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Rollout of VIPER in Myanmar

Analysing verbal autopsy data in Myanmar using the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER)
Analysing verbal autopsy data in Myanmar using the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER)

VIPER and associated guidelines were developed by the University of Melbourne in collaboration with country partners as part of the Bloomberg Data for Health Initiative (D4H) civil registration and vital statistics (CRVS) strengthening activities.

VIPER is an Excel tool that uses a series of prompts, formulas and visualisations to support users to understand the demographic and epidemiological characteristics of their VA population, estimate the completeness of the data and judge the plausibility of the cause of death patterns via comparisons with other datasets.

Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) thumbnail
The Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER)

VIPER and associated guidelines were developed by the University of Melbourne in collaboration with country partners as part of the Bloomberg Data for Health Initiative (D4H) civil registration and vital statistics (CRVS) strengthening activities.

VIPER is an Excel tool that uses a series of prompts, formulas and visualisations to support users to understand the demographic and epidemiological characteristics of their verbal autopsy (VA) population, estimate the completeness of the data and judge the plausibility of the cause of death patterns via comparisons with other datasets.

Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) thumbnail
The Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER)

Its primary aim is to help governments analyse and interrogate this new and expanding source of community mortality and cause of death data, and to understand how this information relates to more traditional datasets generated through medically certified causes of death. 

The first ever VA interpretation and guidance tool to be developed, it has the potential to improve the evidence base for health policy by carefully guiding users to assess the plausibility of data and, where necessary, improve their data collection methods.

VIPER in Myanmar

One of the first countries to benefit from VIPER was Myanmar, a country where 84 per cent of deaths occur outside health facilities and where a large amount of VA data has been generated.  “When we started working in Myanmar we scaled up very quickly, and we ended up having thousands of VA deaths to interpret, across more or less the whole country,” said Sonja Firth, Senior Technical Advisor at UoM, D4H. “Before VIPER existed, I would go into country and work with a group of people on interpreting the data, but not in a formal way. This is when we realised we needed something a bit more formal and a bit less qualitative. The VA interpretation guidelines and VIPER were developed to take people through this process.”


D4H has been assisting the government to collect VA data in Myanmar since 2017, and in 2018 this was expanded to a nationally representative sample of 42 townships. VA data analysis occurs at the national, regional and township level, every six months which represents a significant task for those analysing the data.

The tool has been well received by busy government staff tasked with analysing the VA data, which prior to VIPER was done manually. Khin Sandar Bo, D4H Myanmar Country Coordinator, agrees that VIPER has simplified the process.“ The VIPER tool is very useful for analysis and presentation of VA data, especially for six-monthly and annual data analysis. Previously, staff took at least two weeks for data analysis using Pivot Tables. Now they can do basic data analysis within two or three days using the VIPER tool. It has also reduced data analysis errors.”


While it is still early days for the use of VA and VIPER in population health analysis and planning, there have already been some promising outcomes. The Government of Myanmar recently decided to use VA to monitor non-communicable diseases for the Sustainable Development Goals. 

It’s a good sign for the sustainability of VA that the government see the VA data as important, and that they understand they’re collecting much more complete data than ever before. VIPER will be a valuable tool in interpreting this data
 and translating it into policy.

Khin Sandar Bo,
Myanmar Country Coordinator

IMG_8558-1
D4H training of Myanmar Central Statistics Organisation and Department of Public Health staff in use of VIPER, October 2019

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