Discover the verbal autopsy, to better establish health priorities.

A blurred picture of human health

When less than 50% of a population's deaths do not take place in hospital, and death certificates are the exception, profiling causes of death and consequently defining health priorities becomes a game of impressions and influences.

Prabhat Jha, an Indian immigrant to Canada in the 1970s, wondered about the circumstances surrounding the death of his grandfather in India. In 1989, having become a doctor, Dr. Jha returned to India and questioned his grandmother, who remembered every detail, and was thus able to establish, with a high degree of probability, the cause of death by cross-checking various testimonies.

In 1990, while studying smoking-related diseases, he came up with the idea of using "verbal autopsies" to be carried out during a census in rural communities, where data on deaths are not recorded.

In 2002, the Million Death Study (MDS) was launched in India, one of the largest mortality studies ever carried out. The initial results challenged many preconceived ideas about public health problems in India.

Better-resolution, inexpensive and accessible portraiture.

The procedure has been simplified to the extreme: if the enumerator finds that a person under 70 has died during the year, he or she asks 12 questions. The results are transmitted electronically to a team of doctors who establish the probable cause of death, then the data is compiled.

Because the majority of the world's 60 million annual deaths occur in developing countries, and data is not systematically recorded in these countries, the picture of causes of death remains very blurred. For example, less than 3% of child deaths worldwide are recorded on death certificates. In this context, how can priorities be correctly estimated? Are girls over-represented, for example?

What about deaths due to malaria? What about deaths due to malaria, smoking, alcoholism, cancer, work-related injuries, accidents, suicide, infections, etc.? With a higher-resolution picture, more detailed by country and region, we can intervene more effectively.

For example, we were able to establish that deaths from malaria in India were not 15,000 a year as previously thought, but 200,000 a year! Far more than AIDS. That smoking-related deaths were 1 million a year, resulting in legal changes to tobacco marketing.

With better data, the health authorities in each country are in a position to say to foreign partners and pharmaceutical and medical companies: here, right now our priority is malaria, not AIDS, dengue fever in this region and smoking in the cities. What we need is a prevention campaign, mosquito nets, filtration systems, latrines and so on.

The "Verbal Autopsy" (VA) tool, a detailed technical document, is available as a free download below.

Illustration: Pretty Vectors - ShutterStock

References

Verbal autopsy - World Health Organization
https://www.who.int/home/search?indexCatalogue=genericsearchindex1&searchQuery=Verbal%20autopsy&wordsMode=AnyWord

Download WHO Verbal Autopsy instrument and full manual - 1,1 Mb .pdf
http://www.who.int/entity/healthinfo/statistics/WHO_VA_2012_RC1_Instrument.pdf?ua=1

Million Death Study (MDS) - Instruments and Centre for Global Health Reseach
http://www.cghr.org/projects/million-death-study-project/

The "Million Death Study" analyzes the causes of mortality in developing countries - Academic Affairs
http://www.affairesuniversitaires.ca/actualites/actualites-article/million-death-study-analyse-les-causes-mortalite-les-pays-en-developpement/

The top 10 causes of death - World Health Organization
http://www.who.int/mediacentre/factsheets/fs310/en/index2.html

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