Core Verbal Autopsy Forms, ICD Coding Guidelines, and Proposed Tabulation List for Use in Sample or Sentinel

Vital egistration and !ortality Sur"eillan#e Systems

Submitted to Population Health Metrics, April 2004 PLEASE DO NOT CITE OR REPRODUCE

Philip Setel,1 Ch l p ti R o,2 !u"u# $emed, % ! &' (o&'hu &,4 D &iel Ch &dr moh &,) D *id +hiti&',, -(.. Alberti,/ &d Al & Lope02

MEASURE Evaluation, Carolina Population Center, CB-1820, Universit o! "orth

Carolina at Chapel Hill, Chapel Hill "C, 2#$1% USA &correspon'in( author)*
2

Universit o! +ueenslan', Bris,ane, School o! Population Health*

.an/anian Ministr o! Health, A'ult Mor,i'it an' Mortalit Pro0ect, P1 Bo2 %$23-, 4ar

es Salaa5, .an/ania
3

Chinese Aca'e5 o! Preventive Me'icine* 6on'on School o! H (iene an' .ropical Me'icine, 7eppel Street, 6on'on 8C1, U7 Universit o! "e9castle upon . ne School o! Clinical Me'ical Sciences, 3th :loor 8illia5

6each Buil'in(, "e9castle upon . ne, "C2 3HH, U7

#

U7 4epart5ent o! Health

Abstra#t $a#%ground1 There 2o&ti&ue" to be & e&ormou" ' p i& reli ble 2 u"e o# de th "t ti"ti2" #or the * "t m 3orit4 o# lo5 i&2ome 2ou&trie", 5hi2h e6perie&2e the hi'he"t burde& o# di"e "e7 Neither he lth8# 2ilit48b "ed i&#orm tio& "4"tem" &or *it l re'i"tr tio& pro*ide de9u te &d repre"e&t ti*e d t o& le*el" &d 2 u"e" o# mort lit47 The ppli2 tio& o# *erb l utop"4 :;A< method", " p rt o# emer'i&' te2h&i9ue" o# 2ommu&it48b "ed demo'r phi2 &d mort lit4 "ur*eill &2e &d " mple *it l re'i"tr tio&, o##er the mo"t pr 2ti2 l i&terim "olutio& to thi" d t "hort# ll7 The de*elopme&t &d * lid tio& o# 2ore ;A #orm" #or peri8 &d &eo& t l, 2hild, &d dult de th", &d "uit ble ICD 2odi&' &d t bul tio& pro2edure" re & e""e&ti l #ir"t "tep7 !et&ods1 Three 2ore ;A #orm" :#or peri8 &d &eo& t l, 2hild, &d dult de th"< 5ere de*eloped &d re*i"ed o*er 12 4e r" b "ed o& ppli2 tio& i& more th & )0,000 de th" throu'h pro3e2t o# the T &0 &i & .i&i"tr4 o# $e lth7 E6pert" #rom T &0 &i , +$O, Chi& , Au"tr li , I&di , the U-, &d the US d pted the #orm" to the Chi&e"e 2o&te6t &d h *e m de #urther re*i"io&" #or propo"ed "et o# 2ore #orm" &d & ICD t bul tio& li"t #or u"e i& hi'h mort lit4 "etti&'" 5here de th" re "eldom medi2 ll4 2erti#ied7 esults1 The propo"ed 2ore ;A #orm" &d )/8item ICD t bul tio& th t re"ulted #rom thi" 1284e r period o# re"e r2h, de*elopme&t, &d re2e&t 2oll bor tio&" re pre"e&ted7 The #orm" re &o5 u"ed i& & tio& l mort lit4 mo&itori&' pro'r m" i& T &0 &i &d Chi& , 5ith pl &&ed

ppli2 tio& i& I&do&e"i , Th il &d, &d I&di 7 The4 re l"o u"ed i& re"e r2h "etti&'" i& Ethiopi , C meroo&, &d . l 5i7 Con#lusions1 The 5ide ppli2 tio& o# ;A &d e6p &"io& o# " mple *it l re'i"tr tio& repre"e&t the mo"t promi"i&' i&terim "olutio& #or the l 2= o# 2 u"e8"pe2i#i2 mort lit4 d t #or hi'h mort lit4 2ou&trie"7 A "et o# * lid ted 2ore ;A tool" th t 2 & &d "uit ble ICD 2odi&' &d t bul tio& pro2edure", 5ith mi&im l modi#i2 tio&, be pplied i& di##ere&t & tio& l 2o&te6t" h *e bee& m de * il ble7 The"e 2 & "er*e " the b "i" o# #urther * lid tio& "tudie" to impro*e their per#orm &2e &d reli bilit47

828

$a#%ground The e&duri&' l 2= o# he lth i&#orm tio& i& lo5er i&2ome 2ou&trie" h " re2e&tl4 bee& li=e&ed b4 the +$O to >' theri&' "torm? @1A7 Thi" 2ri"i" i" bei&' pre2ipit ted b4 the r pid e"2 l tio& i& & tio& l reporti&' re9uireme&t" #or i&iti ti*e" r &'i&' #rom po*ert4 redu2tio& "tr te'ie" to the (lob l Bu&d #or AIDS, TC, &d . l ri , &d more re2e&tl4, +$O?" o5& >% b4 )? pro'r m &d the US 'o*er&me&t?" Pre"ide&t?" Emer'e&24 Pro'r m #or AIDS Relie#, &d &e5 (A;I 2ommitme&t" to redu2tio&" i& * 22i&e8pre*e&t ble mort lit4 mo&' 2hildre&7 Additio& ll4, i& the er o# de2e&tr li0 tio&, dem &d" #or reli ble lo2 l re d t re l"o

i&2re "i&'7 Amo&' the 2h lle&'e" # 2i&' the i&ter& tio& l he lth 2ommu&it4 i& miti' ti&' the imp 2t o# thi" >"torm? i" impro*i&' "4"tem" #or the mo&itori&' o# *it l e*e&t", i&2ludi&' 2 u"e o# de th7

