1. Medical Certification on Cause of Death Session V: Verbal Autopsy

2. Medical Certification on Cause of Death 2 Specific Objectives: At the end of the session, the participants will be able to: 1. Define Verbal Autopsy; 2. Enumerate the uses of Verbal Autopsy; 3. Describe the process of doing Verbal Autopsy; 4. Discuss the stages of Verbal Autopsy; and 5. Familiarize with the questionnaires used during Verbal Autopsy interview.

3. Medical Certification on Cause of Death 3 Medically Unattended Deaths In settings where the majority of deaths occur at home and where civil registration systems do not function, there is little chance that deaths occurring away from health facilities will be recorded and certified as to the cause or causes of death.

4. Medical Certification on Cause of Death 4 What is Verbal Autopsy? Verbal autopsy is a process for diagnosing causes of death based on the responses of reliable family members and/or caregiver to series of structured questions regarding signs and symptoms experienced by the deceased before his/her death.

5. Medical Certification on Cause of Death 5 OBJECTIVE OF VA Verbal autopsy methods are most often used in locales where formal medical care is difficult to access. In such locales, deaths often occur at home and official records are inconsistently available. Verbal autopsies may provide important public health information about factors related to deaths and actions taken to address the medical problems and prevent the death.

6. Medical Certification on Cause of Death 6 Uses of Verbal Autopsy Verbal autopsies are the most practical option for assessing cause-of-death patterns for deaths that occur outside health facilities and for deaths in health facilities with only limited diagnostic capability. This is also useful for delayed registration of deaths where the physician is obliged to certify deaths even those he did not attend and have occurred several years before.

7. Medical Certification on Cause of Death 7 The responses are collected by a health worker or a trained lay person in an interview by visiting the household where the death has occurred. These responses are usually reviewed by a physician who will then sign an underlying cause of death on the basis of reported signs and symptoms on the VA questionnaire. Process

8. Medical Certification on Cause of Death 8 Verbal autopsy a primary source of information about causes of death in populations lacking vital registration and medical certification. an essential public health tool for obtaining a reasonable direct estimation of the cause structure of mortality at a community or population level it may not be an accurate method for attributing causes of death at the individual level. -WHO

9. Medical Certification on Cause of Death 9 Verbal autopsy instruments are based on the following assumptions: Each cause of death has a distinct pattern of signs, symptoms, severity and other characteristics. The signs and symptoms experienced by the deceased can be recognized, remembered and reported by lay respondents.

10. Medical Certification on Cause of Death 10 Verbal autopsy instruments are based on the following assumptions: It is possible to correctly diagnose deaths based on the reported information and to categorize them into groups of causes of death that are useful for public health purposes.

11. Medical Certification on Cause of Death 11 Stages of VA: Stage 1 An interviewer (preferably a trained lay person or health worker but not a medical doctor) visits the household where a death has occurred to interview the family using a predesigned questionnaire, and to record all responses in a standardized manner.

12. Medical Certification on Cause of Death 12 Stages of VA: Stage 2 The pattern of responses is reviewed by a physician (never a lay person) to determine the probable cause of death based on the signs and symptoms reported by the respondents

13. Medical Certification on Cause of Death 13 The principle behind the physician reviewing the VA is the assumption that only physicians can correctly interpret the signs and symptoms reported to have been experienced by the deceased, and hence accurately assign the cause of death.

14. Medical Certification on Cause of Death 14 USES OF VA First, it has been primarily used as a research tool in the context of longitudinal population studies, intervention research or epidemiological studies. Second, it has become a source of cause of death statistics to meet the demand for population level cause- specific mortality data to be used in policy, planning, priority setting and benchmarking. Third, VA data are gaining acceptance as a source of cause of death statistics to be used for monitoring progress and evaluating what works and what does not.

15. Medical Certification on Cause of Death 15 Automated Verbal Autopsy In recent years, computer automated coding of VA has been introduced as an alternative to the traditional approach of physician-coded VA in determining the cause of death. Automated methods have the advantage of speed and reduce the burden on physicians who are generally required to prioritize their clinical responsibilities over the activities.

16. Medical Certification on Cause of Death 16 VA QUESTIONNAIRES VA questionnaire 1: For death of a child aged under four weeks VA questionnaire 2: For death of a child aged four weeks to 14 years VA questionnaire 3: For death of a person aged 15 years and above

17. Medical Certification on Cause of Death 17 THANK YOU!