Verbal autopsy (VA) is a method used to determine the cause of death through interviews with the deceased person's next of kin or caregivers. These interviews involve a standardized questionnaire to gather details on symptoms, medical history, and the circumstances leading to death. Healthcare professionals or algorithms then analyze this information to identify the likely cause of death.
The primary goal of verbal autopsy is to describe the causes of death at the community level or population level in areas where there is no medical certification of deaths or it is not yet well-established. <p> Verbal autopsy serves as a valuable tool for countries to obtain the information needed on non-medically certified community deaths to strengthen civil registration and vital statistics (CRVS) systems and provide critical health data for evidence-based health policies and plans.
The WHO verbal autopsy training package offers a comprehensive set of resources designed to ensure training of interviewers and of supervisors/master trainers for standardized and effective data collection procedures. It includes the following key components:
Collectively, these resources play a crucial role in maintaining high-quality data collection and analysis in verbal autopsy methods.
To support the maintenance and update process of the WHO verbal autopsy standards and optimize the field experience for interviewers and respondents, it is important that users report issues encountered with the application of the verbal autopsy instrument.
Issues with the instrument should be submitted to the Public GitHub platform of the WHO verbal autopsy instrument— https://github.com/SwissTPH/WHO-VA/issues – which contains a list of submitted issues and related feedback. To report an issue via the Public GitHub platform, please send an email to who.va.issues@swisstph.ch.
To submit other input or inquiries, including issues involving private and confidential information, translations of the WHO verbal autopsy instrument, and other verbal autopsy implementation support materials, please email WHO directly at verbalautopsy@who.int.
Other versions of the WHO verbal autopsy instrument
The 2016 WHO verbal autopsy (VA) instrument is fully compatible with publicly available analytical software for assigning the cause of death (SmartVA, InterVA, InSilicoVA). A conversion algorithm transforms the output of the WHO VA 2016 questionnaire in files that can be processed by SmartVA, InterVA, and InSilicoVA.
Unofficial translations of the 2022 and 2016 verbal autopsy instrument, as well as supporting materials, have been shared by users and are available upon request. Please contact the verbal autopsy email address. Users are also encouraged to send any translations of WHO verbal autopsy materials to the same email address.
Contact email: verbalautopsy@who.int.
Verbal autopsy can fill a critical gap in measuring the mortality from COVID-19 for deaths which occur outside of a healthcare setting.
A set of questions to identify COVID-19 deaths has been included in version 1.5.3 of the electronic (ODK) 2016 WHO verbal autopsy instrument. The questions have been added to the WHO verbal autopsy questionnaire upon request by countries and to standardize and align questions proposed by different initiatives with the WHO definition of death due to COVID-19, the underlying case definition for surveillance of COVID-19, including questions for rapid mortality surveillance purposes.
A brief technical note has been added to the WHO verbal autopsy standards manual that offers guidance for the use of verbal autopsy to identify COVID-19 deaths. Specific information on each of the new questions can be found in the updated sections of the question by question instructions (Appendices A-C) of the verbal autopsy field interviewer Manual for the 2016 WHO verbal autopsy Instrument.
A WHO verbal autopsy working group was established at the first meeting of the WHO reference group on global health statistics ( RGHS), 9–10 December 2013. The working group was then reorganized as a WHO verbal autopsy reference group (VARG). The VARG supports and advises WHO regarding:
openVA pipeline
Algorithms for assigning causes of death to verbal autopsy data
The algorithms offer an opportunity of identifying the cause of death from the responses of the interview. It is know that all the current algorithms have strengths and weaknesses, depending on the setting and the target cause. At present there is no assessment existing that would allow to give preference to any algorithm.
The list below refers to algorithms that are maintained by different groups. Some algorithms disclose software algorithms and statistical weights, others don't. The list below does not imply any recommendation for any particular algorithm.
The report briefly summarizes the methods and results of the revision.
Community of practice meetings
Organized by the WHO verbal autopsy reference group since March 2022, monthly virtual meetings are held with the community of verbal autopsy users to support those implementing verbal autopsy for estimating causes of death where medical certification is not yet feasible. Participation is open to all of those who are interested. Topics rotate around the following four themes: information technologies, implementation management, data analysis and use, and implementation research. The meetings are conducted in English with live translation for French, Spanish and Portuguese. If you wish to be added to the verbal autopsy community of practice emailing list, please send an email to verbalautopsy@who.int.
