Verbal Autopsy and Social Autopsy Studies (VASA)
Objective
Through a grant to the U.S. Fund for UNICEF on behalf of the WHO/UNICEF-supported Child Health Epidemiology Reference Group (CHERG), the Bill and Melinda Gates Foundation (BMGF) supported a set of 14 activities to provide improved global estimates and measures of the causes and determinants of maternal, neonatal and child morbidity and mortality, of intervention coverage, and of the effectiveness of health interventions. Many of these activities entailed gathering and reviewing existing data and building models to develop estimates; while two activities partly involved gathering new verbal and social autopsy (VASA) data in several high priority countries. Post the CHERG grant, this work continued through the Maternal and Child Epidemiology Estimation (MCEE) grant from the Gates Foundation to the Johns Hopkins Institute for International Programs.
The main purpose of a VASA study is to directly estimate the causes and determinants of neonatal and child mortality, in contrast to the World Health Organization’s modeled estimates of causes of death that most developing countries rely on. The VASA estimates are used to help improve global, regional and country estimates through their incorporation into updates of the modeled estimates, and are also used by countries that conduct a VASA study to improve their own mortality estimates and for health policy and program development.
Verbal autopsy (VA) – causes of death
Verbal autopsy is the most useful tool available to determine cause of death in settings with limited access to health care. A VA inquiry of a child’s death consists of interviewing the main caregiver about the fatal illness. The cause of death is determined from predefined combinations of the reported illness signs; by independent classification of the interview findings by one or more study physicians; or by statistical methods that examine the associations between particular signs and illnesses. Verbal Autopsy is not intended to make a gold standard diagnosis of an individual’s cause of death, however it is the best available method for diagnosing cause of death in settings where many deaths occur outside of medical care and lack proper medical certification. Globally, common causes of death that verbal autopsy can diagnose include birth injury/asphyxia, diarrhea, congenital malformation, preterm delivery, serious infections (sepsis, pneumonia, meningitis) and tetanus in neonates, and AIDS, diarrhea, dysentery, injury, malaria, malnutrition, measles, meningitis, Pertussis and pneumonia in children (1-59 month). Important uses of verbal autopsy cause of death findings include identifying health priorities, allocating sparse resources and evaluating health program impact.
Social autopsy (SA) – social and behavioral determinants of death
While knowledge of the biological causes of child death is important, effective delivery of child survival interventions depends on improved understanding of modifiable cultural, social and health system factors affecting health care access and utilization. Social Autopsy findings detail the most common household (e.g., mother’s and father’s education, pregnancy and wellness care, care seeking and constraints), community (e.g., residence place, time to reach health care in an emergency, social capital) and health system (e.g., ANC content, delivery care, newborn and child care, child illness care) factors that contributed to the deaths. The “Pathway to Survival” conceptual framework (figure), organizes the steps that families, communities and health systems must take to prevent illness and return sick children to health. Social autopsy findings are useful for guiding effective delivery of child survival technologies by informing health policy and program development for increased access and utilization of preventive and curative health care.
For the VASA activity, countries with high burden of child mortality and inadequate data on the causes and determinants of child death were selected with the objective that VASA results can contribute to a national initiative and to global or regional evidence on mortality causes and trends. To-date, VASA studies have been conducted in the following countries: Cameroon, Malawi, Niger, Nigeria and Tanzania.
COMSA VASA Questionnaires
Verbal and Social Autopsy is used in the project. Below are the links to download the data collection instruments used in that study.
Looking for more information?
Please click the link below for an update of the JHU/IIP Social Autopsy Instrument, including VASA and SA resources and tools.
Publications
Kalter, H.D., Perin, J., Amouzou, A. et al. . BMC Med 18, 183 (2020). https://doi.org/10.1186/s12916-020-01639-1
Perin, J., Koffi, A.K., Kalter, H.D. et al. BMC Pregnancy Childbirth 20, 534 (2020). https://doi.org/10.1186/s12884-020-03220-3
Koffi AK, Kalter HD, Loveth EN, Quinley J, Monehin J, Black RE (2017) Beyond causes of death: The social determinants of mortality among children aged 1-59 months in Nigeria from 2009 to 2013. PLoS ONE 12(5): e0177025. https://doi.org/10.1371/journal.pone.0177025.
Adewemimo A, Kalter HD, Perin J, Koffi AK, Quinley J, Black RE (2017) Direct estimates of cause-specific mortality fractions and rates of under-five deaths in the northern and southern regions of Nigeria by verbal autopsy interview. PLoS ONE 12(5): e0178129. https://doi.org/10.1371/journal.pone.0178129.
Koffi AK, Wounang RS, Nguefack F, Moluh S, Libite PR, Kalter HD. J Glob Health. 2017. doi: 10.7189/jogh.07.010601.
Understanding misclassification between neonatal deaths and stillbirths: empirical evidence from Malawi. Liu L, Kalter HD, Chu Y, Kazmi N, Koffi AK, Amouzou A, Joos O, Munos M, Black RE. PLOS ONE. 2016. doi: doi:10.1371/journal.pone.0168743
Kalter HD, Perin J, Black RE. JOGH. 2016. doi: 10.7189/jogh.06.010601
Bensaid K, Yaroh AG, Kalter HD, Koffi AK, Amouzou A, Maina A, Kazmi N. JOGH. 2016. doi: 10.7189/jogh.06.010602
Koffi AK, Maina A, Yaroh AG, Habi O, Bensaid K, Kalter HD. JOGH. 2016. doi: 10.7189/jogh.06.010603
Kalter HD, Yaroh AG, Maina A, Koffi AK, Bensaid K, Amouzou A, Black RE. JOGH. 2016. doi: 10.7189/jogh.06.010604
Nonyane BAS, Kazmi N, Koffi AK, Begum N, Ahmed S, Baqui AH, Kalter HD. JOGH. 2016. doi: 10.7189/jogh.06.010605
Koffi AK, Libite PR, Moluh S, Wounang R, Kalter HD. JOGH. 2015. doi: 10.7189/jogh.05.010413
Liu L, Li M, Cummings S, Black RE. JOGH. 2015. doi: 10.7189/jogh.05.010414
Kalter HD, Roubanatou AM, Koffi A, Black RE. JOGH. 2015. doi: 10.7189/jogh.05.010415
Koffi AK, Mleme T, Nsona H, Banda B, Amouzou A, Kalter HD. JOGH. 2015. doi: 10.7189/jogh.05.010416
Waiswa P, Kalter HD, Jakob R, Black RE for the Social Autopsy Working Group. Bull World Health Organ. 2012. doi:10.2471/BLT.12.105718
Kalter HD, Salgado R, Babille M, Koffi AK, Black RE. Population Health Metrics. 2011. doi:10.1186/1478-7954-9-45