Verbal autopsy (VA) is a method of gathering information about symptoms and circumstances for a deceased individual to determine their cause of death. Health information and a description of events prior to death are acquired from conversations or interviews with a person or persons familiar with the deceased and analyzed by health professionals or computer algorithms to assign likely cause(s) of death. [1]
Verbal autopsy is used in settings where most deaths are otherwise undocumented, which typically means in low- and middle-income countries. Estimates suggest a majority of the 60 million annual global deaths occur without medical attention or official medical certification of the cause of death. [2] VA attempts to establish causes of death for otherwise undocumented subjects, allowing scientists to analyze disease patterns and direct public health policy decisions.
Noteworthy large-scale uses of the verbal autopsy method include the Million Death Study in India, China's national program to document causes of death in rural areas, the Global Burden of Disease Study 2010, and the INDEPTH Network multi-site study. [1] [3] [4] [5] VA is increasingly recognised as an important component of national CRVS (civil registration and vital statistics) systems.
The term verbal autopsy was first coined in a project of the Department of International Health of Johns Hopkins School of Hygiene and Public Health which ran from 1965 to 1973 in Punjab, India. Two research projects were located in villages near Ludhiana, with headquarters in Narangwal village. Objectives of the projects were
Seven years later (1980), the Ministry of Health of Egypt conducted an investigation for prevention of child mortality from DD using a variety of intervention methods for a total population of 200,000, including 29000 children below the age of 5 in three different districts. [11] The VA method as originally developed in Narangwal was slightly modified to the Egyptian setting and again used to identify prevailing mortality patterns among preschoolers. Following implementation of different treatment schedules, child mortality rates dropped significantly in specific input villages over the period of study. The project site was re-visited six years following completion of the investigation confirming utility and effectiveness of the VA method, and applied intervention modalities respectively. [12]
Many iterations and variations of the questionnaires used in VA have been developed by health professionals and researchers. The World Health Organization (WHO), exercising its global mandate to set norms and standards for health, published a book outlining VA standards in 2007. [13] At that time, the emphasis was primarily on standard paper questionnaires that could subsequently be evaluated by physicians to assign causes of death.[ citation needed ]
However, work was already underway in parallel to develop methods for automatically processing VA interview material, because the time, cost and consistency with which physicians were able to assign causes of death to VA interview material were major constraints on the overall process, particularly for large-scale approaches. Additionally, the reason that many deaths were not certified routinely in resource-challenged settings was often associated with a lack of available physicians. Tentative versions of automatic methods were tested in Vietnam in 2003 [14] and in Ethiopia in 2006. [15] Methodological development was led by Prof. Peter Byass at the Umeå Centre for Global Health Research in Sweden, and the name InterVA (for Interpreting Verbal Autopsy) was coined. [16]
As it became increasingly clear that automated interpretation of VA was a promising approach, WHO gave further attention to the structure of the VA interview from the perspective that the interview material might be automatically processed. In 2012 WHO published the first VA standard that was specifically designed for automated processing, defining both interview questions and cause of death categories linked to ICD-10. [17] This was followed by the release of the InterVA-4 model which directly corresponded to the 2012 WHO standard. [18] The open-access InterVA-4 knowledge base was also incorporated into the related InsilicoVA model, which set out to analyse standard VA data using a more complex statistical method. [19]
Around the same time, the Population Health Metrics Research Consortium (PHMRC) [20] were undertaking an empirical study based at several tertiary hospitals to collect a reference database linking clinically investigated final illnesses to subsequent VA interviews. This was envisaged as a knowledge base for building automated VA models, and several possible strategies were proposed at a conference in Indonesia in 2011. [21] The reference database was subsequently made publicly available. [22] However, it was not fully compliant with the 2012 WHO VA standard for VA interviews or cause of death categories. [23] An automated model called SmartVA-Analyze, based on the content of the PHMRC reference database and using the Tariff model, was subsequently released. [24]
On October 1, 2019, Bloomberg Philanthropies announced it would spend $120 million over the next four years to develop verbal autopsies in 25 countries. [25]
In order to harmonize the various VA standards and approaches in use, WHO undertook further revisions and generated a 2016 WHO VA standard. [26] This 2016 WHO standard included all the items from the 2012 WHO version plus all the items from the SmartVA tool as an important strategy for the revision. [27] On the same principle that the 2016 WHO standard was intended to harmonise and unify available VA resources, InterVA-5 was released during 2018 as an integrating model which has the capacity to process input data in the 2012 WHO, SmartVA or 2016 WHO formats and generate causes of death according to the 2016 WHO standard. [28]
Diarrhea, also spelled diarrhoea or diarrhœa in British English, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.
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Christopher Murray is an American physician, health economist, and global health researcher. He is a professor at the University of Washington in Seattle, where he is Chair of Health Metrics Science and the director of the Institute for Health Metrics and Evaluation (IHME).
The Institute for Health Metrics and Evaluation (IHME) is a research institute working in the area of global health statistics and impact evaluation at the University of Washington in Seattle. The Institute is headed by Christopher J.L. Murray, a physician and health economist, and professor at the University of Washington Department of Global Health, which is part of the School of Medicine. IHME conducts research and trains scientists, policymakers, and the public in health metrics concepts, methods, and tools. Its mission includes judging the effectiveness and efficacy of health initiatives and national health systems. IHME also trains students at the post-baccalaureate and post-graduate levels.
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The Million Death Study (MDS) is an ongoing human premature mortality study conducted in India. It began in 1998 and end in 2014. Among a sample size of 14 million Indians, approximately 1 million deaths are assigned medical causes through the Verbal Autopsy method to determine disease patterns and direct public health policy. The principal investigator of the study is Dr. Prabhat Jha, director of the Centre for Global Health Research and professor of epidemiology at the Dalla Lana School of Public Health, University of Toronto, Canada.
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Samuel J. "Sam" Clark is a demographer with expertise in epidemiology and data science. He has worked as a professor in the Department of Sociology at The Ohio State University and the Department of Sociology at the University of Washington. He is an expert on ascertaining cause of death using verbal autopsy.