A Standard Verbal Autopsy Method for Investigating Causes of Death in Infants and ChildrenName: A Standard Verbal Autopsy Method for Investigating Causes of Death in Infants and Children Purpose: Verbal Autopsies are designed to improve the measurement of cause-specific mortality in areas where medical certification of cause of death is rare. Type of Design: Descriptive, cross sectional community-based survey. Where Used: Validation studies were undertaken in Bangladesh, Nicaragua and Uganda. BASIC INFORMATION Name: A Standard Verbal Autopsy Method for Investigating Causes of Death in Infants and Children Origin/Source: World Health Organization (WHO) [WHO/CDS/CSR/ISR/99.4] Johns Hopkins School of Hygiene and Public Health London School Hygiene and Tropical Health Technical Area: Newborn Health Basic Description: A standardized method of determining causes of deaths among infants and children based on semi structured interviews with the mother, next of kin or other caregivers. Specific algorithms for coding common causes of death in infants and children have been developed and tested for validity in Bangladesh, Nicaragua and Uganda. An underlying assumption of the method is that each cause of death investigated has a set of observable features that can be recalled during a verbal autopsy. Country Applications: Validation studies have been undertaken in Bangladesh, Nicaragua and Uganda. Language available: English. The standard questionnaire should be translated into the local language by someone who is fluent both in English and in the local language, and who is familiar with the local lay medical terminology. A local anthropologist or a demographer should check the translation for accuracy of intended meaning. Back translation should also be done and compared to the original questionnaire to make sure that the intent of each question reflects the original medical meaning. Alternative local terms for medical conditions, symptoms and signs of illness should be considered both during the translation phase and also during the interviewing training. Local terms can be printed directly on the questionnaire or inserted by the interviewer. Purpose: Evaluation Technical Scope / Purpose: Management and Assessment of Childhood Illness (infants and children); Measurement of cause-specific mortality. Design: Descriptive, settings in which this method can be used are varried, is flexible ,ranging from cross sectional community-based surveys .to demographic surveillance sites-, to other settings in which deaths are identified and there is a need to know the cause of death. Method: Qualitative and quantitative Key Users of Information: Researchers, policy-makers and programme managers. for assessing impact of programme interventions. Objectives and Scope of the Tool: This tool is designed to improve measurement of cause-specific mortality in areas where medical certification of cause of death is rare. The specific objectives are:
The standard verbal autopsy questionnaire uses a combination of open history questions followed by a series of closed ended questions that ask about specific signs and symptoms prior to death. The questionnaire is coded according to predetermined algorithms so that standardized causes of deaths can be derived. Key Indicators: Many verbal autopsy questionnaires allow for only one cause of death. However, the standard verbal autopsy questionnaire for children (in the present document) allows for multiple causes of death. This is important since many children who die from a combination of causes would have survived if any of the causes had been prevented or treated early enough. Specifically, information is collected on the major causes of childhood death. These are:
Separate Algorithms are presented for causes of deaths in neonates and post neonates. Tool Design: The verbal autopsy is designed to be used in a variety of settings where medical certification of deaths is rare. The questionnaire needs to be adapted carefully to each setting. It is important to note that.
Implementation and Training: When adapting a verbal autopsy questionnaire to a local setting, it is important to have prior knowledge about the community, the health care system, common diseases and causes of death. Some false-positives can result from the verbal autopsy algorithms even if the condition is not present in a population. Translation and back translation is an important part in adapting a questionnaire into the local language (please, see above, "translation issues"). Interviewers, supervisors and trainers should agree on the final draft of the questionnaire. Then, the interviewers should pre-test it by interviewing several caregivers of severely ill or recently deceased children, in a hospital or nearby homes. Problems must be resolved before taking the final questionnaire to the final to the field. Lessons from Experience:
Final Remarks The current document contains a questionnaire, algorithms for coding specific causes of death, and the results of the validation studies in terms of the sensitivity and specificity of each algorithm for each validation study. The underlying mix of causes of death in the population affects the accuracy of the verbal autopsy. This implies that accuracy of the estimates will vary according to the population under study. For example, it has been suggested that verbal autopsies may be better able to identify acute lower respiratory infections (ALRI) in malaria free areas than in areas in which malaria is a common cause of childhood deaths. Cultural aspects may also influence the accuracy of verbal autopsy. The willingness to accept a verbal autopsy interview, the ability of the respondent to describe the final illness and the way the diseases are understood and described in the community will vary from culture to culture. Contact Person: Martha ANKER, E-Mail: ankerm@who.ch |