(lob ll4, o&l4 bout third o# ll de th" re re'i"tered 5ith 'e, "e6 &d 2 u"e @2A7 The * "t m 3orit4 o# the"e re i& de*eloped 2ou&trie"7 +h t little i" =&o5& bout 2 u"e" o# de th i& the 5orld?" poore"t 2ou&trie" : &d tho"e 5ith the hi'he"t mort lit4< 2ome" lmo"t e&tirel4 #rom "ur*e4", &d i" l r'el4 limited to 2 u"e" o# de th mo&' 2hildre&7 E*e& i# # 2ilit48b "ed routi&e he lth i&#orm tio& "4"tem" 2ould be "tre&'the&ed to pro*ide better mort lit4 i&#orm tio&, their bilit4 to 'e&er te repre"e&t ti*e "t ti"ti2" i" limited i& 2ou&trie" li=e T &0 &i , 5here the * "t m 3orit4 o# de th" t =e pl 2e out"ide o# he lth # 2ilitie" @%A7 I& "ub8 S h r & A#ri2 , 5here the 4e r" o# li#e lo"t due to prem ture mort lit4 h *e bee& e"tim ted to 22ou&t bout D0E o# the tot l burde& o# di"e "e @4A, the &eed to remed4 thi" "itu tio& 2ould h rdl4 be more "t r=l4 e*ide&t7

.eeti&' the 2h lle&'e to impro*e the produ2tio& o# mort lit4 "t ti"ti2" i& lo5er i&2ome 2ou&trie" 5ill re9uire &e5 te2h&i9ue", &e5 te2h&olo'ie", &d &e5 thi&=i&' bout "u"t i& ble, repre"e&t ti*e, &d reli ble "4"tem" #or re'i"teri&' &d determi&i&' 2 u"e o# de th7 O&e promi"i&' dire2tio& i" to e6p &d the impleme&t tio& o# " mple or "e&ti&el mort lit4 "ur*eill &2e u"i&' *erb l utop"4 method", ide ll4 i& 2o&3u&2tio& 5ith demo'r phi2

8%8

"ur*eill &2e7 The te2h&i9ue o# *erb l utop"4 :;A< i" be2omi&' & i&2re "i&'l4 popul r &d reli ble method #or the >2ommu&it4 di '&o"i"? o# m 3or 2 u"e" o# de th i& de*elopi&' 2ou&trie" 5here *it l re'i"tr tio& i" l 2=i&'7 ;A h " ppli2 tio&" i& both 2ommu&it48b "ed mort lit4 "ur*eill &2e &d i& #ield re"e r2h7 It h " bee& demo&"tr ted to produ2e * lid e"tim te" o# 2 u"e8"pe2i#i2 mort lit4 #r 2tio&" i& m &4 "etti&'" @)811A, &d h " l"o bee& i&te'r ted i&to the routi&e #u&2tio&" o# lo2 l he lth uthoritie" @12814A7

Thi" p per pre"e&t" "et o# 2ore ;A #orm", method", outli&ed 2odi&' pro2edure", &d t bul tio& li"t" b "ed o& the ;nternational Statistical Classi!ication o! 4iseases an' Relate' Health Pro,le5s, .enth Revision :ICD810< @1)81/A th t 2 & be re2omme&ded #or doptio& &d d pt tio& to * riet4 o# "etti&'"7

To our =&o5led'e, the #orm", 2odi&' pro2edure", &d t bul tio& li"t" pre"e&ted here 2ompri"e the mo"t e6te&"i*e &d 5idel4 u"ed ;A tool=it 4et de*eloped7 The three #orm" :#or de th" to &eo& te"F de th" to 2hildre& bet5ee& o&e mo&th &d #i*e 4e r" o# 'eF &d de th" to per"o&" 'ed #i*e 4e r" &d bo*e< 5ere i&iti ll4 de*eloped " p rt o# the T &0 &i & .i&i"tr4 o# $e lth?" Adult .orbidit4 &d .ort lit4 Pro3e2t :A..P<7 The 2ore #orm" h *e bee& de*eloped 5ith the prim r4 ob3e2ti*e o# determi&i&' 2 u"e o# de th t the 2ommu&it4 le*el i& T &0 &i 7 The4 5ere l"o i&te&ded to1 Ce e "4 to u"e i& "u"t i& ble & tio& l "4"tem o# "e&ti&el demo'r phi2 "ur*eill &2eF C p ble o# 'e&er ti&' 2 u"e" o# de th b "ed o& t bul tio& li"t deri*ed #rom the I&ter& tio& l Cl ""i#i2 tio& o# Di"e "e", Te&th Re*i"io& :ICD810< @1)81/AF Eli2it "i'&" &d "4mptom" li=el4 to be reli bl4 &d 22ur tel4 re2 lled &d reported b4 2 rer" o# the de2e "ed @1DA, &d &e2e"" r4 #or the depe&d ble &d repli2 ble ttributio& o# 2 u"e o# de thF Colle2t rele* &t 2o&te6tu l &d "upporti&' i&#orm tio& "u2h " u"e o# he lth # 2ilitie" i& the period immedi tel4 be#ore de th, &d &4 do2ume&t r4 e*ide&2e * il ble #rom the hou"ehold o# the de2e "edF

848

Ame& ble to the de*elopme&t o# d t 8deri*ed l'orithm" to determi&e the prob ble 2 u"e o# de th @1G, 20A7

