-specific mortality fractions from verbal autopsies: multisite validation study using clinical diagnostic gold standards

    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) ...

    Abraham D Flaxman, Alireza Vahdatpour, Spencer L James, Jeanette K Birnbaum and Christopher JL Murray

    Population Health Metrics 2011 9:35

    Published on: 4 August 2011

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