The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0

Background Verbal autopsy (VA) is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS) systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed. Methods and findings In 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future. Conclusions Despite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality.The World Health Organization, Bill & Melinda Gates Foundation, and Bloomberg Philanthropies, under the Data for Health Initiative, funded the technical work and making the work publicly available. NM was partially supported by the World Health Organization under an Agreement of Performance of Work grant number 2015/ 535961 awarded to the Swiss Tropical and Public Health Institute, Basel, Switzerland. SJC was partially supported by the Bill & Melinda Gates Foundation grant number OPP1082114 awarded to the London School of Hygiene & Tropical Medicine, London, UK, with a subcontract to the University of Washington, Seattle, US. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript