Verbal Autopsy

Maternal, newborn & still birth surveillance

Maternal and Child health Care is a major area of apprehension which is still neglected. In developing countries, Maternal and Child Health (MCH) Indicators are showing slow progress in achieving sustainable goals. According to PDHS 2013 and 2018, maternal mortality ratio (MMR) and neonatal mortality ratio (NMR) were 276 per 10,000 live births and 42 per 1,000 live births, respectively. Furthermore, still birth is also one of the core indicators of MCH domain which is 412 per 1,000 pregnancies in Pakistan.

It is utmost important to identify cause of death so that through adapting proper implementation of certain measures further deaths can be prevented. In developing countries there is lack of proper system to analyze the actual cause of death; the accuracy of data is cornerstone for building a true evidence-based strategy for improvement.

Verbal Autopsy is a method based on an interview with next of kin or other caregivers used to ascertain the cause of a death.

Purpose of Verbal Autopsy

To describe the causes of death at community level or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system.

History of Verbal Autopsy

In Europe, before the 19th century when modern system of death registration was implemented, government representatives visited the households of deceased people to assess the nature of deaths. As an alternative, in the 1950s and 60s in Asia and Africa, systematic interviews by physicians were used to determine causes of death. Workers at the Narangwal project in India labelled this new technique "verbal autopsy" (VA). The interest of World Health Organisation (WHO) in VA (formerly "lay reporting") of health data was first demonstrated in a publication by Dr. Yves Biraud in 1956. During 1970s, WHO encouraged the use of lay reporting of health information by people with no medical information, leading to development of lay reporting forms in 1975. In 2007, needs and demands for standardization led to the 2007 publication of the WHO VA standards, which many researchers have adopted.

However, the WHO 2007 instrument was modified in several projects to accommodate the local needs. In 2011, evidence from use of the WHO instrument and related VA instruments was used to formulate this 2012 VA instrument (document under publication).

The revision and simplification of the 2007 standard WHO VA cause of death list was based on:

Adoption of Verbal Autopsy Strategy By PPHI

PPHI Sindh is the first organisation in the province that adapted the new idea of implementing verbal autopsy to ascertain cause of maternal and neonatal deaths and stillbirths.

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