Cet5ee& 1GG2 &d 2004, *er"io&" o# the"e ;A tool" h *e bee& impleme&ted i& 2ommu&it48 b "ed "e&ti&el demo'r phi2 "ur*eill &2e b4 "e*er l demo'r phi2 "ur*eill &2e "ite" i& T &0 &i , produ2i&' tot l o# more th & )0,000 re'i"tered de th"7 Si&2e 2000, 2ore T &0 &i & #orm" h *e bee& #urther de*eloped 5ith re#ere&2e to other e6i"ti&' &d re2omme&ded tool" @21A, &d tr &"l ted #or u"e i& the Chi&e"e Di"e "e Sur*eill &2e Poi&t S4"tem, the I&di & S mple Re'i"tr tio& S4"tem :&eo& t l #orm<, &d demo'r phi2 "ur*eill &2e "ite" i& . l 5i, Ethiopi , &d C meroo&7 The S5 hili &d Chi&e"e *er"io&" o# the 2ore #orm" re l"o the "ub3e2t o# the l r'e"t * lid tio& "tud4 o# *erb l utop"4 i&"trume&t" 4et u&dert =e&, the re"ult" o# 5hi2h 5ill be * il ble l ter i& 20047

E6perie&2e" #rom I&di @22A, Chi& @2%A, &d T &0 &i @24, 2)A h *e "ho5& ho5, i& 3u"t #e5 "tep", i&#orm tio& 'e&er ted throu'h 2ommu&it48b "ed mort lit4 "ur*eill &2e u"i&' ;A 2 & 'e&er te "t ti"ti2" th t i&#lue&2e poli24, pr 2ti2e, mo&itori&', &d e* lu tio&1 First, t&e e"ent of a deat& is registered i& & 2ti*e reporti&' "4"tem u"i&' 2ommu&it4 reporter"7 Se#ond, VA data are obtained b4 tr i&ed i&ter*ie5er" 5ho *i"it the hou"ehold" o# the de2e "ed 5ithi& "pe2i#ied time period #ter the de th7 The"e 2o&du2t "tru2tured ;A i&ter*ie5", u"i&' the 'e8 ppropri te ;A #orm, 5ith # mil4 member" &d 2 rer" o# the de2ede&t7 T&ird, #auses of deat& are assigned and #oded7 Ph4"i2i & 2erti#ier" u"e ll i&#orm tio& 2o&t i&ed i& the 2ompleted ;A #orm" to ""i'& "pe2i#i2 2 u"e o# de th, &d 5rite de th 2erti#i2 te" 22ordi&' to the i&ter& tio& ll4 'reed #orm t7 I&di*idu l" tr i&ed i& ICD 2odi&' proto2ol" the& ppl4 ppropri te ICD rule" to "ele2t the u&derl4i&' 2 u"e o# de th t the >2ore 2ode? or three 2h r 2ter le*el7 Fourt&, #ause spe#ifi# mortality data are tabulated on a suitable periodi# basis

8)8

'e(g( annually) b4 'e, "e6, 2 u"e or 2 u"e 'roup, &d 'eo'r phi2 or "o2ioe2o&omi2 "tr t 7 The"e d t re #ed i&to routi&e reporti&', pl &&i&', &d mo&itori&' do2ume&t"

&d, o*er time, llo5 &ot o&l4 ""e""me&t o# 2urre&t 2 u"e "tru2ture o# mort lit4, but l"o & & l4"i" o# tre&d"7 +here reli ble popul tio& de&omi& tor" 2 & be obt i&ed #or the re#ere&2e popul tio&", mort lit4 r te" re l"o 2 l2ul ted7 Thi" o&'oi&' 242le o# i&#orm tio& dem &d, 'e&er tio&, &d u"e put" d t i&to the h &d" o# poli24 m =er" th t re &ot * il ble #rom &4 other "our2e7 It" ultim te imp 2t hi&'e" upo& the tool" &d method" pplied t the hou"ehold le*el to obt i& the >r 5? d t 7 Thi" i" the #o2u" o# thi" p per7 Core VA forms Bi'ure" 18% 2o&t i& the E&'li"h *er"io&" o# the 2ore ;A #orm" 2urre&tl4 bei&' * lid ted i& T &0 &i &d Chi& 7 The 2ore ;A #orm" m 4 be #reel4 dupli2 ted &d modi#ied u&der the

term" o# the (NU Bree Do2ume&t tio& Li2e&"e do5&lo d ble #rom http1HH5557&2l7 27u=H mmpHtool"Imethod"H*erb l7php, or *i em il or po"t l m il #rom the 2orre"po&di&' uthor7

The l 4out &d 9ue"tio& #lo5 o# ll three #orm" #ollo5" #e5 o*erridi&' pri&2iple"7 Bir"t, #or re "o&" o# 2o"t &d e "e o# impleme&t tio&, ll #orm" 5ere i&te&ded to #it o& &o more th & t5o photo2opied A48"i0ed p 'e"7 Se2o&d, "=ip p tter&" 5ere *oided u&le"" b"olutel4 &e2e"" r4 i& order to # 2ilit te u"e b4 both medi2 ll4 &d &o&8medi2 ll4 tr i&ed i&ter*ie5er" 5ith di##eri&' le*el" o# liter 247 Third, ll #orm" re "tru2tured "imil rl47 Commo& "e2tio&" re1 Ide&ti#4i&' i&#orm tio&, i&2ludi&' pl 2e o# de thF C u"e o# de th 22ordi&' to re"po&de&tF Short & rr ti*e hi"tor4F S4mptom dur tio& 2he2=li"tF $e lth "er*i2e" u"ed i& the period be#ore de thF

8,8

A&4 medi2 l e*ide&2e * il ble t the hou"ehold, i&2ludi&' 5hether he lth 5or=er i&#ormed the re"po&de&t o# the 2 u"e o# de th7

Other "e2tio&" pert i& to the 'e &d "e6 o# the de2e "ed &d, #or the &eo& t l #orm, the 2o&ditio& o# the mother duri&' &d #ter pre'& &24 &d birth7 The 9ue"tio&" 2o&t i&ed i& the "4mptom dur tio& 2he2=li"t re rr &'ed loo"el4 rou&d & tomi2 l "4"tem", &d re i&te&ded to be " i&#orm ti*e " po""ible i& le di&' to po"iti*e di '&o"i" o# prob ble 2 u"e o# de th, &d the 2o&#ide&t e62lu"io& o# di##ere&ti l di '&o"e"7 Ide ll4, "o2i l "2ie&ti"t "hould be e&' 'ed to ""i"t i& the pilot te"ti&' o# ;A #orm" tr &"l ted i&to ppropri te lo2 l l &'u 'e" &d to ob"er*e the impleme&t tio& o# *erb l utop"4 i&ter*ie5"7 Thi" 5ill help e&"ure th t 9ue"tio&" re u&der"tood b4 re"po&de&t" i& the 5 4 the4 re i&te&ded7

