Particular challenges when it comes to causes of death are the fact that in many low-income countries the vast majority of deaths occur in places where there are no doctors, particularly in homes. People do not necessarily die in clinics or in health centers or even in hospitals. They are either sent home to die or the death is from an acute cause that enables, that doesn't permit. them to travel to a health facility before the death actually occurs.
In those situations, it's particularly challenging to determine with some degree of accuracy and confidence what the cause of death has actually been. And the concern is that the patterns of death in those community settings, with the majority of deaths happening outside of the health system, those patterns of death are going to differ in some meaningful ways from the patterns of death that occur to people who are actually in health facilities. If we were to rely exclusively on the facility data, then, we are concerned about developing a biased or inaccurate picture about the burden of disease and particularly the burden of fatal conditions in the population. A skewed view of that set of circumstances, of course, would lead to health policies and priorities that may not be aligned with the true population-wide conditions of burden of disease or the specific causes that are most important at the community level. In order to address this, there has been a long tradition of something called verbal autopsy.
Now verbal autopsy is also sometimes called a post-mortem caregiver interview. The idea being that some well-trained individual from either the health service or community development would visit the household where a death has taken place, allowing for a discrete period of mourning of the death to take place, and interview those individuals at the household who have been most intimately connected with the terminal events of the deceased person. Those who are providing care, for example, to someone who died in the home. There are a set of structured questions meant to elicit the signs and symptoms experienced by the deceased individual in the period before death.
There are separate questions that one would ask of very tiny babies and neonates. There are questions that are asked of younger children up to early adolescence and there are questions that one would ask of adults including women who may have died from maternal causes. These questions are elicited in a structured way in an interview, and then they are reviewed either by physicians or increasingly analyzed by computer.
There are now very reliable, replicable, stable, well-proven techniques to do statistical analyses of these verbal autopsy interviews. produce what is most likely to be the true underlying cause of death in the system in the situation in which the deceased died at home without having had access to medical services. What that permits is the aggregation of data from the whole population in a geographically representative manner and ultimately the development of what we believe to be a more reliable picture of the leading causes of death in a given population. With that reliable picture comes the ability to provide what we believe to be more well-aligned health policies and programs in terms of setting priorities and also the ability to assess trends over time in the leading causes of death that may take place in the future.
widely spread out and dispersed populations.