Verbal autopsy standards: ascertaining and attributing cause of death

Verbal autopsy is an interview carried out with family members and/or caregivers of the deceased to elicit signs and symptoms and other pertinent information that can later be used to assign a probable underlying cause of death. The purpose of this manual is to disseminate new standard data collection and cause-of-death assignment resources for verbal autopsy, and to provide some general guidelines for their use.

The paper clarifies that verbal autopsy relies basically on an international standard questionnaire. Furthermore, the document finds that: 

• the verbal autopsy has become the primary source of information about causes of death in populations lacking vital registration and medical certification
• the person who identifies the diagnoses from the verbal autopsy is personally responsible for recording the causes of death on a death certificate
• the quality of information and of the diagnoses varies depending on the skills of the interviewer and the memory of the respondents.
  

Recommendations are as follows:

• it should be considered that continual training and considerable experience of staff are essential to ensure that selection rules (the standard rules for selecting the underlying cause of death) are followed correctly
• if necessary, modifying the “signs and symptoms noted during the final illness” checklist of the standard questionnaires should be carried out with high caution
• it is essential to note that modes of death – such as respiratory failure, heart failure or brain death – should not be considered causes of death
• data collected from verbal autopsy with data from full vital registration systems and medical certification must never be merged.