Verbal autopsy standards:
The 2012 WHO verbal autopsy instrument
Release Candidate 1
WHO Library Cataloguing-in-Publication Data
Verbal Autopsy Standards: 2012 WHO Verbal Autopsy lnstrument
Contents: v. 1. Manual
1.Autopsy – methods. 2.Cause of death. 3.Questionnaires - standards. 4.Interviews - standards. 5.Data collection – methods. I.World Health Organization. II.Health Metric Network. III.INDEPTH Network
ISBN 978 92 4 154847 2 (NLM classification: QZ 35)
© World Health Organization 2012
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Acknowledgements
The production of this manual would not have been possible without the collaboration and support of numerous organizations, institutions and individuals. The organizations contributing to this work include World Health Organization (WHO), Health Metrics Network (HMN), INDEPTH Network, Institute for Health Metrics and Evaluation (IHME), All India Institute of Medical Sciences, Centers for Disease Control and Prevention (CDC), Federal University of Minas Gerais, Ghana Health Service, Ifakara Health Institute, London School of Hygiene & Tropical Medicine (LSHTM), Norwegian Institute of Public Health, Swiss Tropical and Public Health Institute, Thailand Ministry of Public Health, The University of Queensland, UCL Centre for International Health and Development, Umeå University, United Nations Population Fund (UNFPA), Office of the United Nations High Commissioner for Refugees (UNHCR), University of Alexandria, University of the Witwatersrand, Uttar Pradesh Center for Maternal, Neonatal and Child Health
This verbal autopsy instrument was produced and reviewed in collaboration with a WHO led- expert group including Kanitta Bundhamcharoen, Thailand Ministry of Public Health; Peter Byass, Umeå University Centre for Global Health; Daniel Chandramohan, London School of Hygiene & Tropical Medicine; Chanpen Choprapawon, Health Policy and Strategic Bureau; Don de Savigny, Swiss Tropical and Public Health Institute; Edward Fottrell, UCL Centre for International Health and Development; Elizabeth França, Federal University of Minas Gerais; Frederik Frøen, Norwegian Institute of Public Health; Gihan Gewaifel, University of Alexandria; Bernardo Hernandez, IHME; Abraham Hodgson, Ghana Health Service; Sennen Hounton, UNFPA; Kathleen Kahn, University of the Witwatersrand; Anand Krishnan, All India Institute of Medical Sciences; Vishwajeet Kumar, Uttar Pradesh Center for Maternal, Neonatal and Child Health; Jordana Leitao, London School of Hygiene & Tropical Medicine; Alan Lopez, The University of Queensland; Rafael Lozano, IHME; Honorati Masanja, Ifakara Health Institute; Lene Mikkelsen, University of Queensland; Dean Yergens, University of Calgary; Thorkild Tylleskär, University of Bergen; Jørn Ivar Klungsøyr, University of Bergen; Carlos Navarro-Colorado, Centers for Disease Control and Prevention (CDC); Erin Nichols, CDC; Sam Notzon, CDC; Mohammad Hafiz Rasooly, Afghanistan Ministry of Public Health; Ian Riley, The University of Queensland; Osman Sankoh, INDEPTH Network; Paul Spiegel , UNHCR; Carla Abou-Zahr; Derege Kebede, WHO; William Soumbey Alley, WHO; Fatima Marinho, WHO; Mohamed Ali, WHO; Enrique Loyola, WHO; Jyotsna Chikersal, WHO; Jun Gao, WHO; Robert Jakob, WHO; Giuseppe Annunziata, WHO; Rajiv Bahl, WHO; Kidist Bartolomeus, WHO; Ties Boerma, WHO; Bedirhan Ustun, WHO; Doris Chou, WHO; Lulu Muhe, WHO; Matthews Mathai; Marc Amexo, HMN.
Table of Contents
1 Purpose and content ...... 1 2 Introduction to verbal autopsy ...... 3 2.1 Historical background ...... 3 2.2 Uses and users of VA data ...... 4 3 The development of the 2012 WHO verbal autopsy instrument ...... 7 3.1 2012 list of causes of death ...... 7 3.2 List of indicators and their definitions, relevant age and sex groups and sample questions ...... 8 4 Application and implementation of the 2012 WHO VA instrument ...... 9 4.1 Sections of the instrument ...... 9 4.2 Technical description of the table of indicators (Appendix 2) ...... 11 4.3 Sample questionnaires ...... 14 4.3.1 Sample VA questionnaire 1: death of a child aged under four weeks ...... 14 4.3.2 Sample VA questionnaire 2: death of a child aged four weeks to 14 years ...... 14 4.3.3 Sample VA questionnaire 3: death of a person aged 15 years and above ...... 14 4.4 Guidelines on augmentation, and local adaptation ...... 15 4.5 Translation ...... 16 4.6 Vital registration ...... 16 4.7 Age categories of death ...... 16 4.8 Infrastructure ...... 17 4.8.1 Interviewers ...... 17 4.8.2 The database ...... 18 4.8.3 Methods for determining causes of death...... 19 4.8.4 Legal requirements, privacy, confidentiality ...... 20 4.9 Appropriate respondents and recall period ...... 20 4.10 Use of verbal autopsy-generated data ...... 20 5 Bibliography ...... 22 Appendix 1: 2012 cause of death list for verbal autopsy with corresponding ICD-10 codes Appendix 2: Table of indicators with skip patterns Appendix 3: Sample VA questionnaire 1: death of a child aged under four weeks Appendix 4: Sample VA questionnaire 2: death of a child aged four weeks to 14 years Appendix 5: Sample VA questionnaire 3: death of a person aged 15 years and above
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The 2012 WHO verbal autopsy instrument Release candidate 1
1 Purpose and content
This 2012 version of the WHO verbal autopsy instrument has been designed to become suitable for routine use. Compared to the 2007 instrument, numbers of conditions and questions have been reduced, based on evidence from the field. The questions have been reformulated to allow for responses with a simple yes or no answer, or a duration in some instances. This approach makes the instrument usable for software that assigns causes of death. The instrument is designed for all age groups, including maternal and perinatal deaths, and also deaths caused by injuries. Sets of questions address information relevant to vital registration, and information relevant to assessment of the cause of death and the context. This manual informs users on how to use the 2012 WHO verbal autopsy (VA) instrument. The components of this manual include: • Background on VA; • Sample VA questionnaires for three age groups (under four weeks; 4weeks-14 years, 15 years and above); • The full matrix of questions, definitions and related skip patterns; • Instructions on how to use the matrix of questions; • Criteria for setting up a data collection infrastructure and the related databases; • Information about available software for assessing a cause of death; • Instructions on how to design a localized questionnaire; • General cause of death certification and coding guidelines for applying the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10)1 to VA; and • A simplified cause of death list for VA with corresponding ICD-10 codes.
All materials (questionnaires, table of indicators with skip patterns and this manual) are available separately for download at www.who.int/healthinfo/statistics/verbalautopsystandards. This manual and its resources are the products of a one-year effort by an expert group led by the World Health Organization (WHO), consisting of researchers, data users, and government agencies, with support by the Health Metrics Network (HMN), the University of Queensland and the INDEPTH Network. The 2012 WHO VA instrument is intended to allow for simple and inexpensive identification of causes of death in places where no other routine system is in place and will serve the needs of countries’ civil registration and vital statistics (CRVS) systems. Independently, this instrument can also be used in research and disease specific programmes. All materials are easily and widely accessible on the WHO web
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Purpose and content
site, in print, and will be incorporated into diverse resource kits, intended for strengthening national vital statistics systems. Additional language versions will be made available through similar channels. Experience from the field and publications on the most widely used and validated VA instruments and procedures (WHO VA standards, InterVA and Population Health Metrics Research Consortium -PHMRC VA instrument)2-4 were systematically reviewed and also assessed against experience in using software for cause of death assignment (InterVA and PHMRC VA instrument). VA users were queried for use of VA instruments and utility of VA questions. This resulted in a simplified VA instrument with a reduced number of questions and causes of death. The systematic application of the 2012 WHO VA instrument will facilitate the application of VA in routine surveillance of vital events and introduce more consistency and cross-comparability of VA-derived mortality data. The correspondence table (Appendix 1) allows for easy conversion to and from ICD-10. The application of a standardized international set of questions will facilitate the compilation of larger databases that finally would provide the evidence for stepwise improvement of VA questionnaires internationally.
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2 Introduction to verbal autopsy
Reliable data on the levels and causes of mortality are cornerstones for building a solid evidence base for health policy, planning, monitoring and evaluation. In settings where the majority of deaths occur at home and where civil registration systems do not function, there is little chance that deaths occurring away from health facilities will be recorded and certified as to the cause or causes of death. As a partial solution to this problem, VA has become a primary source of information about causes of death in populations lacking vital registration and medical certification. VA has become an essential public health tool for obtaining a reasonable direct estimation of the cause structure of mortality at a community or population level, although it may not be an accurate method for attributing causes of death at the individual level. Verbal autopsy is a method used to ascertain the cause of a death based on an interview with next of kin or other caregivers. This is done using a standardized questionnaire that elicits information on signs, symptoms, medical history and circumstances preceding death. The cause of death, or the sequence of causes that led to death, are assigned based on the data collected by a questionnaire and any other available information. Rules and guidelines, algorithms or computer programs, may assist in evaluating the information to determine the cause of death11. The main objective of VA is to describe the causes of death at the community level or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system. A standard VA instrument comprises a VA questionnaire, a list of causes of death or mortality classification system, and sets of diagnostic criteria (either expert or data derived algorithms) for assigning causes of death. The VA process consists of several steps, and many factors can influence the cause specific mortality fractions estimated through this process.5
2.1 Historical background In Europe, before the 19th century when modern systems of death registration were implemented, designated death searchers visited the households of deceased people to assess the nature of deaths. The need for lay reporting of causes of death remained in developing countries where there was a lack of medical capacity to produce death certificates for the population. As an alternative, in the 1950s and 60s in Asia and Africa, systematic interviews by physicians were used to determine causes of death. Workers at the Narangwal project in India labelled this new technique “verbal autopsy”6,7. The interest of WHO in VA (formerly “lay reporting”) of health data was first demonstrated in a publication by Dr. Yves Biraud in 1956. During the 1970s, WHO encouraged the use of lay reporting of health information by people with no medical information, leading to development in 1975 of lay reporting forms. Since the late 1970s and early 80s when the
3 Introduction to verbal autopsy
Reproductive Age Mortality Studies (RAMOS), Matlab and Niakhar questionnaires first emerged, several other questionnaires have been developed for use in research settings and in national or large-scale regional surveys.6 The past two decades have seen a proliferation of interest, research and development in all aspects of the VA process, including data-collection systems where VA is applied, questionnaires’ content and format, targeting of different age groups, cause of death assignment process, coding and tabulation of causes of death and of validation of VA instruments. In 2007, needs and demands for standardization led to the 2007 publication of the WHO VA standards, which many researchers have adopted.8 The standards included:9 • Verbal autopsy questionnaires for three age groups (under four weeks; four weeks to 14 years; and 15 years and above); • Cause of death certification and coding resources consistent with the International Classification of Diseases and Related Health Problems, tenth revision (ICD-10); and • A cause-of-death list for verbal autopsy prepared according to the ICD-10.
However, the WHO 2007 instrument was modified in several projects to accommodate the local needs. In 2011, evidence from use of the WHO instrument and related VA instruments was used to formulate this 2012 VA instrument (document under publication). Besides elimination of unreported causes and focus on useful questions, it was designed to facilitate VA use in routine vital registration systems to improve national cause-specific mortality data.
2.2 Uses and users of VA data VA is used in three main ways. First, it has been primarily used as a research tool in the context of longitudinal population studies, intervention research or epidemiological studies. Second, it has become a source of cause of death statistics to meet the demand for population- level cause-specific mortality data to be used in policy, planning, priority setting and benchmarking. Third, VA data are gaining acceptance as a source of cause of death statistics to be used for monitoring progress and evaluating what works and what does not. Because vital registration coverage has not significantly improved in developing countries, VA methods have been mainly applied in the following data collection systems: clinical trials and large-scale epidemiological studies; demographic surveillance systems; national sample surveillance systems; and household surveys.7 Over the past decade, due to the growing demand for solid estimates of vital events and determinants of health, the primary objective of health and demographic surveillance system (HDSS) sites evolved to encompass: 1.) the production of population-based health information to support evidence-based health policies and 2.) the monitoring and evaluation of health interventions in settings where routine health information and vital registration systems are insubstantial. Well-run HDSS sites are a good source of data for health studies that require longitudinal follow-up. However, HDSS sites do not provide representative data
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for national estimates of cause-specific mortality. When information about a large geographical area is needed, mortality surveys can be used to identify deaths. These surveys have the advantage of covering a much wider geographical area than the HDSS sites and therefore allow comparisons to be made among different regions of a country. Potential users of data generated through VA include communities, health care planners and managers, researchers, global decision-makers and donors. While there is a degree of overlap, these users have different perspectives on the uses of mortality data, which have an impact on the desirable characteristics of VA instruments. Researchers, epidemiologists and global-level decision-makers want VA data to inform burden of disease estimation and program evaluation, implying that cause of death estimates must meet high accuracy standards and be comparable over time and across countries.8 National and sub-national decision-makers and health system managers require cause of death data for planning, budgeting and resource allocation and for monitoring and reporting to donors, implying that VA data needs to be actionable and program relevant. There have been a few instances where VA has been administered on a large scale as an explicit part of the development of national statistics.9 Users of VA have identified the need for simpler data collection instruments coupled with IT (e.g. mobile phones or hand-held devices). These large scale users of VA have a perspective different from that one of researchers, giving priority to the VA instrument’s simplicity, feasibility and adaptability to local contexts, cost-effectiveness and program relevance.8 A simplified VA instrument coupled with automated methods to ascertain causes of death can be a stepping-stone to increase the coverage of operational and representative civil and vital registration systems.
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2012 WHO verbal autopsy instrument Release candidate 1
3 The development of the 2012 WHO verbal autopsy instrument
The WHO standard VA instrument published in 2007 has been successfully applied in many research settings since then. In recent years, there has been growing interest in strengthening countries’ CRVS systems, and this has led to demand for a more simplified and practical VA instrument that is associated with IT applications for data collection and analysis. To produce a simplified VA instrument, WHO carried out a systematic review of the use of VA and led an expert group of researchers, data users and other stakeholders, in collaboration with HMN, the University of Queensland (UQ) and the INDEPTH Network. Based on the compiled experience and evidence from the most widely-used and validated VA procedures (WHO VA standards, InterVA and PHMRC VA instrument),2-4 consensus was reached on a simplified VA instrument for routine use as part of civil registration and vital statistics systems in settings where many deaths are not medically certified. The simplified instrument (2012 WHO VA instrument) comprises a short list of causes of death of public health importance that can be ascertained by way of a limited number of questions suitable for use in interviews and amenable to software analysis to automate the ascertainment of cause of death. The design allows for addition of narrative where so desired and addition of locally relevant questions and diagnoses.
3.1 2012 list of causes of death A review was undertaken to compile evidence for a simplified list of causes of death from research studies including VA using physician certified VA (PCVA) and formulating the cause of death and machine derived VA (under publication). Review of the materials and inputs from VA experts provided evidence on the feasibility and relevance of causes of death that can be reliably ascertained by VA. The revision and simplification of the 2007 standard WHO VA cause of death list was based on: • The frequency of cause of death reporting in VA; their importance and relevance of causes of death for global mortality levels1; • The Cause of Death (CoD) can be addressed by public health interventions; and • The feasibility of the CoD being ascertained through VA.
The list of causes of death resulting from the above process is presented in Appendix 1. Using a minimum set of causes facilitates the merging and comparison of data from VA on an international scale. The ICD-10 codes listed in the list of causes of death in Appendix 1 allow
1 In the simplification of the list of diagnoses attention has been given to the Global Burden of Disease (GBD) groupings. In view of the ongoing edits of the GBD, the correspondence table does not include GBD references. The mentioned ICD-10 codes may serve to distribute cases to the relevant GBD groups.
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comparison with ICD-10 coded data from causes of death ascertained using the international certificate of causes of death.
3.2 List of indicators and their definitions, relevant age and sex groups and sample questions The 2012 VA instrument has 192 cause of death related indicators, subdivided into 4 sections and 118 subgroups. Within sections and subgroups, skip patterns are driven by age, sex, maternal and perinatal information. The indicators were identified by reviewing modifications of the WHO 2007 instrument, queries about used, useless and unused indicators, and with input from analytical software use (InterVA and upcoming PHMRC VA interpretation software). A final expert review of the results and consolidation of the results led to the formulation of the present list of indicators. A file is available for download at www.who.int/healthinfo/statistics/verbalautopsystandards containing the full set of indicators that were considered and the rationale for inclusion or exclusion of each indicator in the 2012 VA instrument. VA cannot ascertain all causes of death. Furthermore, as many validation studies have shown, VA does not perform equally well for all causes that it can ascertain. Taking these limitations into account, the 2012 instrument was developed to ascertain all causes of death that may be attributed with reasonable accuracy from a well-administered VA interview (Appendix 1). The sections allow the addition of variables of topical interest (e.g. risk factors) where necessary. While such augmentation of the 2012 instrument is not encouraged (see Section 4.2 “Guidelines on augmentation, and local adaptation”), as long as all the sections are included and correct cause of death certification and coding procedures are used, it should be possible to generate comparable data over time across populations.
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4 Application and implementation of the 2012 WHO VA instrument
This section describes the use of the 2012 WHO VA instrument and its implementation with different options. It also provides requirements for design of local data collection software. The 2012 WHO VA instrument is designed to be usable in routine assessment of cause of death using VA. The number of questions and targeted diagnoses has been reduced. The questions have been reshaped to be answered with simple yes or no. The durations of indicators preceding death are asked for only a limited number of indicators. Responses to questions on the duration of indicators need to be categorised in a second step in the analysis of the cause of death (see 4.6.2). The 2012 WHO VA instrument is designed for software use. It has a skip pattern embedded that embraces all age groups and special cases in one big questionnaire. Sample questionnaires are provided for three age groups (under four weeks; 4weeks-14 years, 15 years and above), as shown in the Appendices 3-5. Unique variable identifiers and notes for translators and interviewers facilitate the translation of the instrument in the desired language. The English terms were chosen to ensure clarity of the intent of the individual questions. WHO will develop data collection software for generic Java-enabled mobile devices. However, any other software can be designed for use with this instrument following the instructions that are given below. Software for interpreting VA indicators into causes of death without the use of physicians can be used in the majority of cases. At present (2012) InterVA4 is fully compliant with the set of indicators and can be linked for batch processing to the WHO data collection software.
4.1 Sections of the instrument The 2012 VA instrument and all the sample questionnaires derived from the 2012 VA instrument contain both common sections and specific sections appropriate to both the age and sex of the deceased. The full set of questions and the resulting full questionnaire consist of the following sections: 1) Personal information a) Information on the deceased b) Vital registration 2) Information on the respondent 3) Cause of death a) Medical history b) General signs and symptoms
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c) Signs and symptoms associated with pregnancy d) Neonatal and child history, signs and symptoms e) History of injuries and accidents f) Risk factors g) Health service utilization 4) Background and context 5) Recommended optional open narrative text field
For sections 1 and 2, rules for privacy protection should be ensured, except for age and sex information. Section 1a provides essential detail for assigning the cause of death and applying the skip patterns. Section 1b allows linkages to vital registration data, and section 2 provides information that is useful to quality assurance. Section 3 provides essential information for assigning the cause of death. It has a skip pattern by age, sex, and level of detail. This section has 93 cause of death related 1st level questions that have to be asked and 87 sub-questions (2nd level) (31 sub-sub-questions – 3rd level- and 10 4th level questions) that will be asked only if the respective 1st level questions have a positive response. Section 4 provides background information on deaths that occur in non-enumerated populations, i.e. where there is no prior information about the deceased Section 5 may be helpful to assess the diagnosis in cases where software assessment for the diagnosis may not deliver reliable results and physician review is necessary. Its use is optional. The common elements across age groups include, besides the death registration and information about interviewer and respondent, “general questions” and questions that relate to some causes of death and certain generalized signs and symptoms. The “death registration” section – the first page of each questionnaire – contains key identifying and socio- demographic information and data fields necessary for the management of completed forms. It contains standard personal information: • A unique ID, control or reference number for the VA questionnaire being completed; • The date, place and time of the interview and identity of the interviewer; • Key characteristics of the respondent; • The time, place and date of death; • The name, sex and age of the deceased
These sections are, with few exceptions, the same across all age groups and are accordingly in the sample questionnaires for the three age groups that are shown in the appendices. The sections of each questionnaire that contains the essential information for certification of cause of death have a checklist to note the “signs and symptoms noted during the final illness”. With the exception of questions about injuries and accidents, and some questions about generalized systemic signs and symptoms (e.g. fever or intestinal signs and symptoms), the
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questions contained in the checklist of signs and symptoms vary depending on age and/or the sex of the deceased.
4.2 Technical description of the table of indicators (Appendix 2) The table of indicators of the 2012 WHO VA instrument (Appendix 2) consists of one table containing all questions for all age groups. The questions are grouped by sections, as is described in the previous paragraph. A skip pattern by age and sex allows users either to create separate questionnaires or to instruct software to show only the relevant questions, in the given sequence and skip pattern. There are different levels and types of questions: • 1st level questions that are always asked (depending on age and sex). • 2nd-4th levels of nested sub-questions that are asked only if the response to the 1st level question is “yes”. Threshold values for the categorization are listed in the context of the relevant questions. • Age and duration of indicators that have a continuous numerical response will be recorded in the database as reported and will be categorized by pre-defined threshold values by the VA interpretation software. For example, in case of diarrhoea (variable 3B280) the reported duration will be entered in the questionnaire, and in a second step the information will be categorized according to the threshold values that are given in the table of indicators of the 2012 VA instrument (variables 3B290A-C, Appendix 2). • Free text questions that allow entries like name, address, or for a narrative at the end of the interview (optional, not listed). Age and sex skip pattern: A skip matrix by age and sex identifies which questions of what sections would be asked in a particular case. Open narrative: The optional open narrative text field allows for comments and adding additional information. It is particularly useful to provide additional information for physician assessment of the cause of death and for quality control. Colour coding: The colour coding of lines has the following meaning: Green lines Entry of continuous variables. These lines are followed by red lines. Blue lines Single selection out of a range of options. The options are listed in the column “threshold values” and separated by “/”. Blue lines are followed by red lines. Red lines Calculated from the continuous variable or single select. The threshold values are indicated in the column “threshold value”. This categorization of the information is essential for assigning the cause of death using software.
