02130nas a2200217   4500000000100000008004100001100001200042700001500054700001500069700002000084700001800104700001400122700001900136700001600155700002100171245015200192300001000344490000800354520153600362022001401898       2017                            d1 aJoshi R1 aGouda Hebe1 aLopez Alan1 aFlaxman Abraham1 aBrolan Claire1 aRiley Ian1 aAbouZahr Carla1 aFirth Sonja1 aRampatige Rasika00aNew challenges for verbal autopsy: Considering the ethical and social implications of verbal autopsy methods in routine health information systems.  a65-740 v1843 a<p>
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.
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