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Maria A Quigley, Commentary: Verbal autopsies—from small-scale studies to mortality surveillance systems, International Journal of Epidemiology, Volume 34, Issue 5, October 2005, Pages 1087–1088, https://doi.org/10.1093/ije/dyi135
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Reliable information on cause-specific mortality is crucial for summarizing the total disease burden in different settings. In addition, it is essential for evaluating the impact of public health interventions, and for identifying where resources need to be allocated. Yet in the countries with the highest burden of disease, cause-specific mortality data are usually of poor quality, incomplete, or unavailable. In the absence of vital registration data, the verbal autopsy may be used to estimate cause-specific mortality. Trained fieldworkers interview bereaved relatives using a questionnaire to elicit information on symptoms experienced by the deceased before death. Probable causes of death are assigned either by physician review of the completed questionnaires or using predefined diagnostic criteria given in an algorithm.
The verbal autopsy has been used to estimate cause-specific mortality in a variety of methodological settings, the most common being in the context of an epidemiological study. Estimates of cause-specific mortality from these studies are not necessarily generalizable to a wider population, and may not have arisen from a validated verbal autopsy instrument. Recently, data from 46 epidemiological studies were aggregated in a meta-regression model in order to estimate cause-specific mortality fractions in children aged under five at a global level.1 The number of deaths in these 46 studies ranged from 8 to 3776, with all but five studies being based on <1000 deaths. Increasingly, the verbal autopsy is being employed on a much larger scale. For example, in India, a verbal autopsy was conducted on 48 000 adult deaths in Chennai2 and on 80 000 adult deaths in Tamilnadu.3 In Tanzania, the verbal autopsy was employed as a part of a national sentinel mortality surveillance system covering a population of over 400 000.4 In China, a sample-based mortality surveillance system of ∼1% of the total population used a combination of medical certification and verbal autopsy.5