The Table has 18 columns.
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Column letter Column label Explanation
A Variable This column contains the variable ID. The ID indicates the sequence. Its first 2 characters reflect the modular structure that is described above. B Data type The data type informs essentially programmers and designers of form what kind of answer is expected. The currently used types are: Text Free narrative Date A date Time A time in 24-hour notation. 00:00 corresponds to midnight. Single select A range of options of which only one may be selected Yes/No/DontKnow=1/0/9 Any answer chosen on the left side will be encoded with the corresponding number of the right side Number [weeks] Any numeric entry. In square brackets the unit of duration (weeks in this example) is indicated. Calculated (Y/N/DNK) For diagnosing software, the numeric information needs to be categorized. Based on the threshold values, the answers to such question will be calculated and be yes or no. C Threshold values Threshold values instruct on how to categorize the numeric entries to set the answers to « calculated questions » to yes or no.
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Column letter Column label Explanation
D 1st level question Stem question E 2nd level question Sub-question; answer only if stem question is answered with yes. F 3rd level question Sub-sub-question; answer only if sub-question is answered with yes. G 4th level question Sub-sub-sub-question; answer only if sub-sub- question is answered with yes. H AGE_65-Plus Has value « 1 » if the question should be asked for the age group 60 years and older I AGE_50-64 Has value « 1 » if the question should be asked for the given age group J AGE_15-49 Has value « 1 » if the question should be asked for the given age group K AGE_5_14Y Has value « 1 » if the question should be asked for the given age group L AGE_1_4Y Has value « 1 » if the question should be asked for the given age group M AGE1_11M Has value « 1 » if the question should be asked for the age group 1 to 11 months N AGE_U28d Has value « 1 » if the question should be asked for the given age group under 28 days O MALE Has value « 1 » if the question should be asked for the given sex P FEMALE Has value « 1 » if the question should be asked for the given sex Q FEMALE 12-14Y Has value « 1 » if the question should be asked for the given sex and age combination. It has been introduced to be able to capture maternal deaths. S Notes for translators and These notes give some explanations that guide interviewers users and translators about what intent of the question is. It explains the kind of content the question is asked for.
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4.3 Sample questionnaires A set of sample questionnaires will allow the user to understand the way special questionnaires could be designed from the table in Appendix 2. The sample questionnaires further allow to directly use the tool, e.g. on paper based forms. All data should however be entered into a database following the instructions, and in particular retaining the variable id’s unchanged. This will allow use of software, and review and comparison of the responses across VA studies. Sample questionnaires are provided for three age groups (under four weeks; 4weeks-14 years, 15 years and above), as shown in the Appendices 3-5.
4.3.1 Sample VA questionnaire 1: death of a child aged under four weeks Sample VA questionnaire 1 is to determine causes of early neonatal deaths, late neonatal deaths, perinatal deaths and stillbirths to determine causes of those perinatal events and deaths. In addition to a “signs and symptoms noted during the final illness” list, the questionnaire contains questions concerning the history of the pregnancy; delivery; the condition of the baby soon after birth; and the mother’s health and contextual factors. The skip pattern is indicated by the number of “+” in front of the questions, and by some cross references. The subdivision differs slightly from the one proposed by the table in Appendix 2. The content is identical.
4.3.2 Sample VA questionnaire 2: death of a child aged four weeks to 14 years Sample VA questionnaire 2 is designed to ascertain the major causes of post-neonatal child mortality (i.e. starting from the fourth week of life), as well as causes of death that may be seen through 14 years. The 2012 questionnaire 2 includes all the common sections and questions described above, as well as questions related to causes of death in children aged four weeks to 11 months, and pregnancy related questions for 12 to 14 year old female children. The skip pattern is indicated by the number of “+” in front of the questions, and by some cross references. The subdivision differs slightly from the one proposed by the table in Appendix 2. The content is identical.
4.3.3 Sample VA questionnaire 3: death of a person aged 15 years and above Sample VA questionnaire 3 is designed to identify all major causes of death among adolescents and adults (i.e. starting at age 15), including deaths related to pregnancy and childbirth. The 2012 questionnaire 3 includes a section for all female deaths, in addition to the above mentioned common sections and questions. The skip pattern is indicated by the number of “+” in front of the questions, and by some cross references. The subdivision differs slightly from the one proposed by the table in Appendix 2. The content is identical.
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4.4 Guidelines on augmentation, and local adaptation The indicators contained in the 2012 WHO VA instrument address the most relevant causes of death in most populations where the use of VA is a necessary means to obtain cause of death information. The 2012 WHO VA instrument by design allows for evolution of the instrument. As such, users may add questions. Under no circumstances should questions be removed from the list because of the resulting impact on the comparability of the outcomes and the further data-based evolution of the instrument. It is acknowledged that there may be a desire to expand the instrument to address locally relevant conditions. However, adding signs and symptoms to the 2012 WHO VA instrument needs to be carried out with much caution because alteration can compromise the comparability of VA data between populations. In particular, the addition of new questions about particular diseases of interest may bias results if a disproportionate amount of information about only one condition is available in the cause of death assignment process. Modifications may be necessary if there are emerging or locally important causes of death for which there are no questions on the 2012 VA questionnaires. In these circumstances, advice may be sought from WHO for making such modifications. If modifications are necessary, they should be carefully documented and distinguished from the 2012 questionnaire sections and variables. In general, only changes to the wording of existing variables for the purposes of enhancing local comprehension or ensuring cultural acceptability of questions are to be undertaken. The definitions in the 2012 WHO VA instrument may provide some guidance about the meaning that needs to be preserved in such changes. Any need for modification should be shared with WHO together with the rationale for modification. The reporting of modifications made to WHO will inform future revisions of this instrument. Examples of modifications that are unlikely to affect the comparability of results include: • Adding questions or sections about household characteristics or environmental or behavioural risk factors; • Adding or changing questions about usage of a particular health service or health intervention.
Examples of modifications that may affect the comparability of results include: • Changing or adding to response categories in the checklist of “signs and symptoms noted during the final illness”; • Adding new questions about diseases of particular interest (e.g. malaria, HIV/AIDS, diarrhoeal disease).
Adding and removing questions will impact the comparability of the data but also may compromise the usability of software assisted diagnosing. It may not be possible to use the existing software for diagnosing the newly added causes of death.
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4.5 Translation The language chosen in indicators and notes aims to convey the highest level of clarity about the intent of a question. Indicators, instructions and software need to be translated for local use. This is valid also for English because lay language differs between English speaking regions. In the translation process and the notes will inform the translator, and both, notes and questions, should be translated. Translators may need to adapt the wording of the questions to the vocabulary in use in the locations where interviews will be conducted. The notes will guide translators and interviewers. For quality assurance, a second translator should carry out a back-translation to English. For any translations, please use the translation table for the 2012 WHO VA instrument that you can download at www.who.int/healthinfo/statistics/verbalautopsystandards. Fill in your translations in the empty fields as indicated in the file. The given identifiers and the resulting bilingual file will allow users to 1. re-use a translation as necessary for other projects, and 2. load translations into the WHO software for immediate use, if so desired.
4.6 Vital registration For use of the 2012 WHO VA instrument in routine vital registration two options are possible: 1) A death has been certified, and an interviewer is sent to query the cause of death. In this case, the personal data are known and the interview will be conducted only to identify the cause of death. The “information on the deceased” section will be prefilled before the interview and a death registration number (or a similar identifier) will allow the user linkage between the VA outcome and the related entry in the death registration registry. 2) A death is notified and certification and interview are conducted at the same time. In this case, the personal data are not known, or known only in part and need to be recorded at the time of the interview, using the “information on the deceased” section. A registration number will be required to ensure the vital registration linkage between the death registry and the VA data.
4.7 Age categories of death Some projects may be interested only in particular age categories of death, such as perinatal, maternal, child or adult deaths. In this case, the relevant subset of questions can be extracted from the list of indicators of the 2012 WHO VA instrument. The 3 age-group specific questionnaires in the appendices for three age groups (under four weeks; 4weeks-14 years, 15 years and above) may serve as examples here. Where data are captured electronically, the embedded skip pattern would ensure that only the relevant subset of questions would be applied.
16 2012 WHO verbal autopsy instrument Release candidate 1
Where interviews are conducted for all age categories of deaths, ideally the interview data should be captured electronically using the embedded skip patterns. Otherwise (using paper), the interviewers should take always all three age group specific questionnaires during house visits for VA interviews. WHO is making available software for remote data collection and storage in a database. Linkages to analytic diagnostic tools (software for VA diagnosis) are embedded in the data collection software and allow the interviewer to receive the identified cause of death assigned in real time. Independently, any other software can be programmed for using this instrument for data collection, as long as all answers to all questions, assigned cause of death and method of diagnosing are recorded in a database. Further, any tool for diagnosing the cause of death can be used in conjunction, as long as the collected information is sufficient.
4.8 Infrastructure In routine surveillance contexts, information needs to be timely and linked to a response that involves effective dissemination mechanisms, appropriate use of data, and periodic evaluation of the surveillance system. The latter can trigger formulation of recommendations for a revision of the components of the 2012 WHO VA instrument to WHO and local workflows of the VA system in use. Thus, use of VA in routine surveillance involves monitoring, accountability, planning and programming. To develop an adequate instrument for application in large-scale surveillance, the VA instrument needs to be tested and needs to have a system that synergizes with other national mechanisms that are already in place. The infrastructure will depend largely on the given settings. Data should ideally be stored in a centralized location but at a level that facilitates necessary queries. Usually this is likely to be at the district level. All verified district data would then be forwarded to a central database at the national level. Arrangements regarding collection, storage and handling of the vital registration and cause of death data should be made between the offices that are involved. Depending on the national infrastructure these offices are most frequently the Statistical Office, Ministry of Health, Ministry of Justice and Ministry of Interior. Different arrangements may be necessary where VA is conducted in another context, as for research or disease specific programmes.
4.8.1 Interviewers Interviewers should be trained on the instrument and on conducting interviews with persons that may still be in mourning. Interviewers should be given enough time to carry out their task in VA. However, it is proposed that at least one VA interview per month should be conducted by each VA interviewer to retain their proficiency in conducting VA interviews.
17 Application and implementation of the 2012 WHO VA instrument
Interviewers involved in the application of the VA should have the following minimum qualifications: • Have completed at least secondary school and have good working knowledge in the relevant local language(s); • Be acceptable to the local community; where possible, selected by the local community; • Have good training in conducting VA interviews; • Know very well the content and uses of the VA instrument.
In the ideal training, first the interviewer could review all elements and the flow of questions with the help of an expert VA trainer. After discussing any questions that need clarification with the VA trainer, the interviewer can role play a VA interview using the VA trainer as dummy VA respondent. For this role play the VA trainer should have different case scenarios. Such scenarios would include the different variants of interviews (maternal, perinatal, child, adult) and also probable local behaviour on the interview per se, and on sensitive questions. In the next step, the interviewer would conduct real VA interviews in the presence of the expert. The number of VA interviews to be conducted in the presence of the VA trainer required to certify proficiency of individual trainee VA interviewer would vary depending on the skills and abilities. Nevertheless typically it would take at least five VA interviews to become confident in doing VA interviews.
4.8.2 The database Answers to all questions and the identified cause of death assigned for each case should be recorded in a database, regardless of the interview instrument (i.e. paper or electronically), and the method used for assigning the cause of death. The database will retain the cause of death together with a variable that identifies the method of assigning the cause of death. All continuous variables are recorded as continuous variables in the database and are categorized based on the instrument or method used for assigning the cause of death. The name of the interviewer and date, time and duration of the interview are also retained in the database. If data are reported electronically this information can be generated automatically. In order to facilitate software use and to simplify the interviews, questions follow a simple yes/no pattern. However some questions address a time interval or a frequency. In such cases the database should retain the value recorded, and categorization using the recommended threshold value should be done in a second step. The compilation of the information above into a database will provide an instrument for reviewing cases as well as enable sharing of results with WHO to facilitate further improvements to this instrument.
18 2012 WHO verbal autopsy instrument Release candidate 1
In addition to the questions, a narrative can be helpful if there is any intention to use physicians in the assessment of the cause of death, for quality assurance, and for later review. This information should be stored in the database as well.
4.8.3 Methods for determining causes of death In the past decade, methodological developments in automated methods have emerged with significant potential for future application in routine national and research data collection platforms, creating new opportunities for reliable, timely, and useful cause-specific mortality measurement. This has created a shift away from limited individual-level and clinical paradigms towards population-based epidemiological thinking and public health.10 The 2012 VA instrument contains information on diseases, signs and symptoms, the age and sex of the deceased as well as his or her medical history (if available). Additional information may be recorded in the open text field at the end of the interview. To facilitate application in routine surveillance systems, the 2012 VA instrument was specifically developed to ascertain cause of death through automated methods. As a more cost-effective and feasible alternative to physician-coded VA, the WHO recommends the use of automated methods for cause of death identification. The use of automated VA interpretation methods also ensures that causes of death are determined in a standard fashion, removing the variability inherent with physician coding of VA. Diagnostic tools in line with this WHO VA instrument are listed on the WHO VA website (www.who.int/healthinfo/statistics/verbalautopsystandards). At this point in time (2012) only InterVA4 is available. In case the cause of death is assessed by physicians, ideally 2 physicians will review the outcome of an interview and formulate a cause of death. If there is a discrepancy, a 3rd physician would arbitrate the result. The opinion of each physician involved should be separately recorded in the database, as well as the consensus finding.
19 Application and implementation of the 2012 WHO VA instrument
4.8.4 Legal requirements, privacy, confidentiality Ideally, informed consent should be sought from the respondent. Where the legislation or local regulations require that VA be conducted, informed consent may not always be necessary. Personal data, in particular name, geographical information and contact information about the respondent, should be kept separate from the epidemiological data to protect privacy and ensure confidentiality. Additional measures to anonymize the individual record may be subject to the legislation in force. A common case-ID in the personal data set and the VA dataset will allow data linkage between personal and VA data upon formal request in line with national and international regulations.
4.9 Appropriate respondents and recall period The respondent who provides information about the deceased and allows the interviewer to complete the VA questionnaire should be the primary caregiver (usually a family member) who was with the deceased in the period leading to death or a witness to a sudden death or accident. This individual is likely to provide the most reliable and accurate account of the signs and symptoms of importance. It is not uncommon for a VA respondent to require assistance from other household or family members in answering the VA questions. VA interviews should be conducted as soon as practically possible after the report of the event is received, but after any culturally prescribed mourning period has passed. Recalls of more than one year should be interpreted with caution. In general, shorter recall periods are preferable.
4.10 Use of verbal autopsy-generated data ICD-10 provides tabulation lists for mortality and morbidity in volume 1. Other professional groups have made different lists for grouping diseases and presenting mortality statistics. Regardless of the list used, deaths should be classified by sex and into the following age groups: aged < 1 year, aged 1–4 years, and then in 5-year groups from age 5 years to 84 years, followed by a group for those aged 85 years or older. Volume 2, section 5.6.1 of ICD-10, contains a full set of instructions for tabulation. The purpose of VA is to describe the causes of death at the community level or population level in instances where no better alternative sources of mortality data exist. Therefore, VA serves as a limited but essential substitute for medical certification. The quality of information of the diagnoses varies depending on the skills of the interviewer and the memory of the respondents. The 2012 VA cause of death list (Appendix 1) is a core mortality classification system, specifying the most important causes of death in low-income and middle-income countries where it is deemed feasible to certify cause of death using VA. Coding diagnoses using the
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ICD coding system facilitates the merging of data and the retention of as much detail as needed in local settings. The context and method of information gathering to assign cause of death from VA is different from the medical certification of cause of deaths by a physician. The certainty of the cause of death is much lower in VA, and VA cannot reliably ascertain some causes of death. Data from these two methods should not be merged, as it would conceal differences that may result from these methods and lead to misinterpretation of the results.
21 Application and implementation of the 2012 WHO VA instrument
5 Bibliography
1 International Statistical Classification of Diseases and Related Health Problems - Instruction Manual. (World Health Organization, 2010). 2 Verbal autopsy standards: ascertaining and attributing cause of death. (World Health Organization, 2007). 3 InterVA. InterVA,
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Appendix 1: 2012 cause of death list for verbal autopsy with corresponding ICD-10 codes
2012 cause of death list for verbal autopsy with corresponding ICD-10 codes. Column 1 contains the code for the verbal autopsy entity. Column 2 lists the related titles. Column 3 lists the ICD-10 codes that would be used if the condition labelled by column 2 were coded to ICD-10. Column 4 lists the ICD-10 categories that need to be grouped to match the content of the relevant VA entity. ICD-10 ICD-10 Verbal Verbal autopsy title code (to codes (from autopsy code ICD) ICD)
VAs-01 Infectious and parasitic diseases VAs-01.01 Sepsis A41 A40-A41 Acute respiratory infection, J22/J18 J00-J22 VAs-01.02 including pneumonia VAs-01.03 HIV/AIDS related death B24 B20-B24 VAs-01.04 Diarrheal diseases A09 A00-A09 VAs-01.05 Malaria B54 B50-B54 VAs-01.06 Measles B05 B05 G03;G04 A39; G00- VAs-01.07 Meningitis and encephalitis G05 A35 A33-A35 VAs-01.08 Tetanus (obstetrical Excludes: Neonatal tetanus VAs-10.05 A34) VAs-01.09 Pulmonary tuberculosis A16 A15-A16 VAs-01.10 Pertussis A37 A37 VAs-01.11 Haemorrhagic fever A99 A90-A99 B99 A17-A19 A20-A38; Other and unspecified infectious A42-A89; VAs-01.99 disease B00-B19; B25-B49; B55-B99
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Non-communicable diseases
Note: This group covers all non-communicable conditions. Any infection of the systems that are listed in this section should be assigned to the suitable infectious disease category. Any maternal and perinatal condition should be assigned to the maternal and perinatal causes below.
VAs-98 Other and unspecified non- R99 D55-D89; communicable disease E00-E07; E15-E35; Note: E50-E90; This group covers all non-communicable F00-F99; conditions that could not be assigned to G06-G09 another category in this section. There is a G10-G37; separate category for cases where the cause G50-G99; of death is unknown. H00-H95; J30-J39; J47-J99; K00-K31; K35-K38 K40-K93; L00-L99; M00-M99; N00-N16; N20-N99; R00-R09 R11-R94
VAs-02 Neoplasms VAs-02.01 Oral neoplasms C06 C00-C06 VAs-02.02 Digestive neoplasms C26 C15-C26 VAs-02.03 Respiratory neoplasms C39 C30-C39 VAs-02.04 Breast neoplasms C50 C50 Female reproductive neoplasms C57 C51-C58 VAs-02.05
VAs-02.06 Male reproductive neoplasms C63 C60-C63 C80 C07-C14 VAs-02.99 Other and unspecified neoplasms C40-C49
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C60-D48
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VAs-03 Nutritional and endocrine disorders VAs-03.01 Severe anaemia D64 D50-D64 VAs-03.02 Severe malnutrition E46 E40-E46 VAs-03.03 Diabetes mellitus E14 E10-E14
VAs-04 Diseases of the circulatory system I24 (acute I20-I25 VAs-04.01 Acute cardiac disease ischemic) VAs-04.02 Stroke I64 I60-I69 VAs-04.03 Sickle cell with crisis D57 D57 I99 I00-I09 Other and unspecified cardiac I10-I15 VAs-04.99 disease I26-I52 I70-I99
VAs-05 Respiratory disorders Chronic obstructive pulmonary J44 J40-J44 VAs-05.01 disease (COPD) VAs-05.02 Asthma J45 (J46)J45-J46
VAs-06 Gastrointestinal disorders VAs-06.01 Acute abdomen R10 R10 VAs-06.02 Liver cirrhosis K74 K70-K76
VAs-07 Renal disorders VAs-07.01 Renal failure N19 N17-N19
VAs-08 Mental and nervous system disorders VAs-08.01 Epilepsy G40 G40-G41
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VAs-09 Pregnancy-, childbirth and puerperium-related disorders VAs-09.01 Ectopic pregnancy O00 O00 VAs-09.02 Abortion-related death O06 O03-O08 O13 (or O10-O16 VAs-09.03 Pregnancy-induced hypertension O15 for eclampsia) O46 (ante O46; O67; partum) O72 VAs-09.04 Obstetric haemorrhage O72 (post partum) VAs-09.05 Obstructed labour O66 O63-O66 O75.3 (ante O85; O75.3 partum) VAs-09.06 Pregnancy-related sepsis O85 (post partum) VAs-09.07 Anaemia of pregnancy O99 O99.0 VAs-09.08 Ruptured uterus O71 O71 O05 O01-O02; O20-O45; Other and unspecified maternal O47-O62; VAs-09.99 cause O68-O70; O73-O84; O86-O99
VAs-10 Neonatal causes of death VAs-10.01 Prematurity P07 P05-P07 VAs-10.02 Birth asphyxia P21 P20-P22 VAs-10.03 Neonatal pneumonia P23 P23-P25 VAs-10.04 Neonatal sepsis P63 P36 VAs-10.05 Neonatal tetanus A33 A33 VAs-10.06 Congenital malformation Q89 Q00-Q99 P96 P00-P04; P08-P15; Other and unspecified perinatal VAs-10.99 P26-P35; cause of death P37-P94; P96
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VAs-11 Stillbirths VAs-11.01 Fresh stillbirth P95 P95 VAs-11.02 Macerated stillbirth P95 P95
VAs-12 External causes of death
Note: The list of questions contains sub questions that allow for more specificity for accidents. V89 V01-V89 VAs-12.01 Road traffic accident VAs-12.02 Other transport accident V99 V90-V99 VAs-12.03 Accidental fall W19 W00-W19 Accidental drowning and W74 W65-W74 VAs-12.04 submersion Accidental exposure to smoke, fire X09 X00-X19 VAs-12.05 and flames Contact with venomous animals and X29 X20-X29 VAs-12.06 plants X49 X40-X49 Accidental poisoning and exposure VAs-12.07 to noxious substance VAs-12.08 Intentional self-harm X84 X60-X84 VAs-12.09 Assault Y09 X85-Y09 VAs-12.10 Exposure to force of nature X39 X30-X39 X59 S00-T99; W20-W64; Other and unspecified external cause VAs-12.99 W75-W99; of death X50-X59; Y10-Y98
R99 R95-R99 VAs-99 Cause of death unknown
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6 Appendix 2: Table of indicators with skip patterns
7 Appendix 3: Sample VA questionnaire 1: death of a child aged under four weeks
8 Appendix 4: Sample VA questionnaire 2: death of a child aged four weeks to 14 years
9 Appendix 5: Sample VA questionnaire 3: death of a person aged 15 years and above
Read carefully the explanations given in section 4.1 of this manual, and the instructions in the remaining sub-sections of section 4.
