The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0

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.

Causes and contributing factors of maternal mortality in Bosaso District of Somalia. A retrospective study of 30 cases using a Verbal Autopsy approach

“…The VA methodology was introduced in the 1980s and has become a well-utilized and wellvalidated method in settings lacking other routines for determining cause of deaths [8]. VA is now recommended by WHO as the method of choice in such situations and has published well-validated guidelines [9]. Recently, the VA tool has been further developed into the InterVA-4 version, which provides an increased opportunity to obtain information about emergency obstetric care [10].…”

Investigative practice into sudden death in epilepsy: A global survey

“…Pragmatic solutions, validated for SUDEP, which are suited to the limited resources of low‐ and middle‐income countries are needed to identify cause of death, when post‐mortem is not available. One solution is the WHO verbal autopsy, which is a structured interview of decedents relatives to ascertain events leading up to the death, to determine etiology . A further solution is the minimally invasive autopsy, where tissue biopsy and bodily fluids are extracted for examination.…”

Implementing and scaling verbal autopsies: into the unknown

“…This will not only accelerate the design, implementation, and evaluation of cost-effective interventions, but also help to achieve the Sustainable Development Goal (SDG) of 100% birth and 80% death registration [2,4,5]. Verbal autopsies (VA), which involve interviews with next of kin or caregivers of the deceased, have been adopted as a practical means of determining the cause of death in areas where CRVS systems are weak [6,7]. While imperfect, there is ample evidence that VA-based algorithms yield cause of death estimates comparable to other methods [8,9].…”