title: Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool.
abstract: BACKGROUND
  Verbal autopsy (VA) is the only available approach for determining the cause of many deaths, where routine certification is not in place. Therefore, it is important to use standards and methods for VA that maximise efficiency, consistency and comparability. The World Health Organization (WHO) has led the development of the 2012 WHO VA instrument as a new standard, intended both as a research tool and for routine registration of deaths.
  
  
  OBJECTIVE
  A new public-domain probabilistic model for interpreting VA data, InterVA-4, is described, which builds on previous versions and is aligned with the 2012 WHO VA instrument.
  
  
  METHODS
  The new model has been designed to use the VA input indicators defined in the 2012 WHO VA instrument and to deliver causes of death compatible with the International Classification of Diseases version 10 (ICD-10) categorised into 62 groups as defined in the 2012 WHO VA instrument. In addition, known shortcomings of previous InterVA models have been addressed in this revision, as well as integrating other work on maternal and perinatal deaths.
  
  
  RESULTS
  The InterVA-4 model is presented here to facilitate its widespread use and to enable further field evaluation to take place. Results from a demonstration dataset from Agincourt, South Africa, show continuity of interpretation between InterVA-3 and InterVA-4, as well as differences reflecting specific issues addressed in the design and development of InterVA-4.
  
  
  CONCLUSIONS
  InterVA-4 is made freely available as a new standard model for interpreting VA data into causes of death. It can be used for determining cause of death both in research settings and for routine registration. Further validation opportunities will be explored. These developments in cause of death registration are likely to substantially increase the global coverage of cause-specific mortality data.
authors.affiliation: Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. peter.byass@epiph.umu.se
authors.forename: Peter
authors.initials: P
authors.lastname: Byass
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Lucia
authors.initials: L
authors.lastname: D'Ambruoso
authors.forename: Edward
authors.initials: E
authors.lastname: Fottrell
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Graham
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Herbst
authors.forename: Abraham
authors.initials: A
authors.lastname: Hodgson
authors.forename: Sennen
authors.initials: S
authors.lastname: Hounton
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.forename: Anand
authors.initials: A
authors.lastname: Krishnan
authors.forename: Jordana
authors.initials: J
authors.lastname: Leitao
authors.forename: Frank
authors.initials: F
authors.lastname: Odhiambo
authors.forename: Osman A
authors.initials: OA
authors.lastname: Sankoh
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Tollman
mesh_terms: D001344:Autopsy; D001499:Bayes Theorem; D017028:Caregivers; D002423:Cause of Death; D004282:Documentation / Q000592:standards*; D006801:Humans; D038801:International Classification of Diseases; D007407:Interviews as Topic / Q000379:methods; D015233:Models, Statistical; D012015:Reference Standards; D014705:Verbal Behavior; D014944:World Health Organization