A1-7 WHO-VA 2012 RC1 Appendix 2 - List of indicators
Threshold 2nd level 3rd level 4th level Notes for translators and Variable Data type 1st level question
values question question question MALE interviewers FEMALE AGE_1_4Y AGE_U28d AGE_50-64 AGE_15-49 AGE1_11M AGE_5_14Y FEMALE 12- AGE_65-Plus 1A Section Information on Important information the deceased for assessing cause of death and defining skip pattern.
1A100 Text What was the 1111111111 name of the deceased? 1A110 Single Male/Fem Was the deceased 1111111111This can be derived from a select ale female or male? general question about the sex of the deceased. Either male or female must be selected for every case.
1A110A Calculated Was the deceased Male (Y/N/DNK) male? 1111111111
1A110B Calculated Was the deceased Female (Y/N/DNK) female? 1111111111
1A200 Yes/No/D Is date of birth 1111111111 A reliable estimate of age ontKnow= known? at death must be obtained 1/0/9 for every case. This can either be calculated from known dates of birth and death, or reported as a known age at death. There is no point in proceeding beyond this point if sex and age at death cannot be determined.
A2-1 WHO-VA 2012 RC1 Appendix 2 - List of indicators
1A210 Date When was the 1111111111 deceased born?
1A220 Yes/No/D Is date of death 1111111111 ontKnow= known? 1/0/9 1A230 Date When did (s)he 1111111111 die? 1A240 Number [0-130] How many years 1111111111 [years] old was (s)he at death?
1A250 Number [0-12] How many 1111111111 [months] months old was (s)he at death?
1A260 Number [0-31] How many days 1111111111 [days] old was (s)he at death?
1A260A Calculated 65+ years Was (s)he aged 1000000110This can be derived from a (Y/N/DNK) 65 years or over general question about the at death? age of the deceased at the time of death. Select this for someone aged 65 years or over at death.
1A260B Calculated 50-64 Was (s)he aged 0100000110This can be derived from a (Y/N/DNK) years 50 to 64 years at general question about the death? age of the deceased at the time of death. Select this for someone aged 50 to 64 years at death.
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1A260C Calculated 15-49 Was (s)he aged 0010000110This can be derived from a (Y/N/DNK) years 15-49 years at general question about the death? age of the deceased at the time of death. Select this for someone aged 15-49 years at death.
1A260D Calculated 5-14 years Was (s)he aged 0001000111This can be derived from a (Y/N/DNK) 5 to 14 years at general question about the death? age of the deceased at the time of death. Select this for someone aged 5 to 14 years at death.
1A260E Calculated 1-4 years Was (s)he aged 0000100110This can be derived from a (Y/N/DNK) 1 to 4 years at general question about the death? age of the deceased at the time of death. Select this for someone aged 1 to 4 years at death.
1A260F Calculated 1-11 Was (s)he aged 0000010110This can be derived from a (Y/N/DNK) months 1 to 11 months general question about the at death? age of the deceased at the time of death. Select this for someone aged 1 to 11 months at death.
1A260G Calculated ≤28 days Was (s)he aged 0000001110This can be derived from a (Y/N/DNK) 28 days or less general question about the at death? age of the deceased at the time of death. Select this for someone aged 28 days or less at death.
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1A260H Calculated ≤24 hours Did the baby die 0000001110This can be derived from a (Y/N/DNK) within 24 hours general question about the of birth? age of a baby at the time of death. Select this for a baby who died within 24 hours of being born.
1A260I Calculated >24h to Did baby die 0000001110This can be derived from a (Y/N/DNK) 48 hours more than 24 general question about the hours after but age of a baby at the time of less than 48 death. Select this for a baby hours from who died more than 24 birth? hours but less than 48 hours of being born.
1A260J Calculated >48 hours Did baby die 0000001110This can be derived from a (Y/N/DNK) to 6 days more than 48 general question about the hours from birth age of a baby at the time of but within the death. Select this for a baby first week of who died more than 48 life? hours after being born, but within the first week of life.
1A260K Calculated 7 to 28 Did baby die 0000001110This can be derived from a (Y/N/DNK) days after first week, general question about the but within first age of a baby at the time of 28 days? death. Select this for a baby who died after the first week of life, but within the first month.
1A260L Calculated 12 to 19 Was this a 0011000011This can be derived from a (Y/N/DNK) years and woman aged 12 general question about the female to 19 years at age of a woman who died. death? Select this category for a woman aged 12 to 19 years at death.
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1A260M Calculated 20 to 34 Was this a 0010000010This can be derived from a (Y/N/DNK) years and woman aged 20- general question about the female 34 years at age of a woman who died. death? Select this category for a woman aged 20 to 34 years at death.
1A260N Calculated 35 to 49 Was this a 0010000010This can be derived from a (Y/N/DNK) years and woman aged 35- general question about the female 49 years at age of a woman who died. death? Select this category for a woman aged 35 to 49 years at death.
1A400 Yes/No/D Was this a woman 0011000011Select this for a woman ontKnow= who died more who died more than 42 1/0/9 than 42 days but days but less than 1 year less than 1 year after being pregnant or after being delivering a baby. pregnant or delivering a baby?
1A500 Single Citizen by What was her/his 1111111111Record the citizenship or select birth/Nat citizenship/nation nationality of the person uralized ality? who died. citizen/Ali en/ DNK
1A500A Calculated Citizen by Was (s)he a citizen 1111111111 (Y/N/DNK) birth by birth?
1A500B Calculated Naturalize Was (s)he a 1111111111 (Y/N/DNK) d citizen naturalized citizen?
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1A500C Calculated Alien Was (s)he a 1111111111 (Y/N/DNK) foreign national?
1A510 Text What was her/his 1111111111Record the ethnicity of the ethnicity? person who died, using locally accepted ethnic groups. 1A520 Text 1111111111Record her/his place of birth What was her/his (country/province/village). place of birth? 1A530 Text What was her/his 1111111111Record her/his place of usual place of usual residence residence? (country/province/village).. 1A540 Text 1111110111Record her/his place of What was her/his normal residence 1 to 5 place of normal years before death residence 1 to 5 (country/province/village).. years before death? 1A550 Text Where did death 111111111 1Record where the death occur? occurred (country/province/village)..
1A560 Single Hospital/ What was the site 111111111 1Record the site of the select Other of death? death. health facility/ho me/other /DNK 1A560A Calculated Hospital Did (s)he die in a 111111111 1 (Y/N/DNK) hospital?
1A560B Calculated Other Did (s)he die in 111111111 1 (Y/N/DNK) health another health facility facility?
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1A560C Calculated Home Did (s)he die at 111111111 1 (Y/N/DNK) home?
1A560D Calculated Other Did (s)he die in 111111111 1 (Y/N/DNK) another place?
1A600 Single Single/Ma What was her/his 111100011 1Record the marital status of select rried/Divo marital status? the person who died. rced/Wid owed/Too young/DN K
1A600A Calculated Single Was the deceased 111100011 1 (Y/N/DNK) single?
1A600B Calculated Married Was the deceased 111100011 1 (Y/N/DNK) married?
1A600C Calculated Divorced Was the deceased 111100011 1 (Y/N/DNK) divorced?
1A600D Calculated Widowed Was the deceased 111100011 1 (Y/N/DNK) widowed?
1A600E Calculated Too young Was the deceased 111100011 1 (Y/N/DNK) too young to be married?
1A610 Date 1111000111Record the date of What was the marriage, for a married date of marriage? person.
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1A620 Text What was the 1111111111Record the father's name of name of the the person who died. father? 1A630 Text What was the 1111111111Record the mother's name name of the of the person who died. mother? 1A640 Single No formal 1111100111Record the highest level of select education schooling for the person /Primary/ who died. Secondary /Higher/D What was her/his NK highest level of schooling? 1A640A Calculated No formal Did (s)he have no 1111100111 (Y/N/DNK) education formal education?
1A640B Calculated Primary Was her/his 1111100111 (Y/N/DNK) highest level of schooling primary school? 1A640C Calculated Secondary 1111100111 (Y/N/DNK) Was her/his highest level of schooling secondary school? 1A640D Calculated Higher Was her/his 1111100111 (Y/N/DNK) highest level of schooling higher than secondary school? 1A650 Yes/No/D Was (s)he able to 1111000111Record the literacy status of ontKnow= read and write? the person who died. 1/0/9
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1A660 Single Mainly What was her/his 1111000111Record the main economic select employed economic activity activity of the person who /Mainly status in year died, before they became unemploy prior to death? ill. ed/Home- maker/Stu dent/Pens ion/Other /DNK
1A660A Calculated Mainly 1111000111 (Y/N/DNK) employed Was (s)he mainly employed in the year prior to death? 1A660B Calculated Mainly 1111000111 (Y/N/DNK) unemploy Was (s)he mainly ed unemployed in the year prior to death? 1A660C Calculated Home- 1111000111 (Y/N/DNK) maker Was (s)he working as a home.-maker in the year prior to death? 1A660D Calculated Student Was (s)he a 1111000111 (Y/N/DNK) student in the year prior to death? 1A660E Calculated Pension Did (s)he live on a 1111000111 (Y/N/DNK) pension in the year prior to death?
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1A660F Calculated Other 1111000111 (Y/N/DNK) Did (s)he have another economic activity in the year prior to death? 1A670 Text 1111000111Record the occupation of What was her/his the person who died. occupation, that is, what kind of work did (s)he mainly do? 1A7 Section Vital registration These data allow linkage and certification to vital registration
1A700 Text Death registration 1111111111Record the death number/certificat registration number or e certificate number.
1A710 Date Date of 1111111111Record the date of registration registering the death. 1A720 Text Place of 1111111111Record the place of registration registering the death indicating the province/county/city/villag e and whether this was an urban or rural region.
1A730 Text National 1111111111Record the National identification identification number of number of deceased, if available. deceased 2A Section Information on This information is the respondent relevant to quality assurance. 2A100 Text Name of VA 1111111111Record the name of VA respondent respondent.
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2A110 Single Parent/Ch Relationship of 1111111111Record the relationship of select ild/Other respondent to the VA respondent to the family/Fri deceased deceased. end/Healt h worker/Of ficial/Oth er
2A110A Calculated Parent Is the respondent 1111111111 (Y/N/DNK) a parent of the deceased?
2A110B Calculated Child Is the respondent 1111111111 (Y/N/DNK) a child of the deceased?
2A110C Calculated Other Is the respondent 1111111111 (Y/N/DNK) family another family member of the deceased?
2A110D Calculated Friend Is the respondent 1111111111 (Y/N/DNK) a friend of the deceased?
2A110E Calculated Health Is the respondent 1111111111 (Y/N/DNK) worker a health worker?
2A110F Calculated Official Is the respondent 1111111111 (Y/N/DNK) a public official?
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2A110G Calculated Other Is the respondent 1111111111 (Y/N/DNK) in any other kind of relationship to the deceased?
2A115 Yes/No/D Did the 1111111111Record whether the ontKnow= respondent live respondent lived with the 1/0/9 with the deceased deceased. in the period leading to her/his death?
2A120 Text Name of VA 1111111111Record the name of VA interviewer interviewer. 2A130 Time Time at start of 1111111111 interview 2A140 Date Date of interview 1111111111
3A Section Medical history associated with final illness 3A100 Yes/No/D Was there any 1111110111This reflects a diagnosis of ontKnow= diagnosis of tuberculosis made at some 1/0/9 Tuberculosis? kind of medical facility, which may pre-date the deceased's final illness.
3A110 Yes/No/D Was there any 1111110111This reflects a diagnosis of ontKnow= diagnosis of HIV or AIDS (including a 1/0/9 HIV/AIDS? positive HIV test) made at some kind of medical facility, which may pre-date the deceased's final illness.
3A120 Yes/No/D Did (s)he have a 1111110111This reflects a positive test ontKnow= recent positive for malaria within a week of 1/0/9 test for malaria? death.
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3A130 Yes/No/D Did (s)he have a 1111110111This reflects a negative test ontKnow= recent negative for malaria within a week of 1/0/9 test for malaria? death. 3A140 Yes/No/D Was there any 1111110111This reflects a diagnosis of ontKnow= diagnosis of measles made at some kind 1/0/9 Measles? of medical facility, within a month of death.
3A150 Yes/No/D Was there any 1111000111This reflects a diagnosis of ontKnow= diagnosis of High hypertension, and may 1/0/9 Blood pressure? include long-term anti- hypertensive medication, which may pre-date the deceased's final illness. If the hypertension was only diagnosed during pregnancy, this should not be selected.
3A160 Yes/No/D Was there any 1111110111This reflects a diagnosis of ontKnow= diagnosis of heart heart disease made at 1/0/9 disease? some kind of medical facility, which may pre-date the deceased's final illness.
3A170 Yes/No/D Was there any 1111110111This reflects a diagnosis of ontKnow= diagnosis of diabetes made at some 1/0/9 diabetes? kind of medical facility, which may pre-date the deceased's final illness.
3A180 Yes/No/D Was there any 1111110111This reflects a diagnosis of ontKnow= diagnosis of asthma made at some kind 1/0/9 asthma? of medical facility, which may pre-date the deceased's final illness.
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3A190 Yes/No/D Was there any 1111110111This reflects a diagnosis of ontKnow= diagnosis of epilepsy made at some 1/0/9 epilepsy? kind of medical facility, which may pre-date the deceased's final illness.
3A200 Yes/No/D Was there any 1111100111This reflects a diagnosis of ontKnow= diagnosis of cancer made at some kind 1/0/9 cancer? of medical facility, which may pre-date the deceased's final illness. 3A210 Yes/No/D Was there any 1110000110This reflects a diagnosis of ontKnow= diagnosis of chronic obstructive 1/0/9 Chronic pulmonary disease (COPD) Obstructive made at some kind of Pulmonary medical facility, which may Disease (COPD)? pre-date the deceased's final illness. 3A220 Yes/No/D Was there any 1110000110This reflects a diagnosis of ontKnow= diagnosis of dementia made at some 1/0/9 dementia? kind of medical facility, which may pre-date the deceased's final illness.
3A230 Yes/No/D Was there any 1110000110This reflects a diagnosis of ontKnow= diagnosis of clinical depression, which 1/0/9 depression? may have been relevant to the final illness.
3A240 Yes/No/D Was there any 1111000111This reflects a diagnosis of ontKnow= diagnosis of stroke made at some kind 1/0/9 stroke? of medical facility, which may pre-date the deceased's final illness.
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3A250 Yes/No/D Was there any 1111110111This reflects a diagnosis of ontKnow= diagnosis of sickle sickle cell disease made at 1/0/9 cell disease? some kind of medical facility, which may pre-date the deceased's final illness.
3A260 Yes/No/D Was there any 1111100111This reflects a diagnosis of ontKnow= diagnosis of kidney disease made at 1/0/9 kidney disease? some kind of medical facility, which may pre-date the deceased's final illness.
3A270 Yes/No/D Was there any 1111000111This reflects a diagnosis of ontKnow= diagnosis of liver liver disease made at some 1/0/9 disease? kind of medical facility, which may pre-date the deceased's final illness.
3A280 Yes/No/D Did (s)he die 1111111111Select one of these ontKnow= during the wet according to local 1/0/9 season? conditions, with wet season covering months of usual rainfall and immediate aftermath, and dry season covering months with no or very little expected rainfall. 3A290 Yes/No/D Did (s)he die 1111111111Select one of these ontKnow= during the dry according to local 1/0/9 season? conditions, with wet season covering months of usual rainfall and immediate aftermath, and dry season covering months with no or very little expected rainfall.
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3A300 Number [0-999] For how long was 1111111111This reflects the time [weeks] (s)he ill before period that the deceased (s)he died? started feeling ill with onset of symptoms until the time of death.
3A300A Calculated < 3 weeks Was (s)he ill for 1111111111Select this if the final illness (Y/N/DNK) less than 3 weeks lasted less than 3 weeks. before death?
3A300B Calculated ≥ 3 weeks Was (s)he ill for 3 1111111111Select this if the final illness (Y/N/DNK) weeks or more lasted 3 weeks or more. before death?
3A310 Yes/No/D Did (s)he die 1111111111Select this either if the final ontKnow= suddenly? illness lasted less than a 1/0/9 day, or if the final illness seemed to be progressing well and death was not expected. 3B Section General signs and symptoms associated with final illness 3B100 Yes/No/D Did (s)he have a 1111111111Select this if there were any ontKnow= fever? signs of fever during the 1/0/9 final illness. 3B110 Number [0-99] For how long did 1111110111This reflects the period of [weeks] (s)he have a time that the deceased had fever? fever during the final illness, continuously or on and off.
3B110A Calculated < 2 weeks Did (s)he have 1111110111Select this is if the fever (Y/N/DNK) fever for less lasted less than 2 weeks. than 2 weeks before death?
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3B110B Calculated ≥ 2 weeks Did (s)he have 1111110111Select this if the fever (Y/N/DNK) fever for 2 lasted 2 weeks or more. weeks or more before death? 3B120 Yes/No/D Did (s)he have 1111100111If the "any fever" indicator ontKnow= night sweats? is selected, select this one if 1/0/9 the deceased particularly experienced heavy night sweats.
3B130 Yes/No/D Did (s)he have a 1111111111Select this if there was any ontKnow= cough? cough during the final 1/0/9 illness. 3B140 Number [0-99] For how long did 1111110111This reflects the duration of [weeks] (s)he have a cough during the final cough? illness. 3B140A Calculated < 3 weeks Did (s)he have a 1111110111Select this if the cough (Y/N/DNK) cough for less lasted less than 3 weeks. than 3 weeks before death?
3B140B Calculated ≥ 3 weeks Did (s)he have a 1111110111Select this if the cough (Y/N/DNK) cough for 3 lasted 3 weeks or more. weeks or more before death? 3B150 Yes/No/D Was the cough 1111100111If the "any cough" indicator ontKnow= productive, with is selected, select this one if 1/0/9 sputum? the deceased regularly coughed up sputum or mucus.
3B160 Yes/No/D Did (s)he cough 1111100111If the "any cough" indicator ontKnow= up blood? is selected, select this one if 1/0/9 the deceased coughed up blood.
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3B170 Yes/No/D Did (s)he make a 0000111110If the "any cough" indicator ontKnow= whooping sound is selected, select this one if 1/0/9 when coughing? the deceased experienced paroxysms of coughing associated with the characteristic whooping sound of pertussis. Ideally imitate a whoop as it is difficult to describe. Maybe have a audio recording with you.
3B180 Yes/No/D Did (s)he have any 1111111111Select this if there were any ontKnow= breathing problems of breathing 1/0/9 problem? during the final illness (before the moment of death). 3B190 Yes/No/D Did (s)he have 1111111111If the "any breathing ontKnow= fast breathing? problem" indicator is 1/0/9 selected, select this one if the deceased was an infant or child who was breathing much faster than normal.
3B200 Weeks [0-99] For how long 1111111111This reflects the time did (s)he have period that the deceased fast breathing? suffered from breathing much faster than normal during the final illness.
3B200A Calculated < 2 weeks Did (s)he have 1111111111Select this if the fast (Y/N/DNK) fast breathing breathing lasted for less for less than 2 than 2 weeks. weeks? 3B200B Calculated ≥ 2 weeks Did (s)he have 1111110111Select this if the fast (Y/N/DNK) fast breathing breathing lasted for 2 for 2 weeks or weeks or more. more?
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3B210 Yes/No/D Did (s)he have 1111111111Select this if the deceased ontKnow= breathlessness? had difficulty breathing 1/0/9 and was out of breath during the final illness.
3B220 Weeks [0-99] For how long 1111111111This reflects the time did (s)he have period during the final breathlessness? illness that the deceased had difficulty breathing.
3B220A Calculated < 2 weeks Did (s)he have 1111111111Select this if the (Y/N/DNK) breathlessness breathlessness lasted for for less than 2 less than 2 weeks. weeks? 3B220B Calculated ≥ 2 weeks Did (s)he have 1111110111Select this if the (Y/N/DNK) breathlessness breathlessness lasted for 2 for 2 weeks or weeks or more. more? 3B230 Yes/No/D Was (s)he 1111110111If the "any breathing ontKnow= unable to carry problem" indicator is 1/0/9 out daily selected, select this one if routines due to the deceased found it breathlessness? particularly difficult to breathe when physically active, e.g. walking, going up steps. 3B240 Yes/No/D Was (s)he 1111100111If the "any breathing ontKnow= breathless while problem" indicator is 1/0/9 lying flat? selected, select this one if the deceased found it particularly difficult to breathe even when lying down to rest. 3B250 Yes/No/D Did you see the 0001111111If the lower ribs of chest ontKnow= lower chest wall on both sides of the 1/0/9 wall/ribs being chest are pulled in when pulled in as the the child breathes in. child breathed?
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3B260 Yes/No/D Did (s)he have 1111111111If the "any breathing ontKnow= noisy breathing problem" indicator is 1/0/9 (grunting or selected, select this one if wheezing)? the deceased was making wheezing sounds as they breathed (or grunting sounds on breathing in small babies).
3B270 Yes/No/D Did (s)he have 1111100111Select this for older ontKnow= severe chest pain? children or adults who 1/0/9 were experiencing severe pain in their chests, making other activities impossible.
