Verbal autopsy: who needs it?

The "gold standard" is medical certification of cause according to the International Classification of Diseases (ICD) [7]. The WHO verbal autopsy tools are designed to generate causes of death that are "ICD compatible." WHO recommends that mortality data derived from verbal autopsy be tabulated separately from data derived using medical certification and ICD coding [7].While verbal autopsy may not be as reliable as hospital-based certification for identifying causes of death, it is able to produce information not available from a medical certificate. Alongside questions about signs and symptoms in the deceased person, verbal autopsy can ask about risk factors and health care seeking prior to death, elucidating social, economic, behavioral, and health system issues that may have contributed to death. This contextual knowledge is invaluable to health care managers and planners. Potential users of data generated through verbal autopsy include communities, health care planners and managers, researchers, global decision-makers, and donors [8]. While there is a degree of overlap, these users have different perspectives on the uses of mortality data. These in turn have an impact on the desirable characteristics of data collection instruments. Researchers, epidemiologists, and global-level decision-makers want mortality data to inform burden of disease estimation and program evaluation. Cause of death estimates must be scientifically validated, meet high standards of accuracy, and be comparable over time and across countries. Uncertainty in cause-specific mortality fractions can be managed.National/subnational decision-makers and health system managers want cause of death data for planning, budgeting, and resource allocation and for monitoring and reporting to donors. The ability to track trends over time is more important than cross-country comparability. Uncertainty is problematic, especially when data are needed to inform allocation of resources. Data need to be actionab