The proto2ol #or 2ompleti&' ;A #orm" i" "imil r to th t o# &4 2o&#ide&ti l he lth8rel ted i&ter*ie5 5ith the dded 2o&"ider tio& th t the "ub3e2t m tter 2o&2er&" hi'hl4 di"tre""i&' topi2 to mo"t re"po&de&t" :i7e7 the re2e&t de th o# lo*ed o&e<7 O&2e ;A i&ter*ie5er re2ei*e" de th report, "Hhe rr &'e" & ppoi&tme&t to 2o&du2t the ;A i&ter*ie5 : #ter &4 2u"tom r4 mour&i&' period h " el p"ed, but be#ore 2o&2er&" o# 22ur te re2 ll ri"e<7 Ide ll4, thi" "hould be 5ithi& ei'ht 5ee=" o# the de th7 I&#ormed 2o&"e&t mu"t be obt i&ed, &d the 2o&#ide&ti lit4 o# ll i&#orm tio& obt i&ed mu"t be ""ured7 All 9ue"tio&" o& the ;A #orm : "ide #rom the ppropri te "=ip"< mu"t be "=ed o# the re"po&de&t re' rdle"" o# the opi&io& o# the i&ter*ie5er " to their rele* &2e7 Ju lit4 ""ur &2e "hould be per#ormed b4 p rti l re8i&ter*ie5 o# te& to #i#tee& per2e&t " mple, i# thi" i" #e "ible, 'i*e& the "e&"iti*e & ture o# the *erb l utop"4 i&ter*ie57

Training and Capa#ity There i" r &'e o# opi&io&" bout 5hether medi2 l tr i&i&' "hould be pre#erred 9u li#i2 tio& #or ;A i&ter*ie5er" or 5hether edu2 ted but &o&8medi2 ll4 tr i&ed per"o&" 5ould be pre#er ble i& thi" role7 The #ormer po"itio& hold" th t medi2 ll4 tr i&ed i&ter*ie5er" 5ill be more 2o&#ide&t &d 2om#ort ble 5ith the "ub3e2t m tter o# ;A

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i&ter*ie5er, &d th t i# the4 re =&o5& lo2 ll4 " medi2 l "t ## the4 re more li=el4 to h *e the 2o&#ide&2e o# the re"po&de&t7 O& the other h &d, it h " l"o bee& ob"er*ed b4 o&e uthor :DC< th t i& "pite o# tr i&i&' to the 2o&tr r4, medi2 ll4 tr i&ed i&ter*ie5er" #i&d it h rd &ot to let their 2li&i2 l 3ud'eme&t bout the li=el4 2 u"e o# de th ##e2t the 5 4 i& 5hi2h ;A i&ter*ie5" re dmi&i"tered, 5hi2h 2ould i&trodu2e pote&ti ll4 "eriou" bi " i&to the d t 2olle2tio&7 I& re#i&i&' ;A pr 2ti2e, #urther re"e r2h o& thi" topi2 5ould be *er4 u"e#ul7

The import &2e o# tr i&i&' i& dmi&i"teri&' the ;A 9ue"tio&& ire" 2 &&ot be o*eremph "i0ed7 Ap rt #rom tr i&i&' i& 2 re#ul re2ordi&' o# demo'r phi2 det il", the tr i&i&' 2urri2ulum "hould i&2lude "e""io&" o& di"2u""io& o# i&di*idu l "4mptom", &d their de"2riptio& i& lo2 l l &'u 'e #or e "4 re2o'&itio& b4 the re"po&de&t"7 Bor e6 mple, 2le r u&der"t &di&' o# the di##ere&ti tio& bet5ee& li*e &d "till birth" i" e""e&ti l7 Al"o, demo&"tr tio& o# i&ter*ie5i&' te2h&i9ue" b4 e6perie&2ed re"e r2h "t ##, &d o&8"ite "uper*i"io& &d #eedb 2= to #ield i&*e"ti' tor" 2ould e&h &2e the o*er ll 9u lit4 o# d t 2olle2ted u"i&' the"e i&"trume&t"7

Ph4"i2i &" 5ho re*ie5 the 2ompleted A; #orm" u"u ll4 re9uire tr i&i&' i& 2 u"e o# de th 2erti#i2 tio& u"i&' the ICD i&ter& tio& l de th 2erti#i2 te7 A& e6pl & tio& o# the "tru2ture &d 2o&te&t o# the ICD 2l ""i#i2 tio&, &d o# the rule" #or "ele2tio& &d 2odi&' o# the u&derl4i&' 2 u"e o# de th i" l"o &e2e"" r4 to e&"ure u&i#ormit4 o# d t 2ro"" di##ere&t re*ie5erH2oder"7

ICD*+, Coding, e#ommended Tabulation List, and Core Code Glossary Ce2 u"e the4 o#te& "er*e " the be"t or e*e& "ole e*ide&2e o& 2 u"e o# de th #or m &4 2ou&trie" 5ith the hi'he"t mort lit4, i&ter& tio& l 2omp r bilit4 i" import &t i& the ppli2 tio& o# the ;A #orm"7 There#ore, it i" re2omme&ded th t ;A be 2oded to the 2ore, or three82h r 2ter, le*el o# the Te&th re*i"io& o# the ICD u"i&' the i&ter& tio& ll4 'reed three8 li&e de th 2erti#i2 te7 I& 2ert i& 2 "e" :e7'7 i&3urie"< it m 4 be po""ible to 2ode to the #ourth di'it7