3B280 Yes/No/D Did (s)he have 1111111111Select this if there was any ontKnow= diarrhoea? diarrhoea during the final 1/0/9 illness. 3B290 Weeks [0-99] For how long did 1111110111This reflects the time (s)he have period during which the diarrhoea? deceased suffered from diarrhoea. 3B290A Calculated acute < 2 Did (s)he have 1111110111Select this if the diarrhoea (Y/N/DNK) wks. diarrhoea for lasted for less than 2 less than 2 weeks. weeks? 3B290B Calculated persistent Did (s)he have 1111110111Select this if the diarrhoea (Y/N/DNK) 2-4 wks. diarrhoea for 2 lasted for 2 to 4 weeks, not to 4 weeks? necessarily every day.
3B290C Calculated recurrent Did (s)he have 1111110111Select this if the diarrhoea (Y/N/DNK) ≥ 4 wk. diarrhoea for 4 lasted more than 4 weeks, weeks or more? not necessarily every day.
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3B300 Yes/No/D At any time 1111111111If the "any diarrhoea" ontKnow= during the final indicator is selected, select 1/0/9 illness was there this one if the diarrhoea blood in the contained blood. stools?
3B310 Yes/No/D Did (s)he vomit? 1111111111Select this if there was any ontKnow= vomiting during the final 1/0/9 illness. 3B320 Yes/No/D Did (s)he vomit 1111111111If the "any vomiting" ontKnow= "coffee indicator is selected, select 1/0/9 grounds" or this one if the vomit bright contained blood. The point red/blood? is to identify if there was any bleeding of the upper gastrointestinal tract. Whereas strong and acute bleeding might show as fresh or coagulated blood, less strong bleeding would expose the blood some time to gastric acid, and then it would look like ground coffee (particles of a size between 0.5-2 mm of black or dark brown colour). In local languages there may be other analogies to describe this kind of presentation of blood.
3B330 Yes/No/D Did (s)he have any 1111110111Select this if any abdominal ontKnow= abdominal problem has been present. 1/0/9 problem?
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3B340 Yes/No/D Did (s)he have 1111100111If the "any abdominal ontKnow= severe problem" indicator is 1/0/9 abdominal pain? selected, select this one if severe abdominal pain was present during the final illness. 3B350 Weeks [0-99] For how long 1111100111This reflects the time before death period during the final did (s)he have illness that the deceased severe suffered from severe abdominal abdominal pain. pain? 3B350A Calculated < 2 weeks Did (s)he have 1111100111Select this if the severe (Y/N/DNK) severe abdominal pain lasted for abdominal pain less than 2 weeks. for less than 2 weeks? 3B350B Calculated ≥ 2 weeks Did (s)he have 1111100111Select this if the severe (Y/N/DNK) severe abdominal pain lasted for 2 abdominal pain weeks or more. for 2 weeks or more?
3B360 Yes/No/D Did (s)he have a 1111111111Select this if there is ontKnow= more than abnormal distension or 1/0/9 usually protrusion of the abdomen. protruding The word abdomen sounds abdomen? like medical language, and for interviews in English another term might be used to reflect the wording used by the local population, e.g. belly. The best wording here will always depend on the local language.
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3B370 Weeks [0-99] For how long 1111110111This reflects the time did (s)he have a period during the final more than illness in which the usually deceased had a more than protruding usual protruding abdomen. abdomen? The best wording would depend on the local language. 3B370A Calculated < 2 weeks Did (s)he have a 1111110111Select this if the more than (Y/N/DNK) more than usually protruding usually abdomen lasted for less protruding than 2 weeks. abdomen for less than 2 weeks? 3B370B Calculated ≥ 2 weeks Did (s)he have a 1111110111Select this if the more than (Y/N/DNK) more than usually protruding usually abdomen lasted for 2 protruding weeks or more. abdomen for 2 weeks or more?
3B380 Yes/No/D Did (s)he have 1111110111If the "any abdominal ontKnow= any mass in the problem" indicator is 1/0/9 abdomen? selected, select this one if there was mass in the abdomen during the final illness. The abdominal mass would present as a localized enlargement/swelling in the abdominal area. 3B390 Weeks [0-99] For how long 1111110111This reflects the time did (s)he have period during the final the lump inside illness in which the the abdomen? deceased had a lump inside the abdomen.
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3B390A Calculated < 2 weeks Did (s)he have a 1111110111Select this if the lump (Y/N/DNK) lump inside the inside the abdomen lasted abdomen for for less than 2 weeks. less than 2 weeks? 3B390B Calculated ≥ 2 weeks Did (s)he have a 1111110111Select this if the lump (Y/N/DNK) lump inside the inside the abdomen lasted abdomen for 2 for 2 weeks or more. weeks or more?
3B400 Yes/No/D Did (s)he have a 1111100111Select this if headache was ontKnow= severe headache? present during the final 1/0/9 illness. 3B405 Yes/No/D Did (s)he have a 1111110111Select this if neck stiffness ontKnow= stiff or painful was present in the final 1/0/9 neck? illness. This can be characterised by a difficulty in moving the neck.
3B410 Number [0-99] For how long did 1111110111This reflects the time [weeks] (s)he have a stiff period during the final or painful neck? illness during which the deceased suffered from neck pain or stiffness. 3B410A Calculated < 1 week Did (s)he have a 1111110111Select this if the stiff or (Y/N/DNK) stiff or painful painful neck lasted for less neck for less than 1 week. than 1 week?
3B410B Calculated ≥ 1 week Did (s)he have a 1111110111Select this if the stiff or (Y/N/DNK) stiff or painful painful neck lasted for 2 neck for 1 week weeks or more. or more?
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3B420 Yes/No/D Did (s)he have 1110000110This reflects a diagnosis of ontKnow= mental confusion? memory loss or confusion 1/0/9 made at some kind of medical facility, or cognitive problems which were evident to the respondent, which may pre- date the deceased's final illness. 3B430 Number [0-99] For how long did 1110000110This reflects the period of [months] (s)he have time lasting the symptoms mental of mental confusion (e.g. confusion? loss of orientation, memory loss, loss of ability to focus attention, hallucinations, paranoia, aggressive behaviour).
3B430A Calculated ≥ 3 Did (s)he have 1110000110Select this if the mental (Y/N/DNK) months mental confusion lasted for 3 confusion for 3 months or more. months or more? 3B440 Yes/No/D Was (s)he 1111110111Select this if there was a ontKnow= unconscious for coma or unconsciousness 1/0/9 more than 24 for at least the final 24 hours before hours before death, or at death? an earlier stage of the final illness (possibly with return of consciousness).
3B450 Yes/No/D Did the 1111110111This reflects the way the ontKnow= unconsciousness deceased became 1/0/9 start suddenly, unconscious. quickly (at least within a single day)?
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3B460 Yes/No/D Did (s)he have 1111111111Select this if there were ontKnow= convulsions? convulsions or fits during 1/0/9 the final illness. It should NOT be selected for fits at a much earlier time (in which case consider a possible earlier diagnosis of epilepsy) and should NOT be selected for fits that were only seen during pregnancy (in which case see separate indicator).
3B470 Number [0-60] For how long did 1111110111This reflects the [minutes] the convulsions approximate duration in last? minutes of convulsion episodes suffered by the deceased. 3B470A Calculated < 10 Did the 1111110111Select this if the (Y/N/DNK) minutes convulsions last convulsions lasted for less for less than 10 than 10 minutes. minutes?
3B470B Calculated ≥ 10 Did the 1111110111Select this if the (Y/N/DNK) minutes convulsions last convulsions lasted for 10 for 10 minutes minutes or more. or more?
3B480 Yes/No/D Did (s)he 1111110111If the "any convulsions or ontKnow= become fits" indicator is selected, 1/0/9 unconscious select this one if the person immediately became unconscious after the immediately after the convulsion? convulsions.
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3B490 Yes/No/D Did (s)he have any 1111110111Select this if there was any ontKnow= urine problems? problem relating to urine 1/0/9 during the final illness.
3B500 Yes/No/D Did (s)he pass 1111110111Select this if "any urine ontKnow= no urine at all? problem" is selected and 1/0/9 there was no urine produced during at least part of the final illness. 3B510 Yes/No/D Did (s)he go to 1111100111Select this if "any urine ontKnow= urinate more problem" is selected and 1/0/9 often than urination was much more usual? frequent than normal during the final illness.
3B520 Yes/No/D During the final 1111110111Select this if "any urine ontKnow= illness did (s)he problem" is selected and 1/0/9 ever pass blood the urine contained blood in the urine? at any time during the final illness. 3B530 Yes/No/D Did (s)he have any 1111111111Select this if there was any ontKnow= skin problems? skin problem during the 1/0/9 final illness. 3B540 Yes/No/D Did (s)he have 1111111111If the "any skin problem" ontKnow= any ulcers, indicator is selected, select 1/0/9 abscess or sores this one if there were any anywhere ulcers or lesions on the except on the skin, except specifically on feet? the feet.
3B550 Yes/No/D Did (s)he have 1111111111If the "any skin problem" ontKnow= any ulcers, indicator is selected, select 1/0/9 abscess or sores this one if there were any on the feet that ulcers or lesions exclusively were not also on on the feet. other parts of the body?
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3B560 Yes/No/D During the 1111111111If the "any skin problem" ontKnow= illness that led indicator is selected, select 1/0/9 to death, did this one if there was any (s)he have any kind of skin rash anywhere skin rash? on the body, which was not specifically described as measles or herpes zoster (shingles).
3B570 Weeks [0-99] For how long 1111100111This reflects the time did (s)he have period during which the the skin rash? deceased had a skin rash, independent of the type of skin rash. 3B570A Calculated < 1 week Did (s)he have 1111100111Select this if the skin rash (Y/N/DNK) the skin rash for lasted less than 1 week. less than 1 week? 3B570B Calculated ≥ 1 week Did (s)he have 1111100111Select this if the skin rash (Y/N/DNK) the skin rash for lasted 1 week or more 1 week or more? 3B580 Yes/No/D Did (s)he have 1111111111If the "any skin problem" ontKnow= measles rash? indicator is selected, select 1/0/9 this one if the skin problem was described as measles rash. 3B590 Yes/No/D Did (s)he ever 1111100111If the "any skin problem" ontKnow= have shingles or indicator is selected, select 1/0/9 herpes zoster? this one if the skin problem was described as herpes zoster or shingles.
3B600 Yes/No/D Did (s)he bleed 1111110111Select this if there was ontKnow= from the nose, bleeding from the mouth, 1/0/9 mouth or anus? nose or anus during the final illness.
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3B610 Yes/No/D Did (s)he have 1111110111Select this if weight loss ontKnow= noticeable weight occurred during the final 1/0/9 loss? illness. 3B620 Yes/No/D Was (s)he 1111110111Select this if "any weight ontKnow= severely thin or loss" is selected and the 1/0/9 wasted? extent of the weight loss was sufficiently serious to amount to severe wasting.
3B630 Yes/No/D Did (s)he have 1111110111Select this if oral ontKnow= mouth sores or candidiasis (white spots in 1/0/9 white patches in the mouth) was present the mouth or on during the final illness. the tongue? 3B640 Yes/No/D Did (s)he have 1111110111Select this if there was ontKnow= stiffness of the either rigidity of the body 1/0/9 whole body or (limbs, neck, etc. not able was unable to to move) or if it was not open the mouth? possible to open the mouth (lockjaw) during the final illness.
3B650 Yes/No/D Did (s)he have 1111100111Select this if there was ontKnow= swelling facial swelling during the 1/0/9 (puffiness) of the final illness. face? 3B660 Yes/No/D Did (s)he have 1111100111Select this if both feet or ontKnow= both feet swollen? ankles or legs were swollen 1/0/9 during the final illness - but NOT if only one was swollen, for example following an accident.
3B670 Yes/No/D Did (s)he have any 1111110111Select this if there was any ontKnow= lumps? localised lump or lesion on 1/0/9 any part of the body, either at the time of death, or surgically removed prior to death.
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3B680 Yes/No/D Did (s)he have 1111110111Select this is "any localised ontKnow= any lumps or lump or lesion" is selected 1/0/9 lesions in the and the lump or lesion was mouth? located in the mouth.
3B690 Yes/No/D Did (s)he have 1111110111Select this is "any localised ontKnow= any lumps on lump or lesion" is selected 1/0/9 the neck? and the lump or lesion was located in the neck.
3B700 Yes/No/D Did (s)he have 1111110111Select this is "any localised ontKnow= any lumps on lump or lesion" is selected 1/0/9 the armpit? and the lump or lesion was located in the armpit(s).
3B710 Yes/No/D Did (s)he have 1111100111Select this is "any localised ontKnow= any lumps on lump or lesion" is selected 1/0/9 the groin? and the lump or lesion was located in the groin or genitals.
3B720 Yes/No/D Did she have an 1110000010Select this is "any localised ontKnow= ulcer or swelling lump or lesion" is selected 1/0/9 in the breast? and the lump or lesion was located in the breast - only applies to adult females.
3B730 Yes/No/D Did (s)he have 1111000111Select this if there was ontKnow= paralysis of one some degree of paralysis or 1/0/9 side of the body? weakness on one side of the body - possibly affecting the face (maybe causing difficulties in swallowing or talking) or arms/hands or legs/feet.
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3B740 Yes/No/D Did (s)he have 1111000111Select this if there was ontKnow= difficulty or pain difficulty or pain in 1/0/9 while swallowing swallowing liquids during liquids? the final illness.
3B750 Yes/No/D Did (s)he have 1111110111Select this if the white parts ontKnow= yellow of the deceased's eyes had 1/0/9 discoloration of turned distinctly yellow in the eyes? colour (and possibly yellow soles of the feet for small babies).
3B760 Yes/No/D Did her/his hair 1111100111Select this if there was an ontKnow= colour change to abnormal change in hair 1/0/9 reddish or colour - possibly becoming yellowish? reddish or paler - during the final illness.
3B770 Yes/No/D Did (s)he look pale 1111100111Select this if either blood ontKnow= (thinning/lack of test results indicated 1/0/9 blood) or have anaemia or low pale palms, eyes haemoglobin levels, or if or nail beds? the person was unusually pale (inner eyelids, palms of hands, soles of feet) during the final illness.
3B780 Yes/No/D Did (s)he have 0000110110Select this if the eyes were ontKnow= sunken eyes? unusually sunken into the 1/0/9 face during the final illness.
3B790 Yes/No/D Did (s)he drink a 1111100111Select this if the person ontKnow= lot more water drank a lot more water 1/0/9 than usual? than usual during the final illness.
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3B800 Yes/No/D Did she have 0011000011Select this for a woman ontKnow= excessive vaginal aged 12-50 years who had 1/0/9 bleeding in vaginal bleeding in between between menstrual menstrual periods. periods? 3B810 Yes/No/D Did her vaginal 1110000010Select this for a woman ontKnow= bleeding stopped (probably aged 40 years or 1/0/9 naturally during over) whose normal vaginal menopause? bleeding (menstrual periods) had stopped naturally. 3B820 Yes/No/D Did she have 1110000010Select this for a woman ontKnow= vaginal bleeding (probably aged 40 years or 1/0/9 after menopause? over) whose normal vaginal bleeding had stopped naturally, but who later experienced further vaginal bleeding (not menstrual periods). 3C Section Signs and symptoms associated with pregnancy 3C100 Single only one Was she neither 0010000011Select this for a woman select of the pregnant, nor aged 12-50 years who was Yes/No/D questions delivered, within 6 reported not to have been ontKnow= 3C100- weeks of her pregnant or to have 1/0/9 130 can death? delivered within 6 weeks of be her death answered with "yes"
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3C110 Single only one Was she pregnant 0010000011Select this for a woman select of the at the time of aged 12-50 years who was Yes/No/D questions death? reported to have been ontKnow= 3C100- pregnant at the time of her 1/0/9 130 can death. This means that a be foetus, either at an early answered stage of pregnancy or with "yes" nearer full term, remained inside her body at the time of death. This includes a woman who dies undelivered during labour.
3C120 Single only one Did she die within 0010000011Select this for a woman select of the 6 weeks of giving aged 12-50 years who was Yes/No/D questions birth? reported to have delivered ontKnow= 3C100- a baby within 6 weeks of 1/0/9 130 can her death. This means one be or more potentially viable answered babies, born either dead or with "yes" alive, were delivered in the previous 6 weeks.
3C130 Single only one Did she die within 0010000011Select this for a woman select of the 6 weeks of a aged 12-50 years who was Yes/No/D questions pregnancy that reported to have been at ontKnow= 3C100- lasted less than 6 an early stage (first 6 1/0/9 130 can months? months) of pregnancy be within 6 weeks of her answered death, but the pregnancy with "yes" had ended in a spontaneous or induced abortion at a stage before the foetus was viable.
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3C200 Yes/No/D Did she die 0010000011Select this for a woman ontKnow= within 24 hours aged 12-50 years who was 1/0/9 after delivery? reported to have delivered a baby and then died within 24 hours of the delivery. 3C210 Yes/No/D Did she die 0010000011Select this for a woman ontKnow= during labour, aged 12-50 years who was 1/0/9 but reported to have been undelivered? pregnant at the time of her death, who had gone into labour, and who died before a baby was delivered. 3C220 Yes/No/D Was she 0010000011Select this for a woman ontKnow= breastfeeding at aged 12-50 years who was 1/0/9 death? reported to have been breast-feeding her youngest child at the time of her final illness. 3C230 Number [0-99] How many 0010000011Record the number of [births] births, including births this woman had stillbirths, did before the present one she/the mother (twins count as one birth in have before this this context) baby?
3C230A Calculated 0 (first Was this the 0010000011Select this for a woman (Y/N/DNK) pregnancy woman's first aged 12-50 years who was ) pregnancy? reported to have been pregnant for the first time.
A2-34 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3C230B Calculated ≥4 (4 or Did she have 0010000011Select this for a woman (Y/N/DNK) more four or more aged 12-50 years who previous births, including before any current pregnanci stillbirths, pregnancy had 4 (including es) before this stillbirths) or more pregnancy? pregnancies, or who died during her current pregnancy, or within 6 weeks of her current pregnancy ending.
3C240 Yes/No/D Did she have 0010000011Select this for a woman ontKnow= any previous aged 12-50 years who had 1/0/9 Caesarean delivered a baby by section? Caesarean section in any of her previous pregnancies.
3C250 Yes/No/D Did she die 0010000011Select this for a woman ontKnow= during or after a aged 12-50 years who died 1/0/9 multiple while pregnant with twins pregnancy? (or triplets, etc.) or within 6 weeks of a multiple pregnancy ending.
3C260 Yes/No/D During 0010000011Select this for a woman ontKnow= pregnancy, did aged 12-50 years who was 1/0/9 she suffer from diagnosed with high blood high blood pressure specifically during pressure? her pregnancy.
3C270 Yes/No/D Did she have 0010000011Select this for a woman ontKnow= foul smelling aged 12-50 years who was 1/0/9 vaginal known to have had a foul- discharge during smelling vaginal discharge, pregnancy or either during pregnancy, or after delivery? after delivery.
A2-35 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3C280 Yes/No/D During the last 3 0010000011Select this for a woman ontKnow= months of aged 12-50 years who was 1/0/9 pregnancy, did known to have had fits she suffer from specifically during her convulsions? pregnancy.
3C290 Yes/No/D During the last 3 0010000011Select this for a woman ontKnow= months of aged 12-50 years who was 1/0/9 pregnancy did known to have had blurred she suffer from vision specifically during blurred vision? her pregnancy.
3C300 Yes/No/D Did she give 0010000011Select this for a woman ontKnow= birth to a live, aged 12-50 years who was 1/0/9 healthy baby reported to have delivered within 6 weeks a live, healthy baby within of death? 6 weeks of her death.
3C310 Yes/No/D Was there 0010000011Select this for a woman ontKnow= excessive aged 12-50 years who 1/0/9 vaginal bleeding experienced excessive during vaginal bleeding around pregnancy or pregnancy and delivery. after delivery?
3C320 Yes/No/D Was there 0010000011Select this for a woman ontKnow= vaginal bleeding aged 12-50 years with 1/0/9 during the first excessive vaginal bleeding 6 months of during the first 6 months of pregnancy? pregnancy.
3C330 Yes/No/D Was there 0010000011Select this for a woman ontKnow= vaginal bleeding aged 12-50 years who had 1/0/9 during the last 3 excessive vaginal bleeding months of before labour started. pregnancy but before labour started?
A2-36 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3C340 Yes/No/D Was there 0010000011Select this for a woman ontKnow= excessive aged 12-50 years who had 1/0/9 vaginal bleeding excessive vaginal bleeding during labour? during labour.
3C350 Yes/No/D Was there 0010000011Select this for a woman ontKnow= excessive aged 12-50 years who had 1/0/9 vaginal bleeding excessive vaginal bleeding after delivering after the delivery of a baby. the baby?
3C360 Yes/No/D Was the 0010000011Select this for a woman ontKnow= placenta not aged 12-50 years who was 1/0/9 completely known to have had delivered? problems delivering her placenta after her baby was born, with part or all of the placenta remaining inside.
3C365 Yes/No/D Did she deliver 0010000011Select this for a woman ontKnow= or try to deliver aged 12-50 years who had 1/0/9 an abnormally recently delivered or tried positioned to deliver an abnormally baby? positioned baby, e.g. a breech presentation.
3C370 Yes/No/D Was she in 0010000011Select this for a woman ontKnow= labour for aged 12-50 years who was 1/0/9 unusually long known to have had well- (more than 24 established labour for 24 hours)? hours or more, irrespective of the final outcome of that labour.
A2-37 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3C380 Yes/No/D Did she attempt 0010000011Select this for a woman ontKnow= to terminate the aged 12-50 years who was 1/0/9 pregnancy? known to have been recently pregnant and had attempted, with or without succeeding, to terminate her pregnancy.
3C390 Yes/No/D Did she recently 0010000011Select this for a woman ontKnow= have a aged 12-50 years who was 1/0/9 pregnancy that known to have been ended in an recently pregnant and had abortion the pregnancy terminated, (spontaneous or via a spontaneous abortion induced)? or an induced abortion.
