The 2012 WHO verbal autopsy instrument Release Candidate 1

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 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. .

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.

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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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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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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

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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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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 interviewers

These notes give some explanations that guide 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.


17

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.


18

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.


19

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.


20

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


21

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.


22

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, <http://www.interva.net/> (2011). 4 Murray, C. J. et al. Population Health Metrics Research Consortium gold standard verbal autopsy

validation study: design, implementation, and development of analysis datasets. Popul Health Metr 9, 27, doi:1478-7954-9-27 [pii] 10.1186/1478-7954-9-27 (2011).

5 Soleman, N., Chandramohan, D. & Shibuya, K. Verbal autopsy: current practices and challenges. Bull World Health Organ 84, 239-245, doi:S0042-96862006000300020 [pii] /S0042-96862006000300020 (2006).

6 Garenne, M. & Fauveau, V. Potential and limits of verbal autopsies. Bull World Health Organ 84, 164, doi:S0042-96862006000300004 [pii] /S0042-96862006000300004 (2006).

7 Murray, C. J., Lopez, A. D., Feehan, D. M., Peter, S. T. & Yang, G. Validation of the symptom pattern method for analyzing verbal autopsy data. PLoS Med 4, e327, doi:07-PLME-RA-0521 [pii] 10.1371/journal.pmed.0040327 (2007).

8 Abouzahr, C. Verbal autopsy: who needs it? Popul Health Metr 9, 19, doi:1478-7954-9-19 [pii] 10.1186/1478-7954-9-19 (2011).

9 Setel, P. W. Verbal autopsy and global mortality statistics: if not now, then when? Popul Health Metr 9, 20, doi:1478-7954-9-20 [pii] 10.1186/1478-7954-9-20 (2011).

10 Fottrell, E. Advances in verbal autopsy: pragmatic optimism or optimistic theory? Popul Health Metr 9, 24, doi:1478-7954-9-24 [pii] 10.1186/1478-7954-9-24 (2011).

11 Fottrell E, Byass P. Verbal Autopsy – methods in transition. Epidemiologic Reviews 2010; 32:38-55


A1-1

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.

Verbal autopsy code Verbal autopsy title

ICD-10 code (to ICD)

ICD-10 codes (from ICD)

VAs-01 Infectious and parasitic diseases

VAs-01.01 Sepsis A41 A40-A41

VAs-01.02 Acute respiratory infection, including pneumonia

J22/J18 J00-J22

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

VAs-01.07 Meningitis and encephalitis G03;G04 A39; G00-

G05

VAs-01.08

Tetanus Excludes: Neonatal tetanus VAs-10.05

A35 (obstetrical A34)

A33-A35

VAs-01.09 Pulmonary tuberculosis A16 A15-A16 VAs-01.10 Pertussis A37 A37 VAs-01.11 Haemorrhagic fever A99 A90-A99

VAs-01.99 Other and unspecified infectious disease

B99 A17-A19 A20-A38; A42-A89; B00-B19; B25-B49; B55-B99

A1-2

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-communicable disease Note: This group covers all non-communicable conditions that could not be assigned to another category in this section. There is a separate category for cases where the cause of death is unknown.

R99 D55-D89; E00-E07; E15-E35; E50-E90; F00-F99; G06-G09 G10-G37; G50-G99; 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

VAs-02.05 Female reproductive neoplasms

C57 C51-C58

VAs-02.06 Male reproductive neoplasms C63 C60-C63

VAs-02.99 Other and unspecified neoplasms C80 C07-C14

C40-C49


A1-3

C60-D48

A1-4

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

VAs-04.01 Acute cardiac disease I24 (acute ischemic)

I20-I25

VAs-04.02 Stroke I64 I60-I69 VAs-04.03 Sickle cell with crisis D57 D57

VAs-04.99 Other and unspecified cardiac disease

I99 I00-I09 I10-I15 I26-I52 I70-I99

VAs-05 Respiratory disorders

VAs-05.01 Chronic obstructive pulmonary disease (COPD)

