Cause of death: where there is no physician
Situations in which verbal autopsy can be used
VA can be used in different settings and circumstances.
- The most common use of VA is to generate CSMFs in settings where significant proportions of deaths occur at home or in community health centres or similar facilities without trained persons able to complete a MCCOD according to ICD standards.
- VA can also be used in cases when a deceased person is brought to hospital – often called ‘dead on arrival’ (DOA). In such cases, physicians are likely to have no information on which to base a diagnosis of COD, with the result that the death is attributed to ill-defined conditions that are of little value for health purposes. To reduce the number of DOA cases that are certified to ill-defined conditions, verbal autopsies can be conducted with relatives if they can be identified. There may also be records arising from previous hospitalisations that could be consulted to provide useful information on the medical history of the deceased to inform the diagnosis.
- Another use for VA is to provide additional information to a hospital (or health facility)-based physician who is faced with determining the COD in situations where key information needed to do so is missing; for example, medical records or readily apparent physical manifestations. In such cases, physicians often question whoever brought in the body or was present at the death in order to help determine the likely COD. Using VA for this purpose brings a measure of structure, consistency and potentially new diagnostic information in this approach through the use of a structured format and analytic method.
- VA can also be used for COD quality assessment. Physicians could be tasked with systematically reviewing a sample of VAs carried out by health workers or district registrars to ensure that the physicians’ local knowledge of community epidemiological patterns was being correctly reflected in the COD patterns that VA was identifying.
Whatever the specific circumstances in which VA is used, the basic principles and technical prerequisites for VA implementation, should be followed. It is very important to ensure that medical associations, departments of health and other institutions concerned with the training of physicians are aware of the opportunities for application of the VA approach, either to generate COD information where there is no physician available, or to strengthen and inform the diagnostic practices of physicians in cases where there is limited clinical or diagnostic information available on the deceased.