3C400 Yes/No/D Did she give 0010000011Select this for a woman ontKnow= birth in a health aged 12-50 years who was 1/0/9 facility? delivered or delivered recently at a health facility. This question is repeated for neonatal deaths with a slightly different wording.
3C410 Yes/No/D Did she give 0010000011Select this for a woman ontKnow= birth at home? aged 12-50 years who was 1/0/9 delivered or delivered recently at home or on the way to another place. This question is repeated for neonatal deaths with a slightly different wording.
A2-38 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3C420 Yes/No/D Did she give 0010000011Select this for a woman ontKnow= birth elsewhere, aged 12-50 years who was 1/0/9 e.g. on the way delivered or delivered to a facility? recently somewhere other than a health facility or at home, for example while travelling to seek care. This question is repeated for neonatal deaths with a slightly different wording.
3C430 Yes/No/D Did she receive 0010000011Select this for a woman ontKnow= professional aged 12-50 years who had 1/0/9 assistance delivered recently and during the been attended by a delivery? medical professional (doctor, nurse or midwife).
3C440 Yes/No/D Did she have an 0010000011Select this for a woman ontKnow= operation to aged 12-50 years who had 1/0/9 remove her a hysterectomy, probably uterus shortly as an emergency obstetric before death? intervention, shortly before she died.
3C450 Yes/No/D Did she have a 0010000011Select this for a woman ontKnow= normal vaginal aged 12-50 who had a 1/0/9 delivery? normal delivery, without the assistance of forceps/vacuum or through a caesarean section.
3C460 Yes/No/D Did she have an 0010000011Select this for a woman ontKnow= assisted aged 12-50 years who had 1/0/9 delivery, with delivered recently with forceps/vacuum assistance by means of ? forceps or a vacuum device.
A2-39 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3C470 Yes/No/D Did she deliver 0010000011Select this for a woman ontKnow= by Caesarean aged 12-50 years who had 1/0/9 section? delivered recently by means of a Caesarean section. 3C480 Yes/No/D Was the baby 0010000011Select this for a woman age ontKnow= born more than 12-50 years who delivered 1/0/9 one month a baby a month or more early? before the expected date.
3D Section Neonatal/child history, signs and symptoms 3D100 Yes/No/D Was the child part 0000011110Select this for a baby who ontKnow= of a multiple was born as one of a 1/0/9 birth? multiple pregnancy. 3D110 Yes/No/D Was the child 0000011110Select this for a baby who ontKnow= born in a was born in a complicated 1/0/9 complicated delivery, for example delivery? lasting a long time or needing special assistance.
3D120 Yes/No/D Was the baby 0000001110Select this for a neonate ontKnow= born 24 hours or that was born more than 1/0/9 more after the 24 hours after the mother's water broke? waters broke. 3D130 Yes/No/D Did the baby stop 0000001110Select this for a neonate if ontKnow= moving in the the mother could feel that 1/0/9 womb before her baby had stopped labour started? moving inside her womb before the time her labour began. 3D140 Yes/No/D Was baby born in 0000001110Select this for a neonate ontKnow= a normal vaginal who was born in a normal 1/0/9 delivery? vaginal delivery.
A2-40 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3D150 Yes/No/D Was baby born 0000001110Select this for a neonate ontKnow= with who was born with 1/0/9 forceps/vacuum? assistance by means of forceps or a vacuum device. 3D160 Yes/No/D Was baby 0000001110Select this for a neonate ontKnow= delivered by who was born by means of 1/0/9 Caesarean a Caesarean section. section? 3D170 Yes/No/D Did the baby's 0000001110Select this for a neonate ontKnow= bottom, feet, arm that was born from an 1/0/9 or hand come into abnormal (e.g. breech) the vagina before position. The abnormally its head? positioned baby may have been delivered through the vagina, or the abnormal position might have led to a Caesarean section. If it was a Caesarean birth, it doesn’t matter which part of the baby came out first through the abdomen.
3D180 Yes/No/D Was the baby of 0000011110Select this for a neonate or ontKnow= abnormal size? infant that seemed to be of 1/0/9 abnormal size and weight at birth. 3D190 Yes/No/D Was the baby 0000011110Select this for a neonate ontKnow= smaller than and child under 1 year of 1/0/9 normal, age that seemed very weighing under small, or was weighed and 2.5 kg? found to be less than 2.5 kg, at birth.
A2-41 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3D200 Yes/No/D Was the baby 0000001110Select this for a neonate ontKnow= larger than that was too big for an 1/0/9 normal, uncomplicated deliver, or weighing over was weighed and found to 4.5 kg? be more than 4.5 kg, at birth. 3D210 Number [0-52] How many weeks 0000011110This reflects the duration of [weeks] was the the pregnancy from which pregnancy when the dead child was born. the baby was born? 3D210A Calculated < 34 Had the 0000011110Select this for a pregnancy (Y/N/DNK) weeks pregnancy lasted which lasted for less than less than 34 34 weeks. weeks when the baby was born?
3D210B Calculated 34-37 Had the 0000011110Select this for a pregnancy (Y/N/DNK) weeks pregnancy lasted which lasted between 34 between 34 and and 37 weeks. 37 weeks when the baby was born? 3D210C Calculated > 37 Had the 0000011110Select this for a pregnancy (Y/N/DNK) weeks pregnancy lasted which lasted more than 37 more than 37 weeks, i.e. nearly or at full weeks when the term for the birth. baby was born?
3D220 Yes/No/D Was the umbilical 0000001110Select this for a neonate ontKnow= cord wrapped that was born with its cord 1/0/9 several times wrapped several times (more than once) (more than once) around around the neck its neck. of the child at birth?
A2-42 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3D230 Yes/No/D Did the baby/the 0000111110Select this for a baby or ontKnow= child have any young child who was born 1/0/9 noticeable with obvious malformation? malformations of any kind - this may include diagnosed malformations of internal organs, for example heart defects.
3D240 Yes/No/D Did the 0000111110Select this if "any ontKnow= baby/the child congenital malformations" 1/0/9 have a is selected and there is any swelling/defect swelling or defect on the on the back? baby's back.
3D250 Yes/No/D Did the 0000111110Select this if "any ontKnow= baby/the child congenital malformations" 1/0/9 have a very large is selected and the baby head? was born with a very large head.
3D260 Yes/No/D Did the 0000111110Select this if "any ontKnow= baby/the child congenital malformations" 1/0/9 have a very is selected and the baby small head? was born with a very small head.
3D270 Yes/No/D Was the baby/the 0000110110Select this for a baby or ontKnow= child not growing young child who did not 1/0/9 normally? seem to be growing and developing in a way that was normal for his or her age. 3D280 Yes/No/D Was the baby blue 0000001110Select this for a neonate ontKnow= in colour at birth? who was blue in colour, 1/0/9 cyanosed.
A2-43 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3D290 Yes/No/D Did the baby cry 0000001110Select this for a neonate ontKnow= after birth, even if who cried, even if just a 1/0/9 only a little bit? little, after birth.
3D300 Yes/No/D Did the baby 0000001110Select this for a neonate ontKnow= breathe after who was able to breath 1/0/9 birth, even a after birth. little? 3D310 Yes/No/D Was the baby 0000001110Select this for a neonate ontKnow= given assistance who needed assistance to 1/0/9 to breathe at breath after birth. birth? 3D320 Yes/No/D If the baby did not 0000001110Select this for a neonate ontKnow= cry or breathe, that never cried, moved or 1/0/9 was it born dead? breathed after it was delivered - and so was stillborn. 3D330 Yes/No/D Was the dead 0000001110Select this for a stillborn ontKnow= baby macerated, baby whose skin was puffy 1/0/9 that is, showed or mushy. signs of decay?
3D340 Yes/No/D Was the baby able 0000001110Select this for a neonate ontKnow= to suckle or bottle- who was healthy and 1/0/9 feed within the feeding within the first 24 first 24 hours hours from birth. after birth?
3D350 Yes/No/D Did the baby 0000001110Select this for a neonate ontKnow= stop suckling or who initially fed well, but 1/0/9 bottle feeding 3 stopped sucking 3 days or days after birth? more after birth.
A2-44 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3D360 Yes/No/D Did the baby have 0000001110Select this for a neonate ontKnow= convulsions who had convulsions in the 1/0/9 starting within the first 24 hours after birth. first day of life?
3D370 Yes/No/D Did the baby have 0000001110Select this for a neonate ontKnow= convulsions who had convulsions 48 1/0/9 starting on the hours or more after birth. second day or later after birth?
3D380 Yes/No/D Did the baby's 0000001110Select this for a neonate ontKnow= body become stiff, who became rigid and 1/0/9 with the back whose back was bent arched backwards. backwards? 3D390 Yes/No/D Did the child have 0000011110Select this for a baby ontKnow= a bulging or raised whose fontanelle (soft spot 1/0/9 fontanelle? on top of the head) was raised or bulging during the final illness. 3D400 Yes/No/D Did the child have 0000011110Select this for a baby ontKnow= a sunken whose fontanelle (soft spot 1/0/9 fontanelle? on top of the head) was sunken or depressed during the final illness.
3D410 Yes/No/D Did the baby 0000001110Select this for a neonate ontKnow= become who became unconscious 1/0/9 unresponsive or or unresponsive after less unconscious soon than 24 hours from birth. after birth (within less than 24 hours)?
A2-45 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3D420 Yes/No/D Did the baby 0000001110Select this for a neonate ontKnow= become who became unconscious 1/0/9 unresponsive or or unresponsive after more unconscious more than 1 day from birth. than 1 day after birth? 3D430 Yes/No/D Did the baby 0000001110Select this for a neonate ontKnow= become cold to who felt very cold before 1/0/9 the touch before death. it died? 3D440 Yes/No/D Did the baby have 0000001110Select this for a neonate ontKnow= redness or who had red or pussy signs 1/0/9 discharge from of infection around the the umbilical cord umbilicus before death. stump? 3D450 Yes/No/D Did the baby have 0000001110Select this for a neonate ontKnow= yellow palms or who had yellowing of the 1/0/9 soles? skin of their palms or soles.
3D460 Yes/No/D Did the mother 0000001110Select this if the baby's ontKnow= NOT receive mother had not been 1/0/9 tetanus toxoid vaccinated against tetanus (TT) vaccine? during or before her pregnancy. 3D500 Number [0-99] How many births, 0000001110Record the number of [births] including previous pregnancies for stillbirths, did the the neonate's mother baby's mother have before this baby?
3D500A Calculated 0 (first Was this baby 0000001110Select this for a neonate (Y/N/DNK) pregnancy born from the who died, and who was ) mother's first born from the mother's first pregnancy? pregnancy.
A2-46 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3D500B Calculated ≥4 (4 or Did the mother 0000001110Select this for a neonate (Y/N/DNK) more have 4 or more who died, and whose previous births before this mother had had four or pregnanci baby was born? more previous es) pregnancies. 3D510 Yes/No/D During pregnancy, 0000001110Select this for a neonate ontKnow= did the baby's who died, and whose 1/0/9 mother suffer mother was diagnosed from high blood with high blood pressure pressure? during her pregnancy.
3D520 Yes/No/D Did the baby's 0000001110Select this for a neonate ontKnow= mother have foul who died, and whose 1/0/9 smelling vaginal mother was known to have discharge during had a foul-smelling vaginal pregnancy or after discharge, either during delivery? pregnancy, or after delivery. 3D530 Yes/No/D During the last 3 0000001110Select this for a neonate ontKnow= months of who died, and whose 1/0/9 pregnancy, did the mother was known to have baby's mother had fits specifically during suffer from her pregnancy. convulsions?
3D540 Yes/No/D During the last 3 0000001110Select this for a neonate ontKnow= months of who died, and whose 1/0/9 pregnancy did the mother was known to have baby's mother had blurred vision suffer from specifically during her blurred vision? pregnancy.
A2-47 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3D550 Yes/No/D Did the baby's 0000001110Select this for a neonate ontKnow= mother have who died, and whose 1/0/9 vaginal bleeding mother had excessive during the last 3 vaginal bleeding before her months of labour started. pregnancy but before labour started? 3D560 Yes/No/D Was the child 0000001110Select this for a neonate ontKnow= born in a health who died after being 1/0/9 facility? delivered at a health facility. 3D570 Yes/No/D Was the child 0000001110Select this for a neonate ontKnow= born at home? who died after being 1/0/9 delivered at home. 3D580 Yes/No/D Was the child 0000001110Select this for a neonate ontKnow= born somewhere who died after being 1/0/9 else, e.g. on the delivered somewhere other way to a facility? than at a health facility or at home, for example while travelling to seek care.
3D590 Yes/No/D Did the mother 0000001110Select this for a neonate ontKnow= receive who died, and whose 1/0/9 professional delivery was attended by a assistance during medical professional the delivery? (doctor, nurse or midwife).
3E Section History of injuries/accidents
3E100 Yes/No/D Did (s)he suffer 1111111111Select this if there was any ontKnow= from any injury or kind of injury or accident 1/0/9 accident that led associated with the final to her/his death? illness.
A2-48 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3E110 Yes/No/D Was it a road 1111111111Select this if "recent injury ontKnow= traffic accident? or accident" is selected and 1/0/9 it occurred in a road accident of some kind (e.g. as passenger, driver, cyclist, pedestrian).
3E120 Yes/No/D Was (s)he 1111110111Select this if "recent injury ontKnow= injured as a or accident" is selected and 1/0/9 pedestrian/walk if "road traffic accident" is ing? also selected and it occurred while the deceased was walking.
3E130 Yes/No/D Was (s)he 1111111111Select this if "recent injury ontKnow= injured as an or accident" is selected and 1/0/9 occupant of a if "road traffic accident" is car vehicle? also selected and it occurred while the deceased was inside a vehicle/car. 3E140 Yes/No/D Was (s)he 1111111111Select this if "recent injury ontKnow= injured as an or accident" is selected and 1/0/9 occupant of a if "road traffic accident" is bus or heavy also selected and it transport occurred while the vehicle? deceased was inside a vehicle (bus, heavy transport). 3E150 Yes/No/D Was (s)he 1111111111Select this if "recent injury ontKnow= injured as a or accident" is selected and 1/0/9 driver or if "road traffic accident" is passenger of a also selected and it motorcycle? occurred while the deceased was on a motorcycle either as the driver or a passenger.
A2-49 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3E160 Yes/No/D Was (s)he 1111100111Select this if "recent injury ontKnow= injured as a or accident" is selected and 1/0/9 pedal cyclist? if "road traffic accident" is also selected and it occurred while the deceased was riding a bike.
3E170 Yes/No/D Do you know 1111111111Do you know anything ontKnow= anything about about the counter-part that 1/0/9 the counter- was hit during the road part that was hit traffic accident? during the road traffic accident?
3E200 Yes/No/D Was it a 1111111111Was it a pedestrian? ontKnow= pedestrian? 1/0/9 3E210 Yes/No/D Was it a 1111111111Was it a stationary object? ontKnow= stationary 1/0/9 object? 3E220 Yes/No/D Was it a car 1111111111Was it a car vehicle? ontKnow= vehicle? 1/0/9 3E230 Yes/No/D Was it a bus or 1111111111Was it a bus or heavy ontKnow= heavy transport transport vehicle? 1/0/9 vehicle? 3E240 Yes/No/D Was it a 1111111111Was it a motorcycle? ontKnow= motorcycle? 1/0/9 3E250 Yes/No/D Was it a pedal 1111111111Was it a pedal cycle? ontKnow= cycle? 1/0/9 3E260 Yes/No/D Was it something 1111111111Was it something else? ontKnow= else? 1/0/9
A2-50 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3E300 Yes/No/D Was (s)he 1111111111Select this if "recent injury ontKnow= Injured in a non- or accident" is selected and 1/0/9 road transport it occurred in a road accident? transport accident NOT on a road (boat, train, aeroplane, etc.).
3E310 Yes/No/D Was (s)he 1111111111Select this if "recent injury ontKnow= Injured in a fall? or accident" is selected and 1/0/9 it occurred as a result of falling (but NOT falling into water and drowning, and NOT falling into a fire and burning).
3E320 Yes/No/D Did (s)he die of 1111111111Select this if "recent injury ontKnow= drowning? or accident" is selected and 1/0/9 it occurred as a result of drowning in water.
3E330 Yes/No/D Did (s)he suffer 1111111111Select this if "recent injury ontKnow= from burns? or accident" is selected and 1/0/9 it occurred as a result of being burnt in a fire or otherwise exposed to extreme heat.
3E340 Yes/No/D Did (s)he suffer 1111111111Select this if "recent injury ontKnow= from any plant/ or accident" is selected and 1/0/9 animal/insect it occurred as a result of bite or sting being bitten or stung by a that led to poisonous animal (snake, her/his death? scorpion, etc.).
A2-51 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3E400 Yes/No/D Was it a dog? 1111111111Select this if "recent injury ontKnow= or accident" is selected and 1/0/9 if "animal/insect bite" is selected and it occurred as a result of being bitten/attacked by a dog.
3E410 Yes/No/D Was it a snake? 1111111111Select this if "recent injury ontKnow= or accident" is selected and 1/0/9 if "animal/insect bite" is selected and it occurred as a result of being bitten/attacked by a snake.
3E420 Yes/No/D Was it an 1111111111Select this if "recent injury ontKnow= insect? or accident" is selected and 1/0/9 if "animal/insect bite" is selected and it occurred as a result of being bitten/stung by an insect.
3E500 Yes/No/D Was (s)he 1111111111Select this if "recent injury ontKnow= injured by a or accident" is selected and 1/0/9 force of nature? it occurred as a result of an external event (earthquake, volcano, flood, etc.).
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3E510 Yes/No/D Was there any 1111111111Select this if "recent injury ontKnow= poisoning? or accident" is selected and 1/0/9 it occurred as a result of ingesting or being injected with some kind of poisonous material (weed killer, insecticide, non- prescribed drugs, etc.), but NOT as a result of a poisonous bite or sting.
3E520 Yes/No/D Was (s)he 1111111111Select this if "recent injury ontKnow= subject to or accident" is selected and 1/0/9 violence/assault the injury occurred as a ? result of a deliberate action by another person, either as a personal attack or during a war or other outbreak of violence - this can be selected in addition to one of the previous indicators about the mode of injury.
3E530 Yes/No/D Was the injury 1111111111Select this if the deceased ontKnow= intentionally suffered from an injury 1/0/9 inflicted by intentionally infection by someone else? someone else.
3E600 Yes/No/D Was (s)he 1111111111Select this if the deceased ontKnow= injured by a fire suffered from an injury 1/0/9 arm? caused by a fire arm (e.g. pistols and rifles).
3E610 Yes/No/D Was (s)he 1111111111Select this if the deceased ontKnow= injured from a suffered from a stab, cut or 1/0/9 stab, cut or pierce wound. pierce?
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3E620 Yes/No/D Was (s)he 1111111111Select this if the deceased ontKnow= injured by suffered from an injury 1/0/9 machinery? caused by machines or parts of a machine.
3E630 Yes/No/D Was (s)he struck 1111111111Select this if the deceased ontKnow= by an animal or suffered from an injury 1/0/9 object? caused by an animal or object thrown at them.
3E700 Yes/No/D Do you think 1111000111Select this if "recent injury ontKnow= (s)he committed or accident" is selected and 1/0/9 suicide? it is thought to have occurred as a result of a deliberate action by the person who died - this can be selected in addition to one of the previous indicators about the mode of injury.
3F Section Risk factors 3F100 Yes/No/D Did (s)he drink 1110000110Select this if the person ontKnow= alcohol? who died was a regular and 1/0/9 sometimes excessive drinker of alcohol up to the time of the final illness.
3F110 Yes/No/D Did (s)he smoke 1110000110Select this if the person ontKnow= tobacco who died was a regular 1/0/9 (cigarette, cigar, smoker up to the time of pipe, etc.)? the final illness. (make sure you ask for cigarette, cigar, pipe, etc. and not just "smoking").
3G Section Health service utilisation
A2-54 WHO-VA 2012 RC1 Appendix 2 - List of indicators
3G100 Yes/No/D Was (s)he 1111111111Select this if the person ontKnow= adequately who died had been 1/0/9 vaccinated? adequately vaccinated in relation to their age - for a child this information may be available from a health card, but also directly from the VA respondent. "Adequately vaccinated" means that the person had received most of the vaccines appropriate for them.
3G110 Yes/No/D Did (s)he receive 1111111111Select this if the person ontKnow= any treatment for who died obtained 1/0/9 the illness that led treatment from a health to death? facility during their final illness (either out-patient or admitted). 3G120 Yes/No/D Did (s)he receive 1111111111Select this if "treatment for ontKnow= oral rehydration final illness" is selected and 1/0/9 salts? the person who died had been given oral rehydration therapy during their final illness.
3G130 Yes/No/D Did (s)he receive 1111111111Select this if "treatment for ontKnow= (or need) final illness" is selected and 1/0/9 intravenous the person who died had fluids (drip) received treatment treatment? through an IV drip during their final illness.
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3G140 Yes/No/D Did (s)he receive 1111111111Select this if any blood ontKnow= (or need) a transfusion was 1/0/9 blood recommended, prescribed transfusion? or received during the final illness. Do select it if a blood transfusion was prescribed, even if blood was not available or not affordable, and so was not actually given.
3G150 Yes/No/D Did (s)he receive 1111111111Select this if "treatment for ontKnow= (or need) final illness" is selected and 1/0/9 treatment/food the person who died had through a tube received treatment passed through through an IV drip during the nose? their final illness.
3G160 Yes/No/D Did (s)he receive 1111111111Select this if any ontKnow= (or need) intravenous (e.g. by drip or 1/0/9 injectable injection) or intramuscular antibiotics? (by injection) antibiotics were recommended, prescribed or taken during the final illness. Do select it if antibiotics were prescribed, even if they were not available or not affordable, and so were not actually taken.
3G170 Yes/No/D Did (s)he have 1111111111Select this if "treatment for ontKnow= (or need) an final illness" is selected and 1/0/9 operation for any surgical procedures the illness? were performed during the course of the final illness.
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3G180 Yes/No/D Did (s)he have 1111110111Select this if any surgical ontKnow= the operation procedures were 1/0/9 within 1 month performed during the last before death? month of the final illness.