8D8

Bor the purpo"e" o# mort lit4 t bul tio& &d reporti&', the ICD re2omme&d" the u"e o# & ppro*ed 10%8item or D08item >2o&de&"ed li"t?7 The re "o&i&' behi&d the"e li"t" & tur ll4 ""ume" th t 2oder" 5ill h *e de9u te medi2 l re2ord" t their di"po" l to ttribute de th to &4 o# the 2 te'orie" 2o&t i&ed 5ithi& them7 I& the 2 "e o# ;A, "m ller li"t 2o&t i&i&' 2 u"e" o# de th th t the method 2 & be e6pe2ted to determi&e 5ith re "o& ble 2ert i&t4 m 4 be ppropri te7 The ICD "pe2i#i2 ll4 " &2tio&" the de*elopme&t "u2h t ilored t bul tio& li"t" @1,, p 12,A7

T ble 1 2o&"i"t" o# propo"ed ICD ;A t bul tio& li"t, &d 'lo"" r4 m ppi&' the t bul tio& li"t to ICD 2ore 2ode"7 Thi" h " bee& "t4led 22ordi&' to the pri&2iple" o# & ICD >"ele2ted? mort lit4 li"t @2,A, &d 2o&t i&" mo"t 2 u"e" th t re li=el4 to be rele* &t #or 'uidi&' poli24 &d pro'r m de*elopme&t, i& 2ou&trie" 5here "u2h d t re mo"t &eeded7 Al"o, it i" #elt th t

"pe2i#i2 2o&ditio&" me&tio&ed i& thi" li"t re li=el4 to be 2le rl4 ide&ti#ied " u&derl4i&' 2 u"e" o# de th, b "ed o& d t 2olle2ted u"i&' the 'e "pe2i#i2 *erb l utop"4 #ield i&"trume&t"7 @TACLE 1 ACOUT $EREA Future Dire#tions and Issues for De"elopmental esear#& in VA . &4 uthor" 2o&2er&ed 5ith e&"uri&' the 22ur 24 o# the popul tio&8le*el 2 u"e8"pe2i#i2 mort lit4 #r 2tio&" 'e&er ted b4 ;A h *e poi&ted out the 2riti2 l &eed #or * lid tio& o# the tool @), 2/A7 Thi" "tem" #rom & i&e*it ble mou&t o# mi"2l ""i#i2 tio& th t o22ur" mo&' 2 u"e" o# de th 'i*e& the u& * il bilit4 o# &4 do2ume&t r4 e*ide&2e ppro 2hi&' ri'orou" medi2 l re2ord7 The i""ue o# mi"2l ""i#i2 tio& &d the import &2e &d 2omple6itie" o# ;A * lid tio& 5ill &ot be 2o&"idered #urther here be4o&d reiter ti&' #e5 b "i2 poi&t"7

Bir"t, ;A "hould, ide ll4, be * lid ted i& the popul tio&" i& 5hi2h it i" bei&' u"ed @2DA7 Th t " id, 2o&u&drum #or * lid tio& ri"e" i& th t >'old "t &d rd? o# medi2 l re2ord" ' i&"t 5hi2h ;A "hould ide ll4 be 2omp red i", b4 de#i&itio&, l 2=i&' #or popul tio&" i& 5hi2h ;A

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i" & ppropri te i&#orm tio& "our2e7 The"e limit tio&" &ot5ith"t &di&', the * lid tio& o# ;A ' i&"t ll * il ble 2li&i2 l &d l bor tor4 medi2 l e*ide&2e "hould be the ultim te ob3e2ti*e7 L "tl4, " the T &0 &i e6perie&2e h " "ho5& #or m &4 4e r", it i" "till po""ible #or de*elopi&' 2ou&trie" l 2=i&' reli ble d t to m =e 'ood poli24 u"e o# ;A8b "ed 2 u"e8 "pe2i#i2 mort lit4 d t th t re u& d3u"ted #or mi"2l ""i#i2 tio&7

The 2odi&' &d ttributio& o# 2 u"e o# de th i" &other re #or de*elopme&t i& ;A methodolo'ie"7 The 2urre&t pre#erred pr 2ti2e i" #or ph4"i2i &" to ttribute 2 u"e o# de th throu'h 2 re#ul re*ie5 o# #orm" &d ppli2 tio& o# 2li&i2 l "=ill &d =&o5led'e7 P rti2ul rl4 i& "4"tem" 5here & tio& l pro'r m o# mort lit4 mo&itori&' u"i&' ;A 'e&er te" thou" &d" o# #orm" e 2h 4e r, &4 2o"t8e##e2ti*e me &" to redu2e reli &2e o& hum & 2oder" &d mi&imi0e the ri"= o# e6perie&2ed 2oder" # lli&' i&to >rut"? i& their 2odi&' pr 2ti2e" 5ould be o# 're t be&e#it7 There h *e bee& "ome 2omp ri"o&" o# medi2 l re2ord" &d ph4"i2i & ;A 2odi&' to lter& ti*e ;A 2 u"e o# de th ttributio& method" i&2ludi&' e6pert l'orithm", lo'i"ti2 re're""io&, &eur l &et5or=", &d 2 te'ori0 tio& &d re're""io& tree & l4"i" @,, 20, 2GA7 O# the lter& ti*e", &eur l &et5or=" &d 2 te'ori0 tio& &d re're""io& tree & l4"i" "eem to be the mo"t promi"i&', thou'h more re"e r2h &d de*elopme&t i" re9uired be#ore pr 2ti2 l lter& ti*e" 2 & be propo"ed7 Dis#ussion and Con#lusions Thi" p per h " pl 2ed i& the publi2 dom i& "et o# tool" th t re the produ2t o# o*er de2 de o# ppli2 tio&, tri l, ""e""me&t, &d re#i&eme&t prim ril4 u&der the Adult .orbidit4 &d .ort lit4 Pro3e2t7 O*er the p "t "e*er l 4e r", thi" "et o# ;A #orm" h " "ee& i&2re "i&' i&ter& tio& l upt =e &d "ome #urther modi#i2 tio& to "uit lo2 l di"e "e e2olo'ie"7 The4 re l"o the "ub3e2t o# m 3or "tud4 to * lid te 2 u"e o# de th ttributio& i& T &0 &i &d Chi& 7

