Cause of death: where there is no physician
Outputs of verbal autopsy
The fundamental and most important policy-relevant outputs of VA are the numbers of deaths in the population due to various causes, as fractions of the total. These are known as cause-specific mortality fractions (CSMFs) and should be computed separately for each sex and at least for broad age groups (eg under-fives, adolescents, and elderly) if there are insufficient cases for more detailed aged tabulations (eg 5 or 10 year age groups). It is this information about the leading causes of death within each age group that policy makers require in order to adjust health priorities and programs.
Individual COD data from VA is less important for policy and more important for epidemiological research linking specific exposures such as tobacco to specific causes of death. This degree of precision is not required for deciding health priorities, for which CSMFs are generally sufficient. As a result, the accuracy of various diagnostic methods for VA, when the data is to be used to inform policy, should be judged by how reliably the method(s) predict the true COD pattern in the population.
Because the diagnostic procedures used in VA are substantially different, and the clinical evidence available generally much less, than for deaths diagnosed by physicians in hospitals, the number of causes of death that can be diagnosed with VA is substantially fewer, and generally broader, than data on causes of death in hospitals. While that is unlikely to significantly reduce the policy value of VA for preventing deaths in the community, as a general rule, VA data should only be consolidated with hospital statistics if the source of the two (or other sources such as coronial enquiries) can be separately identified. National COD estimates can still be prepared using separate sources, but each will need to be interpreted differently, and combined cautiously.