3G190 Yes/No/D Was (s)he 1111111111Select this if the person had ontKnow= discharged from been admitted to hospital 1/0/9 hospital very ill? during the final illness, and was then sent home in the expectation that they would not recover.
4 Section Background and context 4A100 Yes/No/D In the final days 1111111111Select this if the person ontKnow= before death, did who died travelled to a 1/0/9 (s)he travel to a hospital ( or health facility hospital or health offering a 24-hour service) facility? during the final illness. The main concept is “hospital” which by definition is a 24/7 service. But in some countries there are smaller facilities which are not hospitals, but do offer 24/7 services, so those are included– but not lesser facilities which have no emergency service.
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4A110 Yes/No/D Did (s)he use 1111111111Select this if the person ontKnow= motorised who died travelled to a 1/0/9 transport to get hospital or health facility by to the hospital means of motorised or health transport (car, truck, facility? tractor, motorcycle, scooter or ambulance) during the final illness.
4A120 Yes/No/D Were there any 1111111111Select this if the person ontKnow= problems during who died travelled to a 1/0/9 admission to the hospital or health facility, hospital or and then had problems on health facility? arrival (delays, paperwork, queues, no staff).
4A130 Yes/No/D Were there any 1111111111Select this if the person ontKnow= problems with who died travelled to a 1/0/9 the way (s)he hospital or health facility, was treated and then had problems (medical with how they were treatment, treated (medical treatment, procedures, procedures, inter-personal inter-personal attitudes, respect, dignity). attitudes, respect, dignity) in the hospital or health facility?
A2-58 WHO-VA 2012 RC1 Appendix 2 - List of indicators
4A140 Yes/No/D Were there any 1111111111Select this if the person ontKnow= problems who died travelled to a 1/0/9 getting hospital or health facility, medications, or and then had problems diagnostic tests obtaining essential items in the hospital (drugs, medications or or health other prescriptions, blood facility? products, and/or diagnostic tests such as lab tests and x- rays, either within the facility or needing to be bought elsewhere).
4A150 Yes/No/D Does it take more 1111111111Select this if the person ontKnow= than 2 hours to who died lived in a 1/0/9 get to the nearest household from where it hospital or health would reasonably take facility from the more than 2 hours to reach deceased's the nearest 24-hour health household? facility by the means of transport available to the household members.
4A160 Yes/No/D In the final days 1111111111Select this if there were ontKnow= before death, doubts among those 1/0/9 were there any assisting in the final illness doubts about (family members, etc.) whether medical about whether the final care was needed? illness was sufficiently serious to need treatment at a health facility.
A2-59 WHO-VA 2012 RC1 Appendix 2 - List of indicators
4A170 Yes/No/D In the final days 1111111111Select this if a major part of ontKnow= before death, was treatment for the final 1/0/9 traditional illness was provided by any medicine used? kind of traditional or alternative practitioner (herbal remedies, massages, drinks, foods, amulets, spells or blessings provided by traditional healers, witch doctors or shaman).
4A180 Yes/No/D In the final days 1111111111Select this if a telephone of ontKnow= before death, did any kind (working landline, 1/0/9 anyone use a or cell phone charged and telephone or cell with credit) was used by phone to call for those assisting in the final help? 24 hours of the illness for example to call for help or arrange transportation.
4A190 Yes/No/D Over the course of 1111111111Select this if the total costs ontKnow= illness, did the incurred in the final illness 1/0/9 total costs of care were sufficiently great to and treatment mean that other kinds of prohibit other household expenses (food, household fuel, travel, education etc.) payments? could not be met, or caused debt or sale of household assets.
5A Section Optional open narrative
A2-60 WHO-VA 2012 RC1 Appendix 2 - List of indicators
5A100 Text Any comments 1111111111Recording this information that may provide may be helpful to assess additional the diagnosis in cases information. where software assessment of the diagnosis may not deliver reliable results and physician review is necessary. Its use is optional.
A2-61 2012 WHO VERBAL AUTOPSY SAMPLE QUESTIONNAIRE 1
Death of a child Under 4 weeks (0-28 days)
WHO-VA 2012 RC1 A3-1 Appendix 3 DEATH OF A CHILD AGED UNDER 4 WEEKS (28 DAYS) NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 1. BASIC INFORMATION ABOUT THE INTERVIEW AND THE RESPONDENT
2A120 Name of verbal autopsy interviewer:
Surname
Name
2A140 RECORD THE DATE OF INTERVIEW DAY
MONTH
YEAR
2A130 RECORD THE TIME AT START OF INTERVIEW MORNING/EVENING
MORNING =1 HOUR EVENING=2
MINUTES
2A100 Name of verbal autopsy respondent:
Surname
Name
2A110 What is your relationship to the deceased? FATHER MOTHER SIBLING OTHER RELATIVE (SPECIFY) NO RELATION
2A115 Did you live with the deceased in the period leading to her/his YES death? NO
SECTION 2. INFORMATION ON THE DECEASED AND DATE/PLACE OF DEATH
1A100 What was the name of the deceased?
Surname
Name
1A110 Was the deceased female or male? MALE FEMALE
1A200 Is date of birth known? YES NO
1A210 + When was the deceased born? DAY
MONTH
YEAR
1A220 Is date of death known? YES NO
1A230 + When did s/he die? DAY
MONTH
YEAR
1A260 How old was the deceased when s/he died? DAYS
HOURS
1A500 What was her/his citizenship/nationality? CITIZEN BY BIRTH NATURALIZED CITIZ. ALIEN DON'T KNOW
WHO-VA 2012 RC1 A3-2 Appendix 3 NO. QUESTIONS AND FILTERS CODING CATEGORIES
1A510 What was her/his ethnicity? ETHNICITY A ETHNICITY B ETHNICITY C OTHER (specify)
1A520 What was her/his place of birth?
1 Larger admin area (e.g., province) LARGER ADNMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW 4 Urban/Rural URBAN RURAL 5 Other country OTHER COUNTRY (specify)
1A530 What was her/his place of usual residence?
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW 4 Urban/Rural URBAN RURAL
5 Other country OTHER COUNTRY (specify)
1A550 Where did death occur?
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW
4 Urban/Rural URBAN RURAL
5 Other country OTHER COUNTRY (specify)
1A560 What was the site of death? HOSPITAL OTHER HEALTH FACILITY HOME OTHER (specify) DON'T KNOW
1A630 What was the name of the mother?
Surname Name
1A620 What was the name of the father? Surname
Name
SECTION 3. DEATH REGISTRATION AND CERTIFICATION
1A700 Death registration number
1A710 Date of registration DAY
RECORD '98' IF DON'T KNOW DAY OR MONTH MONTH RECORD '9998' IF DON'T KNOW YEAR
YEAR
WHO-VA 2012 RC1 A3-3 Appendix 3 NO. QUESTIONS AND FILTERS CODING CATEGORIES
1A720 Place where the death is registered:
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
4 Urban/Rural URBAN RURAL 5 Name of local registrar Surname Name
DON'T KNOW
1A730 National identification number of deceased
WHO-VA 2012 RC1 A3-4 Appendix 3 NO. QUESTIONS AND FILTERS CODING CATEGORIES
SECTION 4. RESPONDENT'S ACCOUNT OF ILLNESS/EVENTS LEADING TO DEATH
Could you tell me about the illness/events that led to her his/death?
CAUSE OF DEATH 1 ACCORDING TO RESPONDENT
CAUSE OF DEATH 2 ACCORDING TO RESPONDENT
WHO-VA 2012 RC1 A3-5 Appendix 3 DEATH OF A CHILD AGED UNDER 4 WEEKS (28 DAYS) NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 4. PREGNANCY HISTORY
I would like to ask you some questions concerning the mother and symptoms that the deceased had/showed at birth and shortly after. Some of these questions may not appear to be directly related to the baby's death. Kindly be patient and answer all the questions. They will help us to get a clear picture of all possible symptoms that [NAME] had.
3D500 How many births, including stillbirths, did the baby's mother have NUMBER OF BIRTHS/ before this baby? STILLBIRTHS DON'T KNOW
3D210 How many weeks was the pregnancy when the baby was born? NUMBER OF WEEKS DON'T KNOW
3D510 During the pregnancy did the baby's mother suffer from YES high blood pressure? NO DON'T KNOW
3D550 Did the baby's mother have vaginal bleeding during the last 3 months YES of pregnancy but before labour started? NO DON'T KNOW
3D520 Did the baby's mother have foul smelling vaginal discharge during YES pregnancy and/or after delivery? NO DON'T KNOW
3D540 During the last 3 months of pregnancy did the baby's mother suffer YES from blurred vision? NO DON'T KNOW
3D530 During the last 3 months of pregnancy did the baby's mother suffer YES from convulsions? NO DON'T KNOW
3D100 Was the child part of a multiple birth? YES NO DON'T KNOW
3D110 Was the child born in a complicated delivery? YES NO DON'T KNOW
SECTION 5. DELIVERY HISTORY
3D560 Was the child born in a health facility? YES NO DON'T KNOW
3D570 Was the child born at home? YES NO DON'T KNOW
3D580 Was the child born somewhere else (e.g. on the way to a health facility)?YES NO DON'T KNOW
3D590 Did the mother receive professional assistance during the delivery? YES NO DON'T KNOW
3D120 Was the baby born 24 hours or more after the water broke? YES NO DON'T KNOW
3D130 Did the baby stop moving in the womb before labour started? YES NO DON’T KNOW
3D140 Was baby born in a normal vaginal delivery? YES NO DON’T KNOW
3D150 Was baby born with forceps/vacuum? YES NO DON’T KNOW
3D160 Was baby delivered by caesarean section? YES NO DON’T KNOW
3D170 Did the baby's bottom, feet, arm or hand come into the vagina YES before its head? NO DON'T KNOW
SECTION 6. CONDITION OF THE BABY SOON AFTER BIRTH
3D180 Was the baby of abnormal size? YES NO DON'T KNOW
3D190 + Was the baby smaller than normal, weighing under YES + 2.5 kg? NO DON'T KNOW
WHO-VA 2012 RC1 A3-6 Appendix 3 NO. QUESTIONS AND FILTERS CODING CATEGORIES
3D200 + Was the baby larger than normal, weighing over 4.5 kg? YES NO DON'T KNOW
3D220 Was the umbilical cord wrapped several times (more than once) around YES the neck of the child at birth? NO DON'T KNOW
3D230 Did the baby have any noticeable malformation? YES NO DON'T KNOW
3D240 + Did the baby have a swelling/defect on the back? YES NO DON'T KNOW
3D250 + Did the baby have a very large head? YES NO DON'T KNOW
3D260 + Did the baby have a very small head? YES NO DON'T KNOW
3D280 Was the baby blue in colour at birth? YES NO DON'T KNOW
3D300 Did the baby breathe after birth, even a little? YES NO DON'T KNOW
3D310 Was the baby given assistance to breathe at birth? YES NO DON'T KNOW
3D290 Did the baby ever cry after birth, even if only a little bit? YES NO DON'T KNOW
3D320 If the baby did not cry or breathe, was it born dead? YES NO DON'T KNOW
3D330 + Was the dead baby macerated, that is, showed signs of decay? YES NO DON'T KNOW
SECTION 7. HISTORY OF INJURIES/ACCIDENTS
3E100 Did the baby suffer from any injury or accident YES that led to her/his death? NO DON'T KNOW
3E110 + Did the baby suffer from a road traffic accident? YES NO DON'T KNOW
3E120 + + Was the baby injured as a pedestrian? YES NO DON'T KNOW
3E130 + + + Was the baby injured as an occupant of a car vehicle? YES NO DON'T KNOW
3E140 + + + Was the baby injured as an occupant of a bus/heavy YES + + + transport vehicle? NO DON'T KNOW
3E150 + + Was the baby injured as a passenger of a motorcycle? YES NO DON'T KNOW
3E170 + + Do you know anything about the counter-part that was hit YES + + during the road traffic accident? NO
3E200 + + + Was it a pedestrian? YES NO DON'T KNOW
3E210 + + + Was it a stationary object? YES NO DON'T KNOW
3E220 + + + Was it a car vehicle? YES NO DON'T KNOW
3E230 + + + Was it a bus or heavy transport vehicle? YES NO DON'T KNOW
WHO-VA 2012 RC1 A3-7 Appendix 3 NO. QUESTIONS AND FILTERS CODING CATEGORIES
3E240 + + + Was it a motor cycle? YES NO DON'T KNOW
3E250 + + + Was it a pedal cycle? YES NO DON'T KNOW
3E260 + + + Was it something else? YES (specify) ------NO DON'T KNOW
3E300 + Was the baby injured in a non-road transport accident? YES NO DON'T KNOW
3E310 + + Was the baby injured in a fall? YES NO DON'T KNOW
3E320 + + Did the baby die of drowning? YES NO DON'T KNOW
3E330 + + Did the baby suffer from burns? YES NO DON'T KNOW
3E340 + + Did (s)he suffer from any plant/animal/insect bite or sting that led YES + + to her/his death? NO DON'T KNOW
3E400 + + + Was it a dog? YES NO DON'T KNOW
3E410 + + + Was it a snake? YES NO DON'T KNOW
3E420 + + + Was it an insect? YES NO DON'T KNOW
3E500 + + Was the baby injured by a force of nature? YES NO DON'T KNOW
3E510 + + Was there any poisoning? YES NO DON'T KNOW
3E520 + Was the baby subject to violence or assault? YES NO DON'T KNOW
3E530 + Was the injury or accident intentionally inflicted by someone else? YES NO DON'T KNOW
3E600 + + Was the baby injured by a fire arm? YES NO DON'T KNOW
3E610 + + Was the baby injured from a stab, cut or pierce? YES NO DON'T KNOW
3E620 + + Was the baby injured by machinery? YES NO DON'T KNOW
3E630 + + Was the baby struck by an animal or object? YES NO DON'T KNOW
SECTION 8. NEONATAL ILLNESS HISTORY
3A280 Did the baby die during the wet season? YES NO DON'T KNOW
3A290 Did the baby die during the dry season? YES NO DON'T KNOW
3A300 For how long was the baby ill before s/he died? NUMBER OF HOURS NUMBER OF DAYS DON'T KNOW
WHO-VA 2012 RC1 A3-8 Appendix 3 NO. QUESTIONS AND FILTERS CODING CATEGORIES
3A310 Did the baby die suddenly? YES NO DON'T KNOW
3D340 Was the baby able to suckle or bottle-feed within first 24 hours YES after birth? NO DON'T KNOW
3D350 + Did the baby stop suckling of bottle feeding 3 days after birth? YES NO DON'T KNOW
3B460 Did the baby have convulsions? YES NO DON'T KNOW
3D360 + Did the baby have convulsions starting within the first day of life? YES NO DON'T KNOW
3S370 + Did the baby have convulsions starting on the second day or YES + later after birth? NO DON'T KNOW
3D380 Did the baby's body become stiff, with the back arched backwards? YES NO DON'T KNOW
3D390 Did the child have bulging or raised fontanelle? YES NO DON'T KNOW
3D400 Did the child have a sunken fontanelle? YES NO DON'T KNOW
3D410 + Did the baby become unresponsive or unconscious soon YES + after birth (within less than 24 hours)? NO DON'T KNOW
3D420 + Did the baby become unresponsive or unconscious more YES + than 1 day after birth? NO DON'T KNOW
3B100 Did the baby have a fever? YES NO DON'T KNOW
3D430 Did the baby become cold to the touch before it died? YES NO DON'T KNOW
3B130 Did the baby have a cough? YES NO DON'T KNOW
3B170 + Did the baby make a whooping sound when coughing? YES DEMONSTRATE NO DON'T KNOW
3B180 Did the baby have any breathing problem? YES NO DON'T KNOW
3B190 + Did the baby have fast breathing? YES NO DON'T KNOW
3B210 + Did the baby have breathlessness? YES NO DON'T KNOW
3B250 + Did you see the lower chest wall/ribs being pulled in as the child YES + breathed? NO DON'T KNOW
3B260 + Did the baby have noisy breathing (grunting or wheezing)? YES + DEMONSTRATE NO DON'T KNOW
3B280 Did the baby have diarrhoea? YES NO DON'T KNOW
3B300 + At any time during the final illness was there blood in the stools? YES NO DON'T KNOW
3B310 Did the baby vomit? YES NO DON'T KNOW
3B320 + Did the baby vomit "coffee grounds" or bright red/blood? YES NO DON'T KNOW
WHO-VA 2012 RC1 A3-9 Appendix 3 NO. QUESTIONS AND FILTERS CODING CATEGORIES
3B360 + Did the baby have a more than usual protruding abdomen? YES NO DON'T KNOW
3D440 Did the baby have redness or discharge from the YES umbilical cord stump? NO DON'T KNOW
3B530 Did the baby have any skin problems? YES NO DON'T KNOW
3B540 + Did the baby have any ulcers, abscess or sores YES + anywhere except the feet? NO DON'T KNOW
3B550 + Did the baby have any ulcers, abscess or sores on the feet? YES NO DON'T KNOW
3B560 + During the illness that led to death, did the baby have YES + any skin rash? NO DON'T KNOW
3B580 + + Did the baby have measles rash? YES NO DON'T KNOW
3D450 Did the baby have yellow palms or soles? YES NO DON'T KNOW
3D460 Did the mother receive tetanus toxoid (TT) vaccine? YES NO DON'T KNOW
WHO-VA 2012 RC1 A3-10 Appendix 3 DEATH OF A CHILD AGED UNDER 4 WEEKS (28 DAYS) NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 9 TREATMENT AND HEALTH SERVICE USE FOR THE FINAL ILLNESS
3G100 Was s/he adequately vaccinated? YES NO DON'T KNOW
3G110 Did s/he receive any treatment for the illness that led to death? YES NO DON'T KNOW
3G120 + Did s/he receive oral rehydration salts? YES NO DON'T KNOW
3G130 + Did s/he receive (or needed) intravenous fluids (drip) treatment? YES NO DON'T KNOW
3G140 + Did s/he receive (or needed) a blood transfusion? YES NO DON'T KNOW
3G150 + Did s/he receive (or needed) treatment/food through a tube passed YES + through the nose? NO DON'T KNOW
3G160 + Did s/he receive (or needed) injectable (IV or IM) antibiotics? YES NO DON'T KNOW
3G170 + Did s/he have (or needed) an operation for the illness? YES NO DON'T KNOW
3G190 + Was s/he discharged from the hospital very ill? YES NO DON'T KNOW
SECTION 10. BACKGROUND
4A100 In the final days, did the baby travel to a hospital or health facility? YES NO DON'T KNOW
4A110 + Did s/he use motorised transport to get to the hospital or YES + health facility? NO DON'T KNOW
4A120 + Were there any problems during admission to the hospital or YES + health facility? NO DON'T KNOW
4A130 + Were there any problems with the way (s)he was treated (medical treatment, YES + procedures, inter-personal attitudes, respect, dignity) in the NO + hospital or health facility? DON'T KNOW
4A140 + Were there any problems getting medications, or diagnostic tests YES + in the hospital or health facility? NO DON'T KNOW
4A150 Does it take more than 2 hours to get to the nearest hospital or YES health facility from the deceased's household? NO DON'T KNOW
4A160 In the final days before death, were there any doubts about whether YES medical care was needed? NO DON'T KNOW
4A170 In the final days before death, was traditional medicine used? YES NO DON'T KNOW
4A180 In the final days before death, did anyone use a telephone or cell phone YES to call for help? NO DON'T KNOW
4A190 Over the course of illness, did the total costs of care and treatment YES prohibit other household payments? NO DON'T KNOW
WHO-VA 2012 RC1 A3-11 Appendix 3 5A100 INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
SUPERVISOR'S OBSERVATIONS
NAME OF THE SUPERVISOR: DATE:
WHO-VA 2012 RC1 A3-12 Appendix 3 2012 WHO VERBAL AUTOPSY SAMPLE QUESTIONNAIRE 2
Death of a child aged 4 weeks to 14 years
WHO-VA 2012 RC1 A4-1 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS (29 DAYS) TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 1. BASIC INFORMATION ABOUT THE INTERVIEW AND THE RESPONDENT
2A120 Name of verbal autopsy interviewer:
Surname
Name
2A140 RECORD THE DATE OF INTERVIEW DAY
MONTH
YEAR
2A130 RECORD THE TIME AT START OF INTERVIEW MORNING/EVENING
MORNING =1 HOUR EVENING=2
MINUTES
2A100 Name of verbal autopsy respondent
Surname
Name
2A110 What is your relationship to the deceased? FATHER MOTHER SPOUSE SIBLING OTHER RELATIVE (SPECIFY) NO RELATION
2A115 Did you live with the deceased in the period leading YES to her/his death? NO
SECTION 2. INFORMATION ON THE DECEASED AND DATE/PLACE OF DEATH
1A100 What was the name of the deceased?
Surname
Name
1A110 Was the deceased female or male? FEMALE MALE
1A200 Is date of birth known? YES NO
1A210 + When was the deceased born? DAY
MONTH
YEAR
1A220 Is date of death known? YES NO
1A230 + When did s/he die? DAY
MONTH
YEAR
1A240 How old was the deceased when s/he died? AGE IN YEARS 1A250 IF AGE IS LESS THAN 1 YEAR RECORD IN MONTHS AGE IN MONTHS
1A400 Was this a woman who died more than 42 days but less than 1 year YES after being pregnant or delivering a baby? NO DON'T KNOW
WHO-VA 2012 RC1 A4-2 Appendix 4 NO. QUESTIONS AND FILTERS CODING CATEGORIES 1A500 What was her/his citizenship/nationality? CITIZEN BY BIRTH NATURALIZED CITIZ. ALIEN DON'T KNOW
1A510 What was her/his ethnicity? ETHNICITY A ETHNICITY B ETHNICITY C OTHER (specify)
1A520 What was her/his place of birth? 1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW 4 Urban/Rural URBAN RURAL 5 Other country OTHER COUNTRY (specify)
1A530 What was her/his place of usual residence? 1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW 4 Urban/Rural URBAN RURAL
5 Other country OTHER COUNTRY (specify)
1A540 What was her/his place of normal residence 1 to 5 years before death?
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW
4 Urban/Rural URBAN RURAL
5 Other country OTHER COUNTRY (specify)
1A550 Where did death occur?
