title: Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.
abstract: OBJECTIVE
  Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems.
  
  
  METHODS
  A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification.
  
  
  RESULTS
  A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach.
  
  
  CONCLUSIONS
  The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.
authors.affiliation: Disease Control and Vector Biology, London School of Hygiene and Tropical Medicine, London, UK.
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authors.lastname: Masanja
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authors.forename: Francis
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authors.lastname: Notzon
authors.forename: Mohammad Hafiz
authors.initials: MH
authors.lastname: Rasooly
authors.forename: Osman
authors.initials: O
authors.lastname: Sankoh
authors.forename: Paul
authors.initials: P
authors.lastname: Spiegel
authors.forename: Carla
authors.initials: C
authors.lastname: AbouZahr
authors.forename: Marc
authors.initials: M
authors.lastname: Amexo
authors.forename: Derege
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authors.lastname: Alley
authors.forename: Fatima
authors.initials: F
authors.lastname: Marinho
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ali
authors.forename: Enrique
authors.initials: E
authors.lastname: Loyola
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Chikersal
authors.forename: Jun
authors.initials: J
authors.lastname: Gao
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Annunziata
authors.forename: Rajiv
authors.initials: R
authors.lastname: Bahl
authors.forename: Kidist
authors.initials: K
authors.lastname: Bartolomeus
authors.forename: Ties
authors.initials: T
authors.lastname: Boerma
authors.forename: Bedirhan
authors.initials: B
authors.lastname: Ustun
authors.forename: Doris
authors.initials: D
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mesh_terms: D001344:Autopsy / Q000379:methods* / Q000592:standards; D002423:Cause of Death; D003906:Developing Countries; D006801:Humans; D011159:Population Surveillance / Q000379:methods*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards; D014798:Vital Statistics; D014944:World Health Organization
keywords: InterVA; World Health Organization; cause of death; civil registration; verbal autopsy; vital registration; vital statistics
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