I& Chi& , 5hi2h h " "ub"t &ti ll4 di##ere&t epidemiolo'i2 l pro#ile 2omp red to T &0 &i , lo2 l e6pert" re*ie5ed the ori'i& l #orm" de*eloped i& T &0 &i &d #ou&d it &e2e"" r4 to

re2omme&d the dditio& o# 9ue"tio&" rel ted to "=i& 2olour o# &e5bor&" &d di rrhoe

8108

:&eo& t l #orm<, "=i& 2olour o# lip" :2hild #orm<, &d * 'i& l bleedi&' : dult #orm<7 There 5ere "li'ht modi#i2 tio&" m de to #e5 other 9ue"tio&" i& order to redu2e mbi'uit4 bout "4mptom dur tio&"7 The #orm" re l"o i& u"e i& C meroo& &d Ethiopi , 5ith pl &&ed impleme&t tio& i& I&do&e"i , Th il &d, &d I&di 7

I&2re "i&'l4, 'e&2ie" 2o&2er&ed 5ith 'lob l he lth de*elopme&t h *e re2o'&i0ed the &eed #or 2omp r ble, reli ble, d t o& the he lth out2ome" o# popul tio&" i& lo5 i&2ome 2ou&trie"7 A "et o# * lid ted 2ore ;A tool" th t 2 & &d "uit ble ICD 2odi&' &d t bul tio& pro2edure", 5ith mi&im l modi#i2 tio&, be pplied i& di##ere&t & tio& l 2o&te6t" re & e""e&ti l #ir"t "tep i& meeti&' the"e &eed"7

Buture re"e r2h 5ill llo5 better u&der"t &di&' o# the de'ree to 5hi2h "et o# 2ore tool" 5ith "ome "m ll lo2 ll4 ppropri te modi#i2 tio& 2hie*e their ultim te im1 to 'e&er te reli ble &d i&ter& tio& ll4 2omp r ble 2 u"e "pe2i#i2 mort lit4 "t ti"ti2" " p rt o# & e6p &ded 2ommitme&t to impro*i&' "4"tem" to mo&itor &d me "ure *it l e*e&t"7 I# 5e re &ot be " i'&or &t o# the true mort lit4 burde& &d it" 2ompo&e&t 2 u"e" i& 5orld?" poore"t 2ou&trie" te& 4e r" he&2e " 5e re tod 4 there i" & ur'e&t &eed to u"e the method" &d tool" propo"ed here to "2 le up "e&ti&el or " mple mort lit4 "ur*eill &2e &d *erb l utop"4 i& the m 3orit4 o# de*elopi&' 2ou&trie"7

Competing Interests No&e de2l red : ll uthor"<7 Aut&ors- #ontributions PS 2o&2ei*ed o# &d led the 5riti&' p per, 2o8led de*elopme&t o# the propo"ed 2ore ;A #orm", &d 2o&tributed to the de*elopme&t o# the t bul tio& li"t7 CR 2o8led the de*elopme&t o# the propo"ed t bul tio& li"t, 2o&tributed to 5riti&' p per, &d 2o&tributed to the de*elopme&t o# the propo"ed 2ore ;A #orm"7 !$ 2o8led de*elopme&t o# the 2ore ;A #orm"

8118

&d t bul tio& li"t, &d 2o&tributed to 5riti&' p per7 !( 2o&tributed to 5riti&' p per, &d 2o&tributed to the de*elopme&t o# the propo"ed 2ore ;A #orm"7 DC 2o8led de*elopme&t o# the propo"ed 2ore ;A #orm" &d propo"ed t bul tio& li"t, &d helped edit &d re*i"e the p per7 D+ 2o8led de*elopme&t o# the propo"ed 2ore ;A #orm", 2o&tributed to the de*elopme&t o# the propo"ed t bul tio& li"t, &d helped edit &d re*i"e the p per7 -A 2o&tributed to the de*elopme&t o# the propo"ed 2ore ;A #orm" &d helped edit &d re*i"e the p per7 AL 2o&tributed to the de*elopme&t o# the propo"ed 2ore ;A #orm", &d helped edit &d re*i"e the p per A#%no.ledgements Thi" publi2 tio& i", i& p rt, & output o# the Adult .orbidit4 &d .ort lit4 Pro3e2t :A..P<7 A..P i" pro3e2t o# the T &0 &i & .i&i"tr4 o# $e lth, #u&ded b4 the U- Dep rtme&t #or I&ter& tio& l De*elopme&t :DBID<, &d impleme&ted i& p rt&er"hip 5ith the U&i*er"it4 o# Ne52 "tle upo& T4&e :U-<7 The *ie5" e6pre""ed re &ot &e2e"" ril4 tho"e o# DBID7 +e re p rti2ul rl4 'r te#ul to our Di"tri2t &d .u&i2ip l Cou&2il p rt&er" i& $ i, I'u&' , Il l , -i'om Urb &, &d Teme=e &d the re"ide&t" o# tho"e re " 5ho h *e p rti2ip ted i& demo'r phi2 &d mort lit4 "ur*eill &2e #rom 1GG2K20047

Thi" publi2 tio& i" l"o "upported b4 'r &t P104,2810GHGG0%(LOC82, .he <lo,al Bur'en o! 4isease 2000 in A(in( Populations, US N tio& l I&"titute" o# $e lth, N tio& l I&"titute o& A'ei&'7