J44 J40-J44

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


A1-5

VAs-09 Pregnancy-, childbirth and puerperium-related disorders

VAs-09.01 Ectopic pregnancy O00 O00 VAs-09.02 Abortion-related death O06 O03-O08

VAs-09.03 Pregnancy-induced hypertension O13 (or O15 for eclampsia)

O10-O16

VAs-09.04 Obstetric haemorrhage

O46 (ante partum) O72 (post partum)

O46; O67; O72

VAs-09.05 Obstructed labour O66 O63-O66

VAs-09.06 Pregnancy-related sepsis

O75.3 (ante partum) O85 (post partum)

O85; O75.3

VAs-09.07 Anaemia of pregnancy O99 O99.0 VAs-09.08 Ruptured uterus O71 O71

VAs-09.99 Other and unspecified maternal cause

O05 O01-O02; O20-O45; O47-O62; 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

VAs-10.99 Other and unspecified perinatal cause of death

P96 P00-P04; P08-P15; P26-P35; P37-P94; P96

A1-6

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.

VAs-12.01 Road traffic accident V89 V01-V89

VAs-12.02 Other transport accident V99 V90-V99 VAs-12.03 Accidental fall W19 W00-W19

VAs-12.04 Accidental drowning and submersion

W74 W65-W74

VAs-12.05 Accidental exposure to smoke, fire and flames

X09 X00-X19

VAs-12.06 Contact with venomous animals and plants

X29 X20-X29

VAs-12.07 Accidental poisoning and exposure to noxious substance

X49 X40-X49

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

VAs-12.99 Other and unspecified external cause of death

X59 S00-T99; W20-W64; W75-W99; X50-X59; Y10-Y98

VAs-99 Cause of death unknown R99 R95-R99


A1-7

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.

Variable Data typeThreshold values

1st level question2nd level question

3rd level question

4th level question

AGE_

65-P

lus

AGE_

50-6

4AG

E_15

-49

AGE_

5_14

YAG

E_1_

4YAG

E1_1

1MAG

E_U

28d

MAL

EFE

MAL

EFE

MAL

E 12

-

Notes for translators and interviewers

1A Section Information on the deceased

Important information for assessing cause of death and defining skip pattern.

1A100 Text What was the name of the deceased?

1 1 1 1 1 1 1 1 1 1

1A110 Single select

Male/Female

Was the deceased female or male?

1 1 1 1 1 1 1 1 1 1 This can be derived from a general question about the sex of the deceased. Either male or female must be selected for every case.

1A110A Calculated (Y/N/DNK)

Was the deceased male?

Male

1 1 1 1 1 1 1 1 1 1

1A110B Calculated (Y/N/DNK)

Was the deceased female?

Female

1 1 1 1 1 1 1 1 1 1

1A200 Yes/No/DontKnow=1/0/9

Is date of birth known?

1 1 1 1 1 1 1 1 1 1 A reliable estimate of age at death must be obtained 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.

WHO-VA 2012 RC1 Appendix 2 - List of indicators

A2-1

1A210 Date When was the deceased born?

1 1 1 1 1 1 1 1 1 1


Is date of death known?

1 1 1 1 1 1 1 1 1 1

1A230 Date When did (s)he die?

1 1 1 1 1 1 1 1 1 1

1A240 Number [years]

[0-130] How many years old was (s)he at death?

1 1 1 1 1 1 1 1 1 1

1A250 Number [months]

[0-12] How many months old was (s)he at death?

1 1 1 1 1 1 1 1 1 1

1A260 Number [days]

[0-31] How many days old was (s)he at death?

1 1 1 1 1 1 1 1 1 1


65+ years Was (s)he aged 65 years or over at death?

1 0 0 0 0 0 0 1 1 0 This can be derived from a general question about the age of the deceased at the time of death. Select this for someone aged 65 years or over at death.


50-64 years

Was (s)he aged 50 to 64 years at death?

0 1 0 0 0 0 0 1 1 0 This can be derived from a general question about the age of the deceased at the time of death. Select this for someone aged 50 to 64 years at death.


A2-2

1A260C Calculated (Y/N/DNK)

15-49 years

Was (s)he aged 15-49 years at death?