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW
4 Urban/Rural URBAN RURAL
5 Other country OTHER COUNTRY (specify)
1A560 What was the site of death? HOSPITAL OTHER HEALTH FACILITY HOME OTHER (specify) DON'T KNOW
1A600 What was her/his marital status? NEVER MARRIED MARRIED/LIVING WITH A PARTNER WIDOWED DIVORCED SEPARATED DON'T KNOW
1A610 What was the date of marriage? DAY
RECORD '98' IF DON'T KNOW DAY OR MONTH RECORD '9998' IF DON'T KNOW YEAR MONTH
YEAR
WHO-VA 2012 RC1 A4-3 Appendix 4 NO. QUESTIONS AND FILTERS CODING CATEGORIES
1A630 What was the name of the mother?
Surname
Name
1A620 What was the name of the father?
Surname
Name
1A640 What was her/his highest level of schooling? NO FORMAL EDUCATION PRIMARY SECONDARY HIGHER DON'T KNOW
1A650 Was s/he able to read and write? YES NO DON'T KNOW
1A660 What was her/his economical activity status in year prior to death? USUALLY ECONOMICALLY ACTIVE MAINLY EMPLOYED MAINLY UNEMPLOYED
NOT ECONOMICALLY ACTIVE HOME-MAKER STUDENT PENSION OTHER (specify) DON'T KNOW
1A670 What was her/his occupation, that is, what kind of work did s/he mainly do?
SECTION 3. DEATH REGISTRATION AND CERTIFICATION
1A700 Death registration number
1A710 Date of registration DAY
RECORD '98' IF DON'T KNOW DAY OR MONTH MONTH RECORD '9998' IF DON'T KNOW YEAR
YEAR
1A720 Place where the death is registered:
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
4 Urban/Rural URBAN RURAL 5 Name of local registrar Surname Name
DON'T KNOW
1A730 National identification number of deceased
WHO-VA 2012 RC1 A4-4 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 4. RESPONDENT'S ACCOUNT OF ILLNESS/EVENTS LEADING TO DEATH
Could you tell me about the illness/events that led to her his/death?
CAUSE OF DEATH 1 ACCORDING TO RESPONDENT
CAUSE OF DEATH 2 ACCORDING TO RESPONDENT
SECTION 5. CONTEXT AND HISTORY OF PREVIOUSLY KNOWN MEDICAL CONDITIONS
I would like to ask you some questions concerning the contexts and previously known medical conditions the deceased had; injuries and accidents that the deceased suffered; and signs and symptoms that the deceased had/showed when s/he was ill. Some of these questions may not appear to be directly related to his/her death. Please bear with me and answer all the questions. They will help us to get a clear picture of all possible symptoms that the deceased had.
3A100 Was there any diagnosis of Tuberculosis? YES NO DON'T KNOW
3A110 Was there any diagnosis of HIV/AIDS? YES NO DON'T KNOW
3A120 Did s/he have a recent positive test for Malaria? YES NO DON'T KNOW
3A130 Did s/he have a recent negative test for Malaria? YES NO DON'T KNOW
3A140 Was there any diagnosis of Measles? YES NO DON'T KNOW
3A150 Was there any diagnosis of High Blood Pressure? YES NO DON'T KNOW
3A160 Was there any diagnosis of Heart Disease? YES NO DON'T KNOW
3A170 Was there any diagnosis of Diabetes? YES NO DON'T KNOW
3A180 Was there any diagnosis of Asthma? YES NO DON'T KNOW
3A190 Was there any diagnosis of Epilepsy? YES NO DON'T KNOW
3A200 Was there any diagnosis of Cancer? YES NO DON'T KNOW
WHO-VA 2012 RC1 A4-5 Appendix 4 NO. QUESTIONS AND FILTERS CODING CATEGORIES
3A210 Was there any diagnosis of Chronic Obstructive Pulmonary Disease YES (COPD)? NO DON'T KNOW
3A220 Was there any diagnosis of Dementia? YES NO DON'T KNOW
3A230 Was there any diagnosis of Depression? YES NO DON'T KNOW
3A240 Was there any diagnosis of Stroke? YES NO DON'T KNOW
3A250 Was there any diagnosis of Sickle Cell disease? YES NO DON'T KNOW
3A260 Was there any diagnosis of Kidney disease? YES NO DON'T KNOW
3A270 Was there any diagnosis of Liver disease? YES NO DON'T KNOW
3A280 Did s/he die during the wet season? YES NO DON'T KNOW
3A290 Did s/he die during the dry season? YES NO DON'T KNOW
3A300 For how long was s/he ill before s/he died? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3A310 Did s/he die suddenly? YES NO DON'T KNOW
WHO-VA 2012 RC1 A4-6 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 6. HISTORY OF INJURIES/ACCIDENTS
3E100 Did s/he suffer from any injury or accident that led to her/his death? YES NO DON'T KNOW
3E110 + Did s/he suffer from a road traffic accident? YES NO DON'T KNOW
3E120 + + Was s/he injured as a pedestrian/walking? YES NO DON'T KNOW
3E130 + + Was s/he injured as an occupant of a car vehicle? YES NO DON'T KNOW
3E140 + + Was s/he injured as an occupant of a bus/heavy YES transport vehicle? NO DON'T KNOW
3E150 + + Was s/he injured as a driver or passenger of a motorcycle? YES NO DON'T KNOW
3E160 + + Was s/he injured as a pedal cyclist? YES NO DON'T KNOW
3E170 + + Do you know anything about the counter-part that was hit YES during the road traffic accident? NO
3E200 + + + Was it a pedestrian? YES NO DON'T KNOW
3E210 + + + Was it a stationary object? YES NO DON'T KNOW
3E220 + + + Was it a car vehicle? YES NO DON'T KNOW
3E230 + + + Was it a bus or heavy transport vehicle? YES NO DON'T KNOW
3E240 + + + Was it a motor cycle? YES NO DON'T KNOW
3E250 + + + Was it a pedal cycle? YES NO DON'T KNOW
3E260 + + + Was it something else? YES (specify) NO DON'T KNOW
3E300 + Was s/he injured in a non-road transport accident? YES NO DON'T KNOW
3E310 + + Was s/he injured in a fall? YES NO DON'T KNOW
WHO-VA 2012 RC1 A4-7 Appendix 4 NO. QUESTIONS AND FILTERS CODING CATEGORIES
3E320 + + Did s/he die of drowning? YES NO DON'T KNOW
3E330 + + Did s/he suffer from burns? YES NO DON'T KNOW
3E340 + + Did (s)he suffer from any plant/animal/insect bite or sting that led to YES + + her/his death? NO DON'T KNOW
3E400 + + + Was it a dog? YES NO DON'T KNOW
3E410 + + + Was it a snake? YES NO DON'T KNOW
3E420 + + + Was it an insect? YES NO DON'T KNOW
3E500 + + Was s/he injured by a force of nature? YES NO DON'T KNOW
3E510 + + Was there any poisoning? YES NO DON'T KNOW
3E520 + Was s/he subject to violence or assault? YES NO DON'T KNOW
3E530 + Was the injury or accident intentionally inflicted by someone else? YES NO DON'T KNOW
3E600 + + Was s/he injured by a fire arm? YES NO DON'T KNOW
3E610 + + Was s/he injured from a stab, cut or pierce? YES NO DON'T KNOW
3E620 + + Was s/he injured by machinery? YES NO DON'T KNOW
3E630 + + Was s/he struck by an animal or object? YES NO DON'T KNOW
3E700 + Do you think that s/he committed suicide? YES NO DON'T KNOW
CHECK QUESTIONS 1A240 AND 1A250 FOR AGE AT DEATH:
IF UNDER IF ONE YEAR JUMP TO SECTION 8 ONE YEAR OR OLDER
WHO-VA 2012 RC1 A4-8 Appendix 4 NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 7. SYMPTOMS AND SIGNS NOTED DURING THE FINAL ILLNESS OF INFANTS
3D190 Was the child born smaller than normal, weighing under 2.5 kg? YES NO DON'T KNOW
3D210 How many weeks was the pregnancy when the baby was born? NUMBER OF WEEKS DON'T KNOW
3D390 Did the child have bulging of the fontanelle? YES NO DON'T KNOW
3D400 Did the child have a sunken fontanelle? YES NO DON'T KNOW
WHO-VA 2012 RC1 A4-9 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES
SECTION 8. SYMPTOMS NOTED DURING THE FINAL ILLNESS FOR ALL CHILDREN
3D220 Did the child have any noticeable malformation? YES NO DON'T KNOW
3D240 + Did the child have a swelling or defect on the back? YES NO DON'T KNOW
3D250 + Did the child have a very large head? YES NO DON'T KNOW
3D260 + Did the child have a very small head? YES NO DON'T KNOW
3B100 Did s/he have a fever? YES NO DON'T KNOW
3B110 + For how long did s/he have a fever? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B120 + Did s/he have night sweats? YES NO DON'T KNOW
3B130 Did s/he have a cough? YES NO DON'T KNOW
3B140 + For how long did s/he have a cough? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B170 + Did s/he make a whooping sound when coughing? YES NO DON'T KNOW
3B150 + Was the cough productive with sputum? YES NO DON'T KNOW
3B160 + Did s/he cough out blood? YES NO DON'T KNOW
3B180 Did s/he have any breathing problem? YES NO DON'T KNOW
3B190 + Did s/he have fast breathing? YES NO DON'T KNOW
3B200 + + For how long did s/he have fast breathing? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B210 + Did s/he have breathlessness? YES NO DON'T KNOW
3B220 + + For how long did s/he have breathlessness? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B230 + + Was s/he unable to carry out daily routine activities due to YES + + breathlessness? NO DON'T KNOW
WHO-VA 2012 RC1 A4-10 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES
3B240 + + Was s/he breathless while lying flat? YES NO DON'T KNOW
3B250 + Did you see the lower chest wall/ribs be pulled in as the child YES + breathed? NO DON'T KNOW
3B260 + Did s/he have noisy breathing (grunting or wheezing)? YES + DEMONSTRATE NO DON'T KNOW
3B270 Did s/he have severe chest pain? YES NO DON'T KNOW
3B280 Did s/he have diarrhoea? YES NO DON'T KNOW
3B290 + For how long did s/he have diarrhoea? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B300 + At any time during the final illness was there blood in the stools? YES NO DON'T KNOW
3B310 Did s/he vomit? YES NO DON'T KNOW
3B320 + Did s/he vomit "coffee grounds" or bright red/blood? YES NO DON'T KNOW
3B330 Did s/he have any abdominal problem? YES NO DON'T KNOW
3B340 + Did s/he have severe abdominal pain? YES NO DON'T KNOW
3B350 + + For how long before death did s/he have severe abdominal NUMBER OF DAYS + + pain? NUMBER OF WEEKS DON'T KNOW
3B360 + Did s/he have a more than usual protruding abdomen? YES NO DON'T KNOW
3B370 + + For how long did s/he have a more than usual protruding NUMBER OF DAYS + + abdomen? NUMBER OF WEEKS DON'T KNOW
3B380 + Did s/he have any lump inside the abdomen? YES NO DON'T KNOW
3B390 + + For how long did s/he have the lump inside the abdomen? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B400 Did s/he have a severe headache? YES NO DON'T KNOW
3B405 Did s/he have a stiff or painful neck? YES NO DON'T KNOW
3B410 + For how long did s/he have a stiff or painful neck? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B420 Did s/he have mental confusion? YES NO DON'T KNOW
WHO-VA 2012 RC1 A4-11 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES 3B430 + For how long did s/he have mental confusion? NUMBER OF DAYS NUMBER OF MONTHS DON'T KNOW
3B440 Was s/he unconscious for more than 24 hours? YES NO DON'T KNOW
3B450 + Did the unconsciousness start suddenly, quickly (at least within YES + a single day)? NO DON'T KNOW
3B460 Did s/he have convulsions? YES NO DON'T KNOW
3B470 + For how long did s/he have convulsions? NUMBER OF MINUTES DON'T KNOW
3B480 + Did s/he became unconscious immediately after the convulsion? YES NO DON'T KNOW
3B490 Did s/he have any urine problems? YES NO DON'T KNOW
3B500 + Did s/he pass no urine at all? YES NO DON'T KNOW
3B510 + Did s/he go to urinate more often than usual? YES NO DON'T KNOW
3B520 + During the final illness did s/he ever pass blood in the urine? YES NO DON'T KNOW
3B530 Did s/he have any skin problems? YES NO DON'T KNOW
3B540 + Did s/he have any ulcers, abscess or sores YES + anywhere except on the feet? NO DON'T KNOW 3B550 + Did (s)he have any ulcers, abscess or sores on the feet YES + that were not also on other parts of the body? NO DON'T KNOW
3B560 + During the illness that led to death, did s/he have any skin rash? YES NO DON'T KNOW
3B570 + + For how long did s/he have the skin rash? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B580 + + Did s/he have measles rash? YES NO DON'T KNOW
3B590 + + Did s/he ever have shingles/herpes zoster? YES NO DON'T KNOW
3B600 Did s/he have bleeding from the nose, mouth, or anus? YES NO DON'T KNOW
3B610 Did s/he have noticeable weight loss? YES NO DON'T KNOW
3B620 + Was s/he severely thin or wasted? YES NO DON'T KNOW
WHO-VA 2012 RC1 A4-12 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES 3B630 Did s/he have mouth sores or white patches in the mouth YES or on the tongue? NO DON'T KNOW
3B640 Did s/he have stiffness of the whole body or was unable to open YES the mouth? NO DON'T KNOW
3B650 Did s/he have swelling (puffiness) of the face? YES NO DON'T KNOW
3B660 Did s/he have both feet swollen? YES NO DON'T KNOW
3B670 Did s/he have any lumps? YES NO DON'T KNOW
3B680 + Did s/he have a lumps or lesions in the mouth? YES NO DON'T KNOW
3B690 + Did s/he have any lumps on the neck? YES NO DON'T KNOW
3B700 + Did s/he have any lumps on the armpit? YES NO DON'T KNOW
3B710 + Did s/he have any lumps on the groin? YES NO DON'T KNOW
3B730 Did s/he have paralysis of one side of the body? YES NO DON'T KNOW
3B740 Did s/he have difficulty or pain while swallowing liquids? YES NO DON'T KNOW
3B750 Did s/he have yellow discoloration of the eyes? YES NO DON'T KNOW
3B760 Did her/his hair colour change to reddish or yellowish? YES NO . DON'T KNOW
3B770 Did s/he look pale (thinning/lack of blood) or have pale palms, YES eyes or nail beds? NO DON'T KNOW
3B780 Did s/he have sunken eyes? YES NO DON'T KNOW
3D270 Was the child not growing normally? YES NO DON'T KNOW
3B790 Did (s)he drink a lot more water than usual? YES NO DON'T KNOW CHECK QUESTIONS 1A110, 1A240 AND 1A250 FOR SEX AND AGE AT DEATH:
IF FEMALE IF MALE OR FEMALE JUMP TO SECTION 10 BETWEEN 12 - 14 YEARS UNDER 12 YEARS
WHO-VA 2012 RC1 A4-13 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES
SECTION 9. SYMPTOMS AND SIGNS ASSOCIATED WITH PREGNANCY
3C100 Was she neither pregnant, nor delivered, within 6 weeks of her death? YES skip pregnancy section if YES NO OR DON'T KNOW
3C110 Was she pregnant at the time of death? YES NO OR DON'T KNOW
3C120 Did she die within 6 weeks of giving birth? YES NO OR DON'T KNOW
3C130 Did she die within 6 weeks of a pregnancy that lasted less YES than 6 months? NO DON'T KNOW
3C200 + Did she die within 24 hours after delivery? YES NO DON'T KNOW
3C210 + Did she die during labour, but undelivered? YES NO DON'T KNOW
3C220 + Was she breastfeeding at death? YES NO DON'T KNOW
3C230 + How many births, including stillbirths, did she have NUMBER OF BIRTHS/STILLBIRTHS + before this baby? DON'T KNOW
3C240 + Did she have any previous C-section? YES NO DON'T KNOW
3C250 + Did she die during or after a multiple pregnancy? YES NO DON'T KNOW
3C260 + During pregnancy, did she suffer from high blood pressure? YES NO DON'T KNOW
3C270 + Did she have foul smelling vaginal discharge during pregnancy YES + or after delivery? NO DON'T KNOW
3C280 + During the last 3 months of pregnancy, did she suffer from YES + convulsions? NO DON'T KNOW
3C290 + During the last 3 months of pregnancy, did she suffer from YES + blurred vision? NO DON'T KNOW
3C300 + Did she give birth to a live, healthy baby within 6 weeks of death? YES NO DON'T KNOW
3C310 + Was there any vaginal bleeding during pregnancy or YES + after delivery? NO DON'T KNOW
3C320 + + Was there vaginal bleeding during the first 6 moths YES + + of pregnancy? NO DON'T KNOW
3C330 + + Was there vaginal bleeding during the last 3 months of YES + + pregnancy but before labour started? NO DON'T KNOW
WHO-VA 2012 RC1 A4-14 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES 3C340 + + Was there excessive vaginal bleeding during labour? YES NO DON'T KNOW
3C350 + + Was there excessive vaginal bleeding after delivering the baby? YES NO DON'T KNOW
3C360 + Was the placenta not completely delivered? YES NO DON'T KNOW
3C365 + Did she deliver or try to deliver an abnormally positioned baby? YES NO DON'T KNOW
3C370 + Was she in labour for unusually long (more than 24 hours)? YES NO DON'T KNOW
3C380 Did she attempt to terminate the pregnancy? YES NO DON'T KNOW
3C390 + Did she recently have a pregnancy that ended in YES + an abortion (spontaneous or induced)? NO DON'T KNOW
3C400 + Did she give birth in a health facility? YES NO DON'T KNOW
3C410 + Did she give birth at home? YES NO DON'T KNOW
3C420 Did she give birth elsewhere, e.g. on the way to a facility? YES NO DON'T KNOW
3C430 + Did she receive professional assistance for the delivery? YES NO DON'T KNOW
3C440 + Did she have an operation to remove her uterus shortly YES + before death? NO DON'T KNOW
3C450 + Did she have a normal vaginal delivery? YES NO DON'T KNOW
3C460 + Did she have an assisted delivery, with forceps/vacuum? YES NO DON'T KNOW
3C470 + Was it a delivery with caesarean section? YES NO DON'T KNOW
3C480 + Was the baby born more than one month early? YES NO DON'T KNOW
WHO-VA 2012 RC1 A4-15 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 10. TREATMENT AND HEALTH SERVICE USE FOR THE FINAL ILLNESS
3G100 Was s/he adequately vaccinated? YES NO DON'T KNOW
3G110 Did s/he receive any treatment for the illness that led to death? YES NO DON'T KNOW
3G120 + Did s/he receive oral rehydration salts? YES NO DON'T KNOW
3G130 + Did s/he receive (or needed) intravenous fluids (drip) treatment? YES NO DON'T KNOW
3G140 + Did s/he receive (or needed) a blood transfusion? YES NO DON'T KNOW
3G150 + Did s/he receive (or needed) treatment/food through a tube passed YES + through the nose? NO DON'T KNOW
3G160 + Did s/he receive (or needed) injectable (IV or IM) antibiotics? YES NO DON'T KNOW
3G170 + Did s/he have (or needed) an operation for the illness? YES NO DON'T KNOW
3G180 + + Did s/he have the operation within 1 month before death? YES NO DON'T KNOW
3G190 + Was s/he discharged from the hospital very ill? YES NO DON'T KNOW
SECTION 11. BACKGROUND
4A100 In the final days before death, did s/he travel to a hospital or YES health facility? NO DON'T KNOW
4A110 + Did s/he use motorised transport to get to the hospital or YES + health facility? NO DON'T KNOW
4A120 + Were there any problems during admission to the hospital or YES + health facility? NO DON'T KNOW
4A130 + Were there any problems with the way (s)he was treated (medical treatment, YES + procedures, inter-personal attitudes, respect, dignity) in the NO + hospital or health facility? DON'T KNOW
4A140 + Were there any problems getting medications, or diagnostic tests YES + in the hospital or health facility? NO DON'T KNOW
4A150 Does it take more than 2 hours to get to the nearest hospital or YES health facility from the deceased's household? NO DON'T KNOW
4A160 In the final days before death, were there any doubts about whether YES medical care was needed? NO DON'T KNOW
WHO-VA 2012 RC1 A4-16 Appendix 4 NO. QUESTIONS AND FILTERS CODING CATEGORIES
4A170 In the final days before death, was traditional medicine used? YES NO DON'T KNOW
4A180 In the final days before death, did anyone use a telephone or cell phone YES to call for help? NO DON'T KNOW
4A190 Over the course of illness, did the total costs of care and treatment YES prohibit other household payments? NO DON'T KNOW
WHO-VA 2012 RC1 A4-17 Appendix 4 2012 WHO VERBAL AUTOPSY [FORM 2] DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS
5A100 INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
SUPERVISOR'S OBSERVATIONS
NAME OF THE SUPERVISOR: DATE:
WHO-VA 2012 RC1 A4-18 Appendix 4 2012 WHO VERBAL AUTOPSY SAMPLE QUESTIONNAIRE 3
Death of a person aged 15 years and above
WHO-VA 2012 RC1 A5-1 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 1. BASIC INFORMATION ABOUT THE INTERVIEW AND THE RESPONDENT
2A120 Name of verbal autopsy interviewer:
Surname
Name
2A140 RECORD THE DATE OF INTERVIEW DAY
MONTH
YEAR
2A130 RECORD THE TIME AT START OF INTERVIEW MORNING/EVENING
MORNING =1 HOUR EVENING=2
MINUTES
2A100 Name of verbal autopsy respondent:
Surname
Name
2A110 What is your relationship to the deceased? FATHER MOTHER SPOUSE SIBLING OTHER RELATIVE (SPECIFY) NO RELATION
2A115 Did you live with the deceased in the period leading YES to her/his death? NO
SECTION 2. INFORMATION ON THE DECEASED AND DATE/PLACE OF DEATH
1A100 What was the name of the deceased? Surname
Name
1A110 Was the deceased female or male? FEMALE MALE
1A200 Is date of birth known? YES NO
1A210 + When was the deceased born? DAY
MONTH
YEAR
1A220 Is date of death known? YES NO
1A230 + When did s/he die? DAY
MONTH
YEAR
1A240 How old was the deceased when s/he died? AGE IN YEARS
1A400 Was this a woman who died more than 42 days but less than 1 year YES after being pregnant or delivering a baby? NO DON'T KNOW
1A500 What was her/his citizenship/nationality? CITIZEN BY BIRTH NATURALIZED CITIZ. ALIEN DON'T KNOW
WHO-VA 2012 RC1 A5-2 Appendix 5 NO. QUESTIONS AND FILTERS CODING CATEGORIES
1A510 What was her/his ethnicity? ETHNICITY A ETHNICITY B ETHNICITY C OTHER (specify)
1A520 What was her/his place of birth?