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eferen#es 17 T E* &", S St &"#ield1 /ealt& information in t&e ne. millennium0 a gat&ering storm1 Bulletin o! the 8orl' Health 1r(ani/ation 200%, 2+1D),7 27 AD Lope0, O Ahm d, . (uillot, CD Ber'u"o&, L S lomo&, CLL .urr 4, -$ $ill1 3orld !ortality in 4,,,0 Life Tables for +5+ Countries7 (e&e* 1 +orld $e lth Or' &i0 tio&F 20027 %7 .i&i"tr4 o# $e lth, A..P Te m1 T&e Poli#y Impli#ations of Adult !orbidity and !ortality( 6nd of P&ase + eport( D r e" S l m1 U&ited Republi2 o# T &0 &i F 1GG/7 47 CLL .urr 4, AD Lope0 :ed"7<1 T&e Global $urden of Disease7 Co"to&1 The $ r* rd S2hool o# Publi2 $e lth o& beh l# o# the +orld $e lth Or' &i0 tio& &d the +orld C &=F 1GG,7 )7 D Ch &dr moh &, ($ . ude, LC Rodri'ue", RL $ 4e"1 Verbal Autopsies for Adult Deat&s0 Issues in t&eir De"elopment and Validation7 ;nternational =ournal o! Epi'e5iolo( 1GG4, 47121%82227 ,7 D Ch &dr moh &, ($ . ude, LC Rodri'ue", RL $ 4e"1 Verbal autopsies for adult deat&s0 t&eir de"elopment and "alidation in a multi*#entre study7 .ropical Me'icine an' ;nternational Health 1GGD, 714%,844,7 /7 N D tt , . . &d, ; -um r1 Validation of #auses of infant deat& in t&e #ommunity by "erbal autopsy7 ;n'ian = Pe'iatr 1GDD, 881)GG8,047 D7 - - h&, S Tollm &, . ( re&&e, L (e r1 Validation and appli#ation of "erbal autopsies in a rural area of Sout& Afri#a7 .ropical Me'icine an' ;nternational Health 2000, 81D248D%17 G7 CC .oble4, LT Coerm , S Titu", C Lohr=e, - Sh &'ul , RE Cl 2=1 Validation study of a "erbal autopsy met&od for #auses of #&ild&ood mortality in 9amibia7 = .rop Pe'iatr 1GG,, :41%,)8G7 107 .A Jui'le4, A L7R7., S R7+71 Algorit&ms for "erbal autopsies0 a "alidation study in ;enyan #&ildren7 Bulletin o! the 8orl' Health 1r(anisation 1GG,, <:114/

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8 1)47 117 L Rodri'ue0, $ Re4e", P Tome, C Rid ur , S Blore", $ (ui"2 #re1 Validation of t&e "erbal autopsy met&od to as#ertain a#ute respiratory infe#tion as #ause of deat&7 ;n'ian = Pe'iatr 1GGD, =81)/G8D47 127 R ."5i , D +hiti&', ( - b di, $ . " &3 , P Setel, #or the A..P Te m1 Dar es Salaam Demograp&i# Sur"eillan#e System7 I&1 Population an' Health in 4evelopin( Countries> ?olu5e 1@ Population, Health, an' Survival in ;"4EP.H Sites Edited b4 The INDEPT$ Net5or=7 pp7 14%81)07 Ott 5 1 I&ter& tio& l De*elopme&t Re"e r2h Ce&treF 20021 14%81)07 1%7 R ."5i , D +hiti&', ( - b di, $ . " &3 , P Setel, #or the A..P Te m1 /ai Distri#t Demograp&i# Sur"eillan#e System7 I&1 Population an' Health in 4evelopin( Countries> ?olu5e 1@ Population, Health, an' Survival in ;"4EP.H Sites Edited b4 The INDEPT$ Net5or=7 pp7 1)181)D7 Ott 5 1 I&ter& tio& l De*elopme&t Re"e r2h Ce&treF 20021 1)181)D7 147 R ."5i , D +hiti&', ( - b di, $ . " &3 , P Setel, #or the A..P Te m1 !orogoro ural Demograp&i# Sur"eillan#e System7 I&1 Population an' Health in 4evelopin( Countries> ?olu5e 1@ Population, Health, an' Survival in ;"4EP.H Sites Edited b4 The INDEPT$ Net5or=7 pp7 1,)81/27 Ott 5 1 I&ter& tio& l De*elopme&t Re"e r2h Ce&treF 20021 1,)81/27 1)7 +orld $e lth Or' &i0 tio&1 International statisti#al #lassifi#ation of diseases and related &ealt& problems( Tent& e"ision( Volume +7 (e&e* 1 +orld $e lth Or' &i0 tio&F 1GG%7 1,7 +orld $e lth Or' &i0 tio&1 International statisti#al #lassifi#ation of diseases and related &ealt& problems( Tent& e"ision( Volume 47 (e&e* 1 +orld $e lth Or' &i0 tio&F 1GG%7 1/7 +orld $e lth Or' &i0 tio&1 International statisti#al #lassifi#ation of diseases and related &ealt& problems( Tent& e"ision( Volume 77 (e&e* 1 +orld $e lth Or' &i0 tio&F 1GG%7

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P Setel, ; .=u" , &d the A..P Te m1 Compre&ension of S.a&ili Verbal Autopsy Forms( A!!P Te#&ni#al eport 9o( <7 I&1 BooA Co5prehension o! S9ahili ?er,al Autops :or5s> AMMP .echnical Report "o> # :Editor ed7Med"7<7 Cit41 Adult .orbidit4 &d .ort lit4 Pro3e2t N $e lth I&#orm tio& &d Re"e r2h Se2tio&, Dep rtme&t o# Poli24 &d Pl &&i&', .i&i"tr4 o# $e lth, U&ited Republi2 o# T &0 &i F 20017

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A Coulle, D Ch &dr moh &, P +eller1 A #ase study of using artifi#ial neural net.or%s for #lassifying #ause of deat& from "erbal autopsy7 ;nternational =ournal o! Epi'e5iolo( 2001, 7,1)1)8)207

207

. . dde&1 Assigning Adult Causes of Deat& "ia Verbal Autopsy using Data* deri"ed Algorit&ms7 Pro*o1 Cri'h m !ou&'F 20027 .S27