0 0 1 0 0 0 0 1 1 0 This can be derived from a general question about the age of the deceased at the time of death. Select this for someone aged 15-49 years at death.

1A260D Calculated (Y/N/DNK)

5-14 years Was (s)he aged 5 to 14 years at death?


1A260E Calculated (Y/N/DNK)

1-4 years Was (s)he aged 1 to 4 years at death?


1A260F Calculated (Y/N/DNK)

1-11 months

Was (s)he aged 1 to 11 months at death?

0 0 0 0 0 1 0 1 1 0 This can be derived from a general question about the age of the deceased at the time of death. Select this for someone aged 1 to 11 months at death.

1A260G Calculated (Y/N/DNK)

≤28 days Was (s)he aged 28 days or less at death?

0 0 0 0 0 0 1 1 1 0 This can be derived from a general question about the age of the deceased at the time of death. Select this for someone aged 28 days or less at death.


A2-3

1A260H Calculated (Y/N/DNK)

≤24 hours Did the baby die within 24 hours of birth?

0 0 0 0 0 0 1 1 1 0 This can be derived from a general question about the age of a baby at the time of death. Select this for a baby who died within 24 hours of being born.

1A260I Calculated (Y/N/DNK)

>24h to 48 hours

Did baby die more than 24 hours after but less than 48 hours from birth?

0 0 0 0 0 0 1 1 1 0 This can be derived from a general question about the age of a baby at the time of death. Select this for a baby who died more than 24 hours but less than 48 hours of being born.

1A260J Calculated (Y/N/DNK)

>48 hours to 6 days

Did baby die more than 48 hours from birth but within the first week of life?

0 0 0 0 0 0 1 1 1 0 This can be derived from a general question about the age of a baby at the time of death. Select this for a baby who died more than 48 hours after being born, but within the first week of life.

1A260K Calculated (Y/N/DNK)

7 to 28 days

Did baby die after first week, but within first 28 days?

0 0 0 0 0 0 1 1 1 0 This can be derived from a general question about the age of a baby at the time of death. Select this for a baby who died after the first week of life, but within the first month.

1A260L Calculated (Y/N/DNK)

12 to 19 years and female

Was this a woman aged 12 to 19 years at death?

0 0 1 1 0 0 0 0 1 1 This can be derived from a general question about the age of a woman who died. Select this category for a woman aged 12 to 19 years at death.


A2-4

1A260M Calculated (Y/N/DNK)


Was this a woman aged 20-34 years at death?


1A260N Calculated (Y/N/DNK)


Was this a woman aged 35-49 years at death?



Was this a woman who died more than 42 days but less than 1 year after being pregnant or delivering a baby?

0 0 1 1 0 0 0 0 1 1 Select this for a woman who died more than 42 days but less than 1 year after being pregnant or delivering a baby.

1A500 Single select

Citizen by birth/Naturalized citizen/Alien/ DNK

What was her/his citizenship/nationality?

1 1 1 1 1 1 1 1 1 1 Record the citizenship or nationality of the person who died.


Citizen by birth

Was (s)he a citizen by birth?

1 1 1 1 1 1 1 1 1 1


Naturalized citizen

Was (s)he a naturalized citizen?

1 1 1 1 1 1 1 1 1 1


A2-5


Alien Was (s)he a foreign national?

1 1 1 1 1 1 1 1 1 1

1A510 Text What was her/his ethnicity?

1 1 1 1 1 1 1 1 1 1 Record the ethnicity of the person who died, using locally accepted ethnic groups.

1A520 Text

What was her/his place of birth?

1 1 1 1 1 1 1 1 1 1 Record her/his place of birth (country/province/village).

1A530 Text What was her/his place of usual residence?

1 1 1 1 1 1 1 1 1 1 Record her/his place of usual residence (country/province/village)..

1A540 TextWhat was her/his place of normal residence 1 to 5 years before death?

1 1 1 1 1 1 0 1 1 1 Record her/his place of normal residence 1 to 5 years before death (country/province/village)..

1A550 Text Where did death occur?