Verbal autopsy reference group (VARG) annual meeting 2022 Geneva, Switzerland
Webinar for the launch of the 2022 WHO verbal autopsy instrument
On April 6 2022 and organized by the WHO Classifications and Terminologies Unit, the webinar included an introduction to verbal autopsy, to the development of WHO verbal autopsy instruments and to the application and implementation of verbal autopsy. Details the revision process and methodology of the 2016 WHO verbal autopsy instrument that led to the development of the 2022 WHO verbal autopsy instrument, as well as a demo of electronic tools for the 2022 WHO verbal autopsy instrument. More information
WHO verbal autopsy reference group workshop (VARG), Bangkok, Thailand
First face-to-face meeting since the COVID-19 pandemic. The workshop focused on the following key priorities of the VARG workplan: development of training manuals for the 2022 WHO verbal autopsy instrument; presentation of emerging results from existing research efforts in verbal autopsy; presentation of the assessment of the gap in resources and guidelines for the verbal autopsy community of users; review of feedback on use of the 2022 WHO verbal autopsy instrument; monitoring use and users of the WHO verbal autopsy instrument – development of user engagement surveys and maintenance of WHO verbal autopsy implementation map; review of VARG workplan 2021-2022 and planning for the 2022-2023 workplan. The applications of verbal autopsy in Thailand were also presented by the Thailand verbal autopsy team.
Verbal autopsy reference group (VARG) annual meeting, 2021
Virtual workshop: Revision of the 2016 WHO Verbal Autopsy instrument – Final Phase
Part 1: 23-25 February 2021 and part 2: 3-4 May 2021
Workshop conducted to a) identify a list of questions for removal from the 2016 WHO verbal autopsy instrument that yields a verbal instrument that is as short and simplified as possible without drops in performance for algorithms and physician-coded verbal autopsy (PCVA) use; and b) finalize the resolution of issues identified with the 2016 WHO verbal instrument. Workshop convened members of the WHO verbal autopsy reference group (VARG) alongside a panel of physicians with experience in physician certified verbal autopsy.
Training Workshop – Item reduction for the 2016 WHO verbal autopsy Instrument
A virtual training with country teams was conducted on the item reduction process, methodologies and item response and importance analysis on October 26, 28, 30, 2020.
Verbal autopsy reference group (VARG) annual meeting, 2020
The WHO verbal autopsy reference group (VARG) convened virtually at the WHO Family of International Classifications (WHO-FIC) Network annual meeting on 21 October 2020. The WHO-FIC Network, a network of WHO Collaborating Centres, NGOs, and selected experts, was established in 1970 to support WHO’s work on international classifications. The principal role of the WHO-FIC Network is to promote the implementation, use, maintenance, development, and updating of the WHO reference health classifications. More information
Response pattern analysis for the revision of the 2016 WHO verbal autopsy instrument
The technical virtual workshop was structured in two parts, with the first taking place July 8-9, and the second on July 15-16. During the course of the workshop, the methodology and results of analyses with collected 2016 WHO verbal autopsy data were presented through quantitative and qualitative approaches for the item reduction of the WHO verbal autopsy instrument. The agreed process involves the data-driven review of the feasibility of questions and expert-led assessment about actions to be taken. The virtual workshop brought together 78 participants, including the members of the verbal autopsy reference group, officials of several low middle income countries that are using verbal autopsy, experts in the field and key partners.
Verbal autopsy reference group (VARG) annual meeting, 2019
The WHO verbal autopsy reference group (VARG) convened at the WHO Family of International Classifications (WHO-FIC) Network annual meeting in Banff, Canada on October 9, 2019. The WHO-FIC Network, a network of WHO Collaborating Centres, NGOs, and selected experts, was established in 1970 to support WHO’s work on international classifications. The principal role of the WHO-FIC Network is to promote the implementation, use, maintenance, development, and updating of the WHO reference health classifications.
WHO VARG meeting for the item reduction of the 2016 WHO verbal autopsy instrument, Lisbon
Two-day meeting convened with a technical group consisting of the developers of the algorithms and the coordination of the verbal autopsy reference group (VARG) to produce a draft methodology for the item reduction of the 2016 WHO verbal autopsy instrument.
