Verbal Autopsy

Improving Cause of Death Reporting

Alvin T. Onaka, Ph.D Hawaii State Department of Health

June 2, 2013

What is Verbal Autopsy?

• 2 Step Procedure

• Data Collection

• Cause of Death Assignment

Data Collection

• Trained Interviewer• Questionnaire• Signs & Symptoms• Demographic Characteristics• Informant familiar with the Deceased

Cause of Death Assignment

• Physician Review of Verbal Autopsy Data

• ICD Certification

• Coding & Tabulation

• Computerized Algorithms

Global Congress on Verbal Autopsy

• State of the Science

• Bali, Indonesia

• February 2011

Population Health Metrics Publication Series

• Verbal Autopsy: Innovation, Application, Opportunities – Improving Cause of Death Measurement

Verbal Autopsy: Advancing Science, Facilitating Application

• Christopher J.L. Murray, U of Washington• Alan D. Lopez, U of Queensland• Kenji Shibuya, U of Tokyo• Rafael Lozano, U of Washington

New Automated Methods • Iris

• A more accurate, faster and cheaper method than traditional physician review

Issues

• Standard Survey Questionnaire• Free Text Narrative• Structured Questions• Recording Household Medical Docs

Issues

• Interviewer• Education• Training

Issues

• Choice of Respondent• Proximity to Deceased• Education• Age• Sex• Cultural Factors

Issues

• Cause of Death Assignment & ICD Coding Physician/Trained Health Professional Review Using Standard Protocols Computerized Programs ICD Mortality Tabulation Lists

Issues

• Recall by relatives of symptoms/illness prior to death is sometimes difficult because of similar symptoms• Identification of clearly distinguishable

symptom complexes for each cause of interest are not available for some adult causes

Historically Useful & Validated

• Infant & Child Deaths• Maternal Deaths• Deaths due to Injuries

Verbal Autopsy Projects

• U.S. Affiliated Pacific Islands• Malawi• Kenya

Mahalo (Thank You)