1 1 1 1 1 1 1 1 1 1 Record where the death occurred (country/province/village)..

1A560 Single select

Hospital/Other health facility/home/other/DNK

What was the site of death?

1 1 1 1 1 1 1 1 1 1 Record the site of the death.


Hospital Did (s)he die in a hospital?

1 1 1 1 1 1 1 1 1 1


Other health facility

Did (s)he die in another health facility?

1 1 1 1 1 1 1 1 1 1


A2-6


Home Did (s)he die at home?

1 1 1 1 1 1 1 1 1 1


Other Did (s)he die in another place?

1 1 1 1 1 1 1 1 1 1

1A600 Single select

Single/Married/Divorced/Widowed/Too young/DNK

What was her/his marital status?

1 1 1 1 0 0 0 1 1 1 Record the marital status of the person who died.


Single Was the deceased single?

1 1 1 1 0 0 0 1 1 1


Married Was the deceased married?

1 1 1 1 0 0 0 1 1 1


Divorced Was the deceased divorced?

1 1 1 1 0 0 0 1 1 1


Widowed Was the deceased widowed?

1 1 1 1 0 0 0 1 1 1


Too young Was the deceased too young to be married?

1 1 1 1 0 0 0 1 1 1

1A610 DateWhat was the date of marriage?

1 1 1 1 0 0 0 1 1 1 Record the date of marriage, for a married person.


A2-7

1A620 Text What was the name of the father?

1 1 1 1 1 1 1 1 1 1 Record the father's name of the person who died.

1A630 Text What was the name of the mother?

1 1 1 1 1 1 1 1 1 1 Record the mother's name of the person who died.

1A640 Single select

No formal education/Primary/Secondary/Higher/DNK

What was her/his highest level of schooling?

1 1 1 1 1 0 0 1 1 1 Record the highest level of schooling for the person who died.


No formal education

Did (s)he have no formal education?

1 1 1 1 1 0 0 1 1 1


Primary Was her/his highest level of schooling primary school?

1 1 1 1 1 0 0 1 1 1


SecondaryWas her/his highest level of schooling secondary school?

1 1 1 1 1 0 0 1 1 1


Higher Was her/his highest level of schooling higher than secondary school?

1 1 1 1 1 0 0 1 1 1


Was (s)he able to read and write?

1 1 1 1 0 0 0 1 1 1 Record the literacy status of the person who died.


A2-8

1A660 Single select

Mainly employed/Mainly unemployed/Home-maker/Student/Pension/Other/DNK

What was her/his economic activity status in year prior to death?

1 1 1 1 0 0 0 1 1 1 Record the main economic activity of the person who died, before they became ill.


Mainly employed Was (s)he mainly

employed in the year prior to death?

1 1 1 1 0 0 0 1 1 1


Mainly unemployed

Was (s)he mainly unemployed in the year prior to death?

1 1 1 1 0 0 0 1 1 1


Home-maker Was (s)he working

as a home.-maker in the year prior to death?

1 1 1 1 0 0 0 1 1 1


Student Was (s)he a student in the year prior to death?

1 1 1 1 0 0 0 1 1 1


Pension Did (s)he live on a pension in the year prior to death?

1 1 1 1 0 0 0 1 1 1


A2-9


Other

Did (s)he have another economic activity in the year prior to death?

1 1 1 1 0 0 0 1 1 1

1A670 TextWhat was her/his occupation, that is, what kind of work did (s)he mainly do?

1 1 1 1 0 0 0 1 1 1 Record the occupation of the person who died.

1A7 Section Vital registration and certification

These data allow linkage to vital registration

1A700 Text Death registration number/certificate

1 1 1 1 1 1 1 1 1 1 Record the death registration number or certificate number.

1A710 Date Date of registration

1 1 1 1 1 1 1 1 1 1 Record the date of registering the death.

1A720 Text Place of registration

1 1 1 1 1 1 1 1 1 1 Record the place of registering the death indicating the province/county/city/village and whether this was an urban or rural region.