Verbal autopsy data analysis workshop for Tanzania’s Ministry of Health, community development, gender, elderly and children.
This workshop was conducted on July 29-30, 2019, in Dar es Salaam, Tanzania. The workshop brought together stakeholders for the civil registration and vital statistics (CRVS)- verbal autopsy (VA) demonstration sites (over 200 wards across 4 Regions) and included staff from the Ministry of Health, National Bureau of Statistics, the Civil Registration Agency (RITA), Muhimbili National Hospital, Ifakara Health Institute, and the National Institute for Medical Research and facilitators from the Swiss Tropical and Public Health Institute and the University of Ohio. All WHO verbal autopsy data were run through Open VA and processed with Inter-VA and In Silico algorithms. Results were compared with physician coded verbal autopsy, sorted for discordance, and discussed, along with scenarios for going to national scale.
Verbal autopsy data analysis workshop for Ghana Health Service
The workshop was conducted in Accra, Ghana on February 6-7, 2018, with the VA implementation team of the Ghana Health Service Facilitators from Swiss Tropical and Public Health Institute with support from Vital Strategies assisted the processing of CRVS-VA Pre-Test data from WHO VAs for all deaths for one year from one District using OpenVA with Inter-VA and InSilico. Results were used to plan the extension of implementation to full regional scale.
WHO AFRO EMRO Workshop on ICD-10 Compliant Medical Certification of Causes of Death and Verbal Autopsy Methods.
This workshop was conducted with the support from Vital Strategies in Luxor, Egypt, 25-39 November 2018 with participants from Egypt, Uganda, Sudan, Morocco, Cameroon, Malawi, Liberia, Lesotho and Gambia. The workshop provided a full orientation to the requirements to establish and integrate verbal autopsy with WHO verbal autopsy instruments and methods into routine national civil registration and vital statistics systems.
Ohio 2018
As the collection of VA data is rapidly increasing, there is a need to develop further tools and guidance regarding the analysis of verbal autopsy raw data for the purpose of quality control. To meet this need the WHO verbal autopsy reference group hosted a workshop on 05 -16 November 2018 in Columbus, USA. More information and presentations for the training of trainers.
2018 WHO-FIC verbal autopsy reference group meeting
The WHO verbal autopsy reference group (formerly working group) convened for the first time at the WHO Family of International Classifications (WHO-FIC) Network annual meeting in Seoul, South Korea on October 24, 2018. The WHO-FIC Network, a network of WHO Collaborating Centres, NGOs, and selected experts, was established in 1970 to support WHO’s work on international classifications. The principal role of the WHO-FIC Network is to promote the implementation, use, maintenance, development, and updating of the WHO reference health classifications, which now officially includes verbal autopsy. More information
Technical Meeting on Mortality Data Analysis with Verbal Autopsy, Washington DC, 2018
A technical workshop on 12-14 September 2018 to generate a draft set of principles, considerations, and recommendations about how countries can: 1) yield high quality statistics from verbal autopsy data and 2) integrate verbal autopsy results and other sources of mortality data into their mortality data processes. Meeting materials and a summary of outcomes are available. More information
Singapore ODK and GitHub 2018
To share experiences and build global capacity in focus countries of the Bloomberg Philanthropies Data for Health Initiative and beyond on the use of the Open Data Kit (ODK) platform for electronic data collection for VA and the use of the GitHub platform for questionnaire management, the Initiative together with Swiss TPH organised two workshops on 28 May - 01 June and 11-15 June 2018 in Singapore. More information
Singapore openVA Pipeline 2018
To facilitate the automatic determination of the cause of death from verbal autopsy and to automate the processing of that data from the data collection platform (Open Data Kit) to DHIS2, the openVA Pipeline was developed. To gather developers and users, a meeting was organised on 23-25 May 2018 in Singapore. More information
Accra 2017
Implementing verbal autopsy within civil registration and vital statistics (CRVS) systems is a major undertaking, and global experience on how to achieve such integration and obtain cause of death data from community death as part of routine processes is rapidly accumulating in countries. To share experiences and discuss emerging international best practice, partners in the Initiative together with other relevant global stakeholders convened a meeting of global “verbal autopsy in civil registration and vital statistics” practitioners on 11-14 December 2017 in Accra, Ghana. More information