New challenges for verbal autopsy: Considering the ethical and social implications of verbal autopsy methods in routine health information systems. (July 2017)

• Record Type: Journal Article
• Authors: Gouda, Hebe N.; Flaxman, Abraham D.; Brolan, Claire E.; Joshi, Rohina; Riley, Ian D.; AbouZahr, Carla; Firth, Sonja; Rampatige, Rasika; Lopez, Alan D.
• Is Part Of: Social science & medicine. Volume 184(2017)
• Page Start: 65
• Page End: 74
• Publication Date: 2017-07
• Subjects: Verbal autopsy -- Ethics -- Civil registration and vital statistics -- Health information system -- Cause-of-death -- Implementation; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2017.05.002
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Verbal autopsy (VA) methods are designed to collect cause-of-death information from populations where many deaths occur outside of health facilities and where death certification is weak or absent. A VA consists of an interview with a relative or carer of a recently deceased individual in order to gather information on the signs and symptoms the decedent presented with prior to death. These details are then used to determine and assign a likely cause-of-death. At a population level this information can be invaluable to help guide prioritisation and direct health policy and services. To date VAs have largely been restricted to research contexts but many countries are now venturing to incorporate VA methods into routine civil registration and vital statistics (CRVS) systems. Given the sensitive nature of death, however, there are a number of ethical, legal and social issues that should be considered when scaling-up VAs, particularly in the cross-cultural and socio-economically disadvantaged environments in which they are typically applied. Considering each step of the VA process this paper provides a narrative review of the social context of VA methods. Harnessing the experiences of applying and rolling out VAs as part of routine CRVS systems in a number of low and middle income countries, we identify potential issues that countries and implementing institutions need to consider when incorporating VAs into CRVS systems and point to areas that could benefit from further research and deliberation. Highlights: Countries require cause-of-death (COD) statistics for effective public health planning. Verbal autopsy (VA) can provide COD where medical death certification is absent or weak. VA methods are currently being incorporated into Civil Registration and Vital Statistics systems. Presents a number of social, cultural, legal and ethical issues that should be considered when scaling-up VA. Countries must carefully consider the regulatory structures necessary for VA in routine systems.