217

N tio& l Se&ti&el Sur*eill &2e S4"tem1 eport of 3or%s&op on Drafting Core Verbal Autopsy Tools for use by sites #ontributing mortality data to t&e 9SS7 I&1 BooA Report o! 8orAshop on 4ra!tin( Core ?er,al Autops .ools !or use , sites contri,utin( 5ortalit 'ata to the "SS :Editor ed7Med"7<7 Cit41 Dep rtme&t o# Poli24 &d Pl &&i&', .i&i"tr4 o# $e lth, U&ited Republi2 o# T &0 &i F 20017

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Re'i"tr r (e&er l o# I&di 1 Sample egistration System7 I&1 BooA Sa5ple Re(istration S ste5 :Editor ed7Med"7<, *ol7 20047 Cit41 ;it l St ti"ti2" Di*i"io&, O##i2e o# the Re'i"tr r (e&er l o# I&di F 20027

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( ! &', O $u &', L T &1 Priorities of disease #ontrol in C&ina**analysis on mortality data of 9ational Disease Sur"eillan#e Points System7 Chinese =ournal o! Epi'e5iolo( 1GG,, +<11GG82027

247

(lob l Borum #or $e lth Re"e r2h1 T&e +,>5, eport on /ealt& esear#& +5557 I&1 :oru5 2F 1GGDF (e&e* 7

2)7

+orld $e lth Or' &i0 tio&1 3orld /ealt& eport 4,,7 * S&aping t&e Future7 (e&e* 1 +orld $e lth Or' &i0 tio&F 200%7

2,7

+orld $e lth Or' &i0 tio&1 Statisti#al Presentation7 I&1 ;nternational statistical classi!ication o! 'iseases an' relate' health pro,le5s> .enth Revision Edited b4

81)8

+orld $e lth Or' &i0 tio&, *ol7 27 (e&e* 1 +orld $e lth Or' &i0 tio&F 1GG%7 2/7 . A&=er1 T&e effe#t of mis#lassifi#ation error on reported #ause*spe#ifi# mortality fra#tions from "erbal autopsy7 ;nt = Epi'e5iol 1GG/, 4=110G08,7 2D7 D Ch &dr moh &, P Setel, . Jui'le41 6ffe#t of mis#lassifi#ation of #auses of deat& in "erbal autopsy0 #an it be ad?usted1 ;nternation =ournal o! Epi'e5iolo( 2001, 7,1)0G8)147 2G7 A Coulle1 T&e role of neural net.or%s in publi# &ealt& pra#ti#e0 a #ase study in #ause of deat& #lassifi#ation7 Lo&do&1 U&i*er"it4 o# Lo&do& S2hool o# $4'ei&e &d Tropi2 l .edi2i&eF 1GGG7 .S27

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Table 1. Proposed VA tabulation list mapped to ICD core codes VA-001 VA-00" VA-00$ VA-00% VA-00# VA-00( VA-00. VA-00/ VA-00! VA-010 VA-011 VA-01" VA-01$ VA-01% VA-01# VA-01( VA-01. VA-01/ VA-01! VA-0"0 VA-0"1 VA-0"" VA-0"$ VA-0"% VA-0"# VA-0"( VA-0". VA-0"/ VA-0"! VA-0$0 VA-0$1 VA-0$" VA-0$$ VA-0$% VA-0$# VA-0$( VA-0$. VA-0$/ VA-0$! VA-0%0 VA-0%1 VA-0%" VA-0%$ VA-0%% VA-0%# VA-0%( VA-0%. VA-0%/ VA-0%! Intestinal infectious diseases (including diarrhoeal diseases Tuberculosis Tetanus &easles Viral hepatitis )uman immunodeficienc* +irus ,)IV- disease &alaria 0eishmaniasis 1emainder of infectious and parasitic diseases &alignant neoplasm of lip2 oral ca+it* and phar*n3 &alignant neoplasm of oesophagus &alignant neoplasm of stomach &alignant neoplasm of small intestine &alignant neoplasm of colon2 rectum and anus &alignant neoplasm of li+er and intrahepatic bile ducts &alignant neoplasm of trachea2 bronchus and lung &alignant neoplasm of breast &alignant neoplasm of cer+i32 other and unspecified2 parts of uterus 1emainder of malignant neoplasms 4utritional anaemias Diabetes mellitus &alnutrition &ental and beha+ioural disorders &eningitis )*pertensi+e diseases Ischaemic heart diseases Cerebro+ascular diseases Pneumonia Chronic obstructi+e pulmonar* diseases 7astric and duodenal ulcer Cirrhosis li+er Disorders of the :idne* Pregnanc* ;ith aborti+e outcome )*pertensi+e disorders of pregnanc* &aternal haemorrhage <bstructed labour Complications predominantl* related to the puerperium <ther maternal causes Prematurit* and lo; birth ;eight 'irth trauma 'irth asph*3ia2 and other respirator* disorders specific to the perinatal period =till births All other conditions originating in the perinatal period Congenital malformations of the central ner+ous s*stem Abdominal pain 6e+er of un:no;n origin Con+ulsions2 not else;here classified ?nspecified causes of mortalit* All other diseases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e3cept 1102 1#02 1#( D00-D%/2D##-D/!2 500-50.251#-5$%2 5#0-5//270%-7!/2 )00-)!#2I01-I0!2 I"(-I#"2 I.0-I!!2 800-8112 8"0-8$!2 8%#8!!2900-9""2 9"/-9.$2 9.#-9!"2 000-0!/2 &00-&!!2 4$0-4!/2>10->!! V01-V!! @00-@1! @(#-@.% A00-A0!

VA-0#0 VA-0#1 VA-0#" VA-0#$

Transport accidents 6alls Accidental dro;ning and submersion 53posure to smo:e2 fire and flames

81/8

VA-0#% VA-0## VA-0#( VA-0#.

Accidental poisoning b* and e3posure to no3ious substances Intentional self-harm Assault All other e3ternal causes

A%0-A%! A(0-A/% A/#-B0! @"0-@(%2 @.#-@!!2 A10-A$!2 A#0-A#!2 B10-B/!

81D8