1A730 Text National identification number of deceased

1 1 1 1 1 1 1 1 1 1 Record the National identification number of deceased, if available.

2A Section Information on the respondent

This information is relevant to quality assurance.

2A100 Text Name of VA respondent

1 1 1 1 1 1 1 1 1 1 Record the name of VA respondent.


A2-10

2A110 Single select

Parent/Child/Other family/Friend/Health worker/Official/Other

Relationship of respondent to deceased

1 1 1 1 1 1 1 1 1 1 Record the relationship of the VA respondent to the deceased.


Parent Is the respondent a parent of the deceased?

1 1 1 1 1 1 1 1 1 1


Child Is the respondent a child of the deceased?

1 1 1 1 1 1 1 1 1 1


Other family

Is the respondent another family member of the deceased?

1 1 1 1 1 1 1 1 1 1


Friend Is the respondent a friend of the deceased?

1 1 1 1 1 1 1 1 1 1


Health worker

Is the respondent a health worker?

1 1 1 1 1 1 1 1 1 1


Official Is the respondent a public official?

1 1 1 1 1 1 1 1 1 1


A2-11

2A110G Calculated (Y/N/DNK)

Other Is the respondent in any other kind of relationship to the deceased?

1 1 1 1 1 1 1 1 1 1


Did the respondent live with the deceased in the period leading to her/his death?

1 1 1 1 1 1 1 1 1 1 Record whether the respondent lived with the deceased.

2A120 Text Name of VA interviewer

1 1 1 1 1 1 1 1 1 1 Record the name of VA interviewer.

2A130 Time Time at start of interview

1 1 1 1 1 1 1 1 1 1

2A140 Date Date of interview 1 1 1 1 1 1 1 1 1 1

3A Section Medical history associated with final illness


Was there any diagnosis of Tuberculosis?

1 1 1 1 1 1 0 1 1 1 This reflects a diagnosis of tuberculosis made at some kind of medical facility, which may pre-date the deceased's final illness.


Was there any diagnosis of HIV/AIDS?

1 1 1 1 1 1 0 1 1 1 This reflects a diagnosis of HIV or AIDS (including a positive HIV test) made at some kind of medical facility, which may pre-date the deceased's final illness.


Did (s)he have a recent positive test for malaria?

1 1 1 1 1 1 0 1 1 1 This reflects a positive test for malaria within a week of death.


A2-12


Did (s)he have a recent negative test for malaria?

1 1 1 1 1 1 0 1 1 1 This reflects a negative test for malaria within a week of death.


Was there any diagnosis of Measles?

1 1 1 1 1 1 0 1 1 1 This reflects a diagnosis of measles made at some kind of medical facility, within a month of death.


Was there any diagnosis of High Blood pressure?

1 1 1 1 0 0 0 1 1 1 This reflects a diagnosis of hypertension, and may 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.


Was there any diagnosis of heart disease?

1 1 1 1 1 1 0 1 1 1 This reflects a diagnosis of heart disease made at some kind of medical facility, which may pre-date the deceased's final illness.


Was there any diagnosis of diabetes?

1 1 1 1 1 1 0 1 1 1 This reflects a diagnosis of diabetes made at some kind of medical facility, which may pre-date the deceased's final illness.


Was there any diagnosis of asthma?

1 1 1 1 1 1 0 1 1 1 This reflects a diagnosis of asthma made at some kind of medical facility, which may pre-date the deceased's final illness.


A2-13


Was there any diagnosis of epilepsy?

1 1 1 1 1 1 0 1 1 1 This reflects a diagnosis of epilepsy made at some kind of medical facility, which may pre-date the deceased's final illness.


Was there any diagnosis of cancer?

1 1 1 1 1 0 0 1 1 1 This reflects a diagnosis of cancer made at some kind of medical facility, which may pre-date the deceased's final illness.


Was there any diagnosis of Chronic Obstructive Pulmonary Disease (COPD)?

1 1 1 0 0 0 0 1 1 0 This reflects a diagnosis of chronic obstructive pulmonary disease (COPD) made at some kind of medical facility, which may pre-date the deceased's final illness.