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW
4 Urban/Rural URBAN RURAL
5 Other country OTHER COUNTRY (specify)
1A530 What was her/his place of usual residence?
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW
4 Urban/Rural URBAN RURAL
5 Other country OTHER COUNTRY (specify)
1A540 What was her/his place of normal residence 1 to 5 years before death?
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW
4 Urban/Rural URBAN RURAL
5 Other country OTHER COUNTRY (specify)
1A550 Where did death occur?
1 Larger admin area (e.g., province) LARGER ADMIN AREA
2 Smaller admin area (e.g., county) SMALLER ADMIN AREA
3 Locality (e.g., city, village) LOCALITY
DON'T KNOW
4 Urban/Rural URBAN RURAL
5 Other country OTHER COUNTRY (specify)
1A560 What was the site of death? HOSPITAL OTHER HEALTH FACILITY HOME OTHER (specify) DON'T KNOW
1A600 What was her/his marital status? NEVER MARRIED MARRIED/LIVING WITH A PARTNER WIDOWED DIVORCED SEPARATED DON'T KNOW
1A610 What was the date of marriage? DAY
RECORD '98' IF DON'T KNOW DAY OR MONTH RECORD '9998' IF DON'T KNOW YEAR MONTH
YEAR
WHO-VA 2012 RC1 A5-3 Appendix 5 NO. QUESTIONS AND FILTERS CODING CATEGORIES
1A630 What was the name of the mother?
Surname
Name
1A620 What was the name of the father?
Surname
Name
1A640 What was her/his highest level of schooling? NO FORMAL EDUCATION PRIMARY SECONDARY HIGHER DON'T KNOW
1A650 Was s/he able to read and write? YES NO DON'T KNOW
1A660 What was her/his economical activity status in year prior to death? USUALLY ECONOMICALLY ACTIVE MAINLY EMPLOYED MAINLY UNEMPLOYED
NOT ECONOMICALLY ACTIVE HOME-MAKER STUDENT PENSION OTHER (specify) DON'T KNOW
1A670 What was her/his occupation, that is, what kind of work did s/he mainly do?
SECTION 3. DEATH REGISTRATION AND CERTIFICATION
1A700 Death registration number
1A710 Date of registration DAY
RECORD '98' IF DON'T KNOW DAY OR MONTH MONTH RECORD '9998' IF DON'T KNOW YEAR
YEAR
1A720 Place where the death is registered:
1 Larger admin area (e.g., province)
2 Smaller admin area (e.g., county)
3 Locality (e.g., city, village)
4 Urban/Rural URBAN RURAL 5 Name of local registrar Surname Name DON'T KNOW
1A730 National identification number of deceased
WHO-VA 2012 RC1 A5-4 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 4. RESPONDENT'S ACCOUNT OF ILLNESS/EVENTS LEADING TO DEATH
Could you tell me about the illness/events that led to her his/death?
CAUSE OF DEATH 1 ACCORDING TO RESPONDENT
CAUSE OF DEATH 2 ACCORDING TO RESPONDENT
SECTION 5. CONTEXT AND HISTORY OF PREVIOUSLY KNOWN MEDICAL CONDITIONS
I would like to ask you some questions concerning the context and previously known medical conditions the deceased had; injuries and accidents that the deceased suffered; and signs and symptoms that the deceased had/showed when s/he was ill. Some of these questions may not appear to be directly related to his/her death. Please bear with me and answer all the questions. They will help us to get a clear picture of all possible symptoms that the deceased had.
3A100 Was there any diagnosis of Tuberculosis? YES NO DON'T KNOW
3A110 Was there any diagnosis of HIV/AIDS? YES NO DON'T KNOW
3A120 Did s/he have a recent positive test for Malaria? YES NO DON'T KNOW
3A130 Did s/he have a recent negative test for Malaria? YES NO DON'T KNOW
3A140 Was there any diagnosis of Measles? YES NO DON'T KNOW
3A150 Was there any diagnosis of High Blood Pressure? YES NO DON'T KNOW
3A160 Was there any diagnosis of Heart Disease? YES NO DON'T KNOW
3A170 Was there any diagnosis of Diabetes? YES NO DON'T KNOW
3A180 Was there any diagnosis of Asthma? YES NO DON'T KNOW
3A190 Was there any diagnosis of Epilepsy? YES NO DON'T KNOW
3A200 Was there any diagnosis of Cancer? YES NO DON'T KNOW
WHO-VA 2012 RC1 A5-5 Appendix 5 NO. QUESTIONS AND FILTERS CODING CATEGORIES
3A210 Was there any diagnosis of Chronic Obstructive Pulmonary Disease YES (COPD)? NO DON'T KNOW
3A220 Was there any diagnosis of Dementia? YES NO DON'T KNOW
3A230 Was there any diagnosis of Depression? YES NO DON'T KNOW
3A240 Was there any diagnosis of Stroke? YES NO DON'T KNOW
3A250 Was there any diagnosis of Sickle Cell disease? YES NO DON'T KNOW
3A260 Was there any diagnosis of Kidney disease? YES NO DON'T KNOW
3A270 Was there any diagnosis of Liver disease? YES NO DON'T KNOW
3A280 Did s/he die during the wet season? YES NO DON'T KNOW
3A290 Did s/he die during the dry season? YES NO DON'T KNOW
3A300 For how long was s/he ill before s/he died? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3A310 Did s/he die suddenly? YES NO DON'T KNOW
WHO-VA 2012 RC1 A5-6 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 6. HISTORY OF INJURIES/ACCIDENTS
3E100 Did s/he suffer from any injury or accident that led to her/his death? YES that led to her/his death? NO DON'T KNOW
3E110 + Did s/he suffer from a road traffic accident? YES NO DON'T KNOW
3E120 + + Was s/he injured as a pedestrian/walking? YES NO DON'T KNOW
3E130 + + Was s/he injured as an occupant of a car vehicle? YES NO DON'T KNOW
3E140 + + Was s/he injured as an occupant of a bus/heavy YES transport vehicle? NO DON'T KNOW
3E150 + + Was s/he injured as a driver or passenger of a motorcycle? YES NO DON'T KNOW
3E160 + + Was s/he injured as a pedal cyclist? YES NO DON'T KNOW
3E170 + + Do you know anything about the counter-part that was hit YES during the road traffic accident? NO
3E200 + + + Was it a pedestrian? YES NO DON'T KNOW
3E210 + + + Was it a stationary object? YES NO DON'T KNOW
3E220 + + + Was it a car vehicle? YES NO DON'T KNOW
3E230 + + + Was it a bus or heavy transport vehicle? YES NO DON'T KNOW
3E240 + + + Was it a motor cycle? YES NO DON'T KNOW
3E250 + + + Was it a pedal cycle? YES NO DON'T KNOW
3E260 + + + Was it something else? YES (specify)------NO DON'T KNOW
3E300 + Was s/he injured in a non-road transport accident? YES NO DON'T KNOW
3E310 + + Was s/he injured in a fall? YES NO DON'T KNOW
WHO-VA 2012 RC1 A5-7 Appendix 5 NO. QUESTIONS AND FILTERS CODING CATEGORIES
3E320 + + Did s/he die of drowning? YES NO DON'T KNOW
3E330 + + Did s/he suffer from burns? YES NO DON'T KNOW
3E340 + + Did (s)he suffer from any plant/animal/insect bite or sting YES + + that led to her/his death? NO DON'T KNOW
3E400 + + + Was it a dog? YES NO DON'T KNOW
3E410 + + + Was it a snake? YES NO DON'T KNOW
3E420 + + + Was it an insect? YES NO DON'T KNOW
3E500 + + Was s/he injured by a force of nature? YES NO DON'T KNOW
3E510 + + Was there any poisoning? YES NO DON'T KNOW
3E520 + Was s/he subject to violence or assault? YES NO DON'T KNOW
3E530 + Was the injury or accident intentionally inflicted by someone else? YES NO DON'T KNOW
3E600 + + Was s/he injured by a fire arm? YES NO DON'T KNOW
3E610 + + Was s/he injured from a stab, cut or pierce? YES NO DON'T KNOW
3E620 + + Was s/he injured by machinery? YES NO DON'T KNOW
3E630 + + Was s/he struck by an animal or object? YES NO DON'T KNOW
3E700 + Do you think that s/he committed suicide? YES NO DON'T KNOW
CHECK QUESTION 1A110 FOR SEX OF THE DECEASED:
IF FEMALE IF MALE SECTION 9
SECTION 7 AND 8
WHO-VA 2012 RC1 A5-8 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES
SECTION 7. SYMPTOMS AND SIGNS ASSOCIATED WITH ILLNESS OF WOMEN
3B720 Did she have an ulcer or swelling in the breast? YES NO DON'T KNOW
3B800 Did she have excessive vaginal bleeding in between menstrual YES periods? NO DON'T KNOW
3B810 Did her vaginal bleeding stopped naturally during menopause? YES NO DON'T KNOW
3B820 Did she have vaginal bleeding after menopause? YES NO DON'T KNOW
SECTION 8. SYMPTOMS AND SIGNS ASSOCIATED WITH PREGNANCY
3C100 Was she neither pregnant, nor delivered, within 6 weeks of her death? YES skip pregnancy section if YES NO OR DON'T KNOW
3C110 Was she pregnant at the time of death? YES NO OR DON'T KNOW
3C120 Did she die within 6 weeks of giving birth? YES NO OR DON'T KNOW
3C130 Did she die within 6 weeks of a pregnancy that lasted less YES than 6 months? NO DON'T KNOW
3C200 + Did she die within 24 hours after delivery? YES NO DON'T KNOW
3C210 + Did she die during labour, but undelivered? YES NO DON'T KNOW
3C220 + Was she breastfeeding at death? YES NO DON'T KNOW
3C230 + How many births, including stillbirths, did she have NUMBER OF BIRTHS/STILLBIRTHS + before this baby? DON'T KNOW
3C240 + Did she have any previous C-section? YES NO DON'T KNOW
3C250 + Did she die during or after a multiple pregnancy? YES NO DON'T KNOW
3C260 + During pregnancy, did she suffer from high blood pressure? YES NO DON'T KNOW
3C270 + Did she have foul smelling vaginal discharge during pregnancy YES + or after delivery? NO DON'T KNOW
3C280 + During the last 3 months of pregnancy, did she suffer from YES + convulsions? NO DON'T KNOW
WHO-VA 2012 RC1 A5-9 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES
3C290 + During the last 3 months of pregnancy, did she suffer from YES + blurred vision? NO DON'T KNOW
3C300 + Did she give birth to a live, healthy baby within 6 weeks of death? YES NO DON'T KNOW
3C310 + Was there any vaginal bleeding during pregnancy or YES + after delivery? NO DON'T KNOW
3C320 + + Was there vaginal bleeding during the first 6 moths YES + + of pregnancy? NO DON'T KNOW
3C330 + + Was there vaginal bleeding during the last 3 months of YES + + pregnancy but before labour started? NO DON'T KNOW
3C340 + + Was there excessive vaginal bleeding during labour? YES NO DON'T KNOW
3C350 + + Was there excessive vaginal bleeding after delivering the baby? YES NO DON'T KNOW
3C360 + Was the placenta not completely delivered? YES NO DON'T KNOW
3C365 + Did she deliver or try to deliver an abnormally positioned baby? YES NO DON'T KNOW
3C370 + Was she in labour for unusually long (more than 24 hours)? YES NO DON'T KNOW
3C380 Did she attempt to terminate the pregnancy? YES NO DON'T KNOW
3C390 + Did she recently have a pregnancy that ended in YES + an abortion (spontaneous or induced)? NO DON'T KNOW
3C400 + Did she give birth in a health facility? YES NO DON'T KNOW
3C410 + Did she give birth at home? YES NO DON'T KNOW
3C420 + Did she give birth elsewhere, e.g. on the way to a facility? YES NO DON'T KNOW
3C430 + Did she receive professional assistance for the delivery? YES NO DON'T KNOW
3C440 + Did she have an operation to remove her uterus shortly YES + before death? NO DON'T KNOW
WHO-VA 2012 RC1 A5-10 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES
3C450 + Did she have a normal vaginal delivery? YES NO DON'T KNOW
3C460 + Did she have an assisted delivery, with forceps/vacuum? YES NO DON'T KNOW
3C470 + Was it a delivery with caesarean section? YES NO DON'T KNOW
3C480 + Was the baby born more than one month early? YES NO DON'T KNOW
SECTION 10. SYMPTOMS NOTED DURING THE FINAL ILLNESS
3B100 Did s/he have a fever? YES NO DON'T KNOW
3B110 + For how long did s/he have a fever? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B120 + Did s/he have night sweats? YES NO DON'T KNOW
3B130 Did s/he have a cough? YES NO DON'T KNOW
3B140 + For how long did s/he have a cough? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B150 + Was the cough productive with sputum? YES NO DON'T KNOW
3B160 + Did s/he cough out blood? YES NO DON'T KNOW
3B180 Did s/he have any breathing problem? YES NO DON'T KNOW
3B190 + Did s/he have fast breathing? YES NO DON'T KNOW
3B200 + + For how long did s/he have fast breathing? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B210 + Did s/he have breathlessness? YES NO DON'T KNOW
3B220 + + For how long did s/he have breathlessness? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B230 + + Was s/he unable to carry out daily routine activities due to YES + + breathlessness? NO DON'T KNOW
3B240 + + Was s/he breathless while lying flat? YES NO DON'T KNOW
WHO-VA 2012 RC1 A5-11 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES
3B260 + Did s/he have noisy breathing (grunting or wheezing)? YES + DEMONSTRATE NO DON'T KNOW
3B270 Did s/he have severe chest pain? YES NO DON'T KNOW
3B280 Did s/he have diarrhoea? YES NO DON'T KNOW
3B290 + For how long did s/he have diarrhoea? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B300 + At any time during the final illness was there blood in the stools? YES NO DON'T KNOW
3B310 Did s/he vomit? YES NO DON'T KNOW
3B320 + Did s/he vomit "coffee grounds" or bright red/blood? YES NO DON'T KNOW
3B330 Did s/he have any abdominal problem? YES NO DON'T KNOW
3B340 + Did s/he have severe abdominal pain? YES NO DON'T KNOW
3B350 + + For how long before death did s/he have severe abdominal NUMBER OF DAYS + + pain? NUMBER OF WEEKS DON'T KNOW
3B360 + Did s/he have more than usual protruding abdomen? YES NO DON'T KNOW
3B370 + + For how long did s/he have a more than usual protruding NUMBER OF DAYS + + abdomen? NUMBER OF WEEKS DON'T KNOW
3B380 + Did s/he have any lump inside the abdomen? YES NO DON'T KNOW
3B390 + + For how long did s/he have the lump inside the abdomen? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B400 Did s/he have a severe headache? YES NO DON'T KNOW
3B405 Did s/he have a stiff or painful neck? YES NO DON'T KNOW
3B410 + For how long did s/he have a stiff or painful neck? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B420 Did s/he have mental confusion? YES NO DON'T KNOW
3B430 + For how long did s/he have mental confusion? NUMBER OF DAYS NUMBER OF MONTHS DON'T KNOW
3B440 Was s/he unconscious for more than 24 hours? YES NO DON'T KNOW
WHO-VA 2012 RC1 A5-12 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES
3B450 Did the unconsciousness start suddenly, YES quickly (at least within a single day)? NO DON'T KNOW
3B460 Did s/he have convulsions? YES NO DON'T KNOW
3B470 + For how long did s/he have convulsions? NUMBER OF MINUTES DON'T KNOW
3B480 + Did s/he became unconscious immediately after the convulsion? YES NO DON'T KNOW
3B490 Did s/he have any urine problems? YES NO DON'T KNOW
3B500 + Did s/he pass no urine at all? YES NO DON'T KNOW
3B510 + Did s/he go to urinate more often than usual? YES NO DON'T KNOW
3B520 + During the final illness did s/he ever pass blood in the urine? YES NO DON'T KNOW
3B530 Did s/he have any skin problems? YES NO DON'T KNOW
3B540 + Did s/he have any ulcers, abscess or sores YES + anywhere except the feet? NO DON'T KNOW
3B550 + Did (s)he have any ulcers, abscess or sores on the feet YES + that were not also on other parts of the body? NO DON'T KNOW
3B560 + During the illness that led to death, did s/he have any skin rash? YES NO DON'T KNOW
3B570 + + For how long did s/he have the skin rash? NUMBER OF DAYS NUMBER OF WEEKS DON'T KNOW
3B580 + + Did s/he have measles rash? YES NO DON'T KNOW
3B590 + + Did s/he ever have shingles/herpes zoster? YES NO DON'T KNOW
3B600 Did s/he have bleeding from the nose, mouth, or anus? YES NO DON'T KNOW
3B610 Did s/he have weight loss? YES NO DON'T KNOW
3B620 + Was s/he severely thin or wasted? YES NO DON'T KNOW
3B630 Did s/he have mouth sores or white patches in the mouth YES or on the tongue? NO DON'T KNOW
3B640 Did s/he have stiffness of the whole body or was unable to open YES the mouth? NO DON'T KNOW
WHO-VA 2012 RC1 A5-13 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES
3B650 Did s/he have swelling (puffiness) of the face? YES NO DON'T KNOW
3B660 Did s/he have both feet swollen? YES NO DON'T KNOW
3B670 Did s/he have any lumps? YES NO DON'T KNOW
3B680 + Did s/he have any lumps or lesions in the mouth? YES NO DON'T KNOW
3B690 + Did s/he have any lumps on the neck? YES NO DON'T KNOW
3B700 + Did s/he have any lumps on the armpit? YES NO DON'T KNOW
3B710 + Did s/he have any lumps on the groin? YES NO DON'T KNOW
3B730 Did s/he have paralysis of one side of the body? YES NO DON'T KNOW
3B740 Did s/he have difficulty or pain while swallowing liquids? YES NO DON'T KNOW
3B750 Did s/he have yellow discoloration of the eyes? YES NO DON'T KNOW
3B760 Did her/his hair colour change to reddish or yellowish? YES NO . DON'T KNOW
3B770 Did s/he look pale (thinning/lack of blood) or have pale palms, YES eyes or nail beds? NO DON'T KNOW
3B780 Did s/he have sunken eyes? YES NO DON'T KNOW
3B790 Did (s)he drink a lot more water than usual? YES NO DON'T KNOW
WHO-VA 2012 RC1 A5-14 Appendix 5 2012 WHO VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
NO. QUESTIONS AND FILTERS CODING CATEGORIES SECTION 10. TREATMENT AND HEALTH SERVICE USE FOR THE FINAL ILLNESS
3G100 Was s/he adequately vaccinated? YES NO DON'T KNOW
3G110 Did s/he receive any treatment for the illness that led to death? YES NO DON'T KNOW
3G120 + Did s/he receive oral rehydration salts? YES NO DON'T KNOW
3G130 + Did s/he receive (or needed) intravenous fluids (drip) treatment? YES NO DON'T KNOW
3G140 + Did s/he receive (or needed) a blood transfusion? YES NO DON'T KNOW
3G150 + Did s/he receive (or needed) treatment/food through a tube passed YES + through the nose? NO DON'T KNOW
3G160 + Did s/he receive (or needed) injectable (IV or IM) antibiotics? YES NO DON'T KNOW
3G170 + Did s/he have (or needed) an operation for the illness? YES NO DON'T KNOW
3G180 + + Did s/he have the operation within 1 month before death? YES NO DON'T KNOW
3G190 + Was s/he discharged from the hospital very ill? YES NO DON'T KNOW
SECTION 11. RISK FACTORS
3F100 Did s/he drink alcohol? YES NO DON'T KNOW
3F110 Did s/he smoke tobacco. (cigarette, cigar, pipe, etc.)? YES NO DON'T KNOW
SECTION 12. BACKGROUND
4A100 In the final days before death, did s/he travel to a hospital or YES health facility? NO DON'T KNOW
4A110 + Did s/he use motorised transport to get to the hospital or YES + health facility? NO DON'T KNOW
4A120 + Were there any problems during admission to the hospital or YES + health facility? NO DON'T KNOW
4A130 + Were there any problems with the way (s)he was treated (medical treatment, YES + procedures, inter-personal attitudes, respect, dignity) in the NO + hospital or health facility? DON'T KNOW
4A140 + Were there any problems getting medications, or diagnostic tests YES + in the hospital or health facility? NO DON'T KNOW
WHO-VA 2012 RC1 A5-15 Appendix 5 NO. QUESTIONS AND FILTERS CODING CATEGORIES
4A150 Does it take more than 2 hours to get to the nearest hospital or YES health facility from the deceased's household? NO DON'T KNOW
4A160 In the final days before death, were there any doubts about whether YES medical care was needed? NO DON'T KNOW
4A170 In the final days before death, was traditional medicine used? YES NO DON'T KNOW
4A180 In the final days before death, did anyone use a telephone or cell phone YES to call for help? NO DON'T KNOW
4A190 Over the course of illness, did the total costs of care and treatment YES prohibit other household payments? NO DON'T KNOW
WHO-VA 2012 RC1 A5-16 Appendix 5 INTERNATIONAL SIMPLIFIED VERBAL AUTOPSY [FORM 3] DEATH OF A PERSON AGED 15 YEARS AND ABOVE
5A100 INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
SUPERVISOR'S OBSERVATIONS
NAME OF THE SUPERVISOR: DATE:
WHO-VA 2012 RC1 A5-17 Appendix 5