Was there any diagnosis of dementia?

1 1 1 0 0 0 0 1 1 0 This reflects a diagnosis of dementia made at some kind of medical facility, which may pre-date the deceased's final illness.


Was there any diagnosis of depression?

1 1 1 0 0 0 0 1 1 0 This reflects a diagnosis of clinical depression, which may have been relevant to the final illness.


Was there any diagnosis of stroke?

1 1 1 1 0 0 0 1 1 1 This reflects a diagnosis of stroke made at some kind of medical facility, which may pre-date the deceased's final illness.


A2-14


Was there any diagnosis of sickle cell disease?

1 1 1 1 1 1 0 1 1 1 This reflects a diagnosis of sickle cell disease made at some kind of medical facility, which may pre-date the deceased's final illness.


Was there any diagnosis of kidney disease?

1 1 1 1 1 0 0 1 1 1 This reflects a diagnosis of kidney disease made at some kind of medical facility, which may pre-date the deceased's final illness.


Was there any diagnosis of liver disease?

1 1 1 1 0 0 0 1 1 1 This reflects a diagnosis of liver disease made at some kind of medical facility, which may pre-date the deceased's final illness.


Did (s)he die during the wet season?

1 1 1 1 1 1 1 1 1 1 Select one of these according to local conditions, with wet season covering months of usual rainfall and immediate aftermath, and dry season covering months with no or very little expected rainfall.


Did (s)he die during the dry season?

1 1 1 1 1 1 1 1 1 1 Select one of these according to local conditions, with wet season covering months of usual rainfall and immediate aftermath, and dry season covering months with no or very little expected rainfall.


A2-15

3A300 Number [weeks]

[0-999] For how long was (s)he ill before (s)he died?

1 1 1 1 1 1 1 1 1 1 This reflects the time period that the deceased started feeling ill with onset of symptoms until the time of death.


< 3 weeks Was (s)he ill for less than 3 weeks before death?

1 1 1 1 1 1 1 1 1 1 Select this if the final illness lasted less than 3 weeks.


≥ 3 weeks Was (s)he ill for 3 weeks or more before death?

1 1 1 1 1 1 1 1 1 1 Select this if the final illness lasted 3 weeks or more.


Did (s)he die suddenly?

1 1 1 1 1 1 1 1 1 1 Select this either if the final illness lasted less than a 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/DontKnow=1/0/9

Did (s)he have a fever?

1 1 1 1 1 1 1 1 1 1 Select this if there were any signs of fever during the final illness.

3B110 Number [weeks]

[0-99] For how long did (s)he have a fever?

1 1 1 1 1 1 0 1 1 1 This reflects the period of time that the deceased had fever during the final illness, continuously or on and off.

3B110A Calculated (Y/N/DNK)

< 2 weeks Did (s)he have fever for less than 2 weeks before death?

1 1 1 1 1 1 0 1 1 1 Select this is if the fever lasted less than 2 weeks.


A2-16

3B110B Calculated (Y/N/DNK)

≥ 2 weeks Did (s)he have fever for 2 weeks or more before death?

1 1 1 1 1 1 0 1 1 1 Select this if the fever lasted 2 weeks or more.


Did (s)he have night sweats?

1 1 1 1 1 0 0 1 1 1 If the "any fever" indicator is selected, select this one if the deceased particularly experienced heavy night sweats.


Did (s)he have a cough?

1 1 1 1 1 1 1 1 1 1 Select this if there was any cough during the final illness.


[0-99] For how long did (s)he have a cough?

1 1 1 1 1 1 0 1 1 1 This reflects the duration of cough during the final illness.


< 3 weeks Did (s)he have a cough for less than 3 weeks before death?

1 1 1 1 1 1 0 1 1 1 Select this if the cough lasted less than 3 weeks.


≥ 3 weeks Did (s)he have a cough for 3 weeks or more before death?

1 1 1 1 1 1 0 1 1 1 Select this if the cough lasted 3 weeks or more.


Was the cough productive, with sputum?

1 1 1 1 1 0 0 1 1 1 If the "any cough" indicator is selected, select this one if the deceased regularly coughed up sputum or mucus.


Did (s)he cough up blood?

1 1 1 1 1 0 0 1 1 1 If the "any cough" indicator is selected, select this one if the deceased coughed up blood.


A2-17


Did (s)he make a whooping sound when coughing?

0 0 0 0 1 1 1 1 1 0 If the "any cough" indicator is selected, select this one if 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.


Did (s)he have any breathing problem?

1 1 1 1 1 1 1 1 1 1 Select this if there were any problems of breathing during the final illness (before the moment of death).


Did (s)he have fast breathing?

1 1 1 1 1 1 1 1 1 1 If the "any breathing problem" indicator is 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 did (s)he have fast breathing?

1 1 1 1 1 1 1 1 1 1 This reflects the time period that the deceased suffered from breathing much faster than normal during the final illness.


< 2 weeks Did (s)he have fast breathing for less than 2 weeks?

1 1 1 1 1 1 1 1 1 1 Select this if the fast breathing lasted for less than 2 weeks.


≥ 2 weeks Did (s)he have fast breathing for 2 weeks or more?

1 1 1 1 1 1 0 1 1 1 Select this if the fast breathing lasted for 2 weeks or more.


A2-18


Did (s)he have breathlessness?

1 1 1 1 1 1 1 1 1 1 Select this if the deceased had difficulty breathing and was out of breath during the final illness.

3B220 Weeks [0-99] For how long did (s)he have breathlessness?

1 1 1 1 1 1 1 1 1 1 This reflects the time period during the final illness that the deceased had difficulty breathing.


< 2 weeks Did (s)he have breathlessness for less than 2 weeks?

1 1 1 1 1 1 1 1 1 1 Select this if the breathlessness lasted for less than 2 weeks.


≥ 2 weeks Did (s)he have breathlessness for 2 weeks or more?

1 1 1 1 1 1 0 1 1 1 Select this if the breathlessness lasted for 2 weeks or more.


Was (s)he unable to carry out daily routines due to breathlessness?

1 1 1 1 1 1 0 1 1 1 If the "any breathing problem" indicator is selected, select this one if the deceased found it particularly difficult to breathe when physically active, e.g. walking, going up steps.


Was (s)he breathless while lying flat?

1 1 1 1 1 0 0 1 1 1 If the "any breathing problem" indicator is selected, select this one if the deceased found it particularly difficult to breathe even when lying down to rest.


Did you see the lower chest wall/ribs being pulled in as the child breathed?

0 0 0 1 1 1 1 1 1 1 If the lower ribs of chest wall on both sides of the chest are pulled in when the child breathes in.


A2-19


Did (s)he have noisy breathing (grunting or wheezing)?

1 1 1 1 1 1 1 1 1 1 If the "any breathing problem" indicator is selected, select this one if the deceased was making wheezing sounds as they breathed (or grunting sounds on breathing in small babies).


Did (s)he have severe chest pain?

1 1 1 1 1 0 0 1 1 1 Select this for older children or adults who were experiencing severe pain in their chests, making other activities impossible.


Did (s)he have diarrhoea?

1 1 1 1 1 1 1 1 1 1 Select this if there was any diarrhoea during the final illness.

3B290 Weeks [0-99] For how long did (s)he have diarrhoea?

1 1 1 1 1 1 0 1 1 1 This reflects the time period during which the deceased suffered from diarrhoea.


acute < 2 wks.

Did (s)he have diarrhoea for less than 2 weeks?

1 1 1 1 1 1 0 1 1 1 Select this if the diarrhoea lasted for less than 2 weeks.


persistent 2-4 wks.

Did (s)he have diarrhoea for 2 to 4 weeks?

1 1 1 1 1 1 0 1 1 1 Select this if the diarrhoea lasted for 2 to 4 weeks, not necessarily every day.

3B290C Calculated (Y/N/DNK)

recurrent ≥ 4 wk.

Did (s)he have diarrhoea for 4 weeks or more?

1 1 1 1 1 1 0 1 1 1 Select this if the diarrhoea lasted more than 4 weeks, not necessarily every day.


A2-20


At any time during the final illness was there blood in the stools?

1 1 1 1 1 1 1 1 1 1 If the "any diarrhoea" indicator is selected, select this one if the diarrhoea contained blood.


Did (s)he vomit? 1 1 1 1 1 1 1 1 1 1 Select this if there was any vomiting during the final illness.


Did (s)he vomit "coffee grounds" or bright red/blood?

1 1 1 1 1 1 1 1 1 1 If the "any vomiting" indicator is selected, select this one if the vomit contained blood. The point 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.


Did (s)he have any abdominal problem?

1 1 1 1 1 1 0 1 1 1 Select this if any abdominal problem has been present.


A2-21


Did (s)he have severe abdominal pain?

1 1 1 1 1 0 0 1 1 1 If the "any abdominal problem" indicator is selected, select this one if severe abdominal pain was present during the final illness.

3B350 Weeks [0-99] For how long before death did (s)he have severe abdominal pain?

1 1 1 1 1 0 0 1 1 1 This reflects the time period during the final illness that the deceased suffered from severe abdominal pain.


< 2 weeks Did (s)he have severe abdominal pain for less than 2 weeks?

1 1 1 1 1 0 0 1 1 1 Select this if the severe abdominal pain lasted for less than 2 weeks.


≥ 2 weeks Did (s)he have severe abdominal pain for 2 weeks or more?

1 1 1 1 1 0 0 1 1 1 Select this if the severe abdominal pain lasted for 2 weeks or more.


Did (s)he have a more than usually protruding abdomen?

1 1 1 1 1 1 1 1 1 1 Select this if there is abnormal distension or protrusion of the abdomen. The word abdomen sounds 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.


A2-22

3B370 Weeks [0-99] For how long did (s)he have a more than usually protruding abdomen?

1 1 1 1 1 1 0 1 1 1 This reflects the time period during the final illness in which the deceased had a more than usual protruding abdomen. The best wording would depend on the local language.


< 2 weeks Did (s)he have a more than usually protruding abdomen for less than 2 weeks?

1 1 1 1 1 1 0 1 1 1 Select this if the more than usually protruding abdomen lasted for less than 2 weeks.


≥ 2 weeks Did (s)he have a more than usually protruding abdomen for 2 weeks or more?

1 1 1 1 1 1 0 1 1 1 Select this if the more than usually protruding abdomen lasted for 2 weeks or more.


Did (s)he have any mass in the abdomen?

1 1 1 1 1 1 0 1 1 1 If the "any abdominal problem" indicator is 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 did (s)he have the lump inside the abdomen?

1 1 1 1 1 1 0 1 1 1 This reflects the time period during the final illness in which the deceased had a lump inside the abdomen.


A2-23


< 2 weeks Did (s)he have a lump inside the abdomen for less than 2 weeks?

1 1 1 1 1 1 0 1 1 1 Select this if the lump inside the abdomen lasted for less than 2 weeks.


≥ 2 weeks Did (s)he have a lump inside the abdomen for 2 weeks or more?

1 1 1 1 1 1 0 1 1 1 Select this if the lump inside the abdomen lasted for 2 weeks or more.


Did (s)he have a severe headache?

1 1 1 1 1 0 0 1 1 1 Select this if headache was present during the final illness.


Did (s)he have a stiff or painful neck?

1 1 1 1 1 1 0 1 1 1 Select this if neck stiffness was present in the final illness. This can be characterised by a difficulty in moving the neck.


[0-99] For how long did (s)he have a stiff or painful neck?

1 1 1 1 1 1 0 1 1 1 This reflects the time period during the final illness during which the deceased suffered from neck pain or stiffness.


< 1 week Did (s)he have a stiff or painful neck for less than 1 week?

1 1 1 1 1 1 0 1 1 1 Select this if the stiff or painful neck lasted for less than 1 week.


≥ 1 week Did (s)he have a stiff or painful neck for 1 week or more?

1 1 1 1 1 1 0 1 1 1 Select this if the stiff or painful neck lasted for 2 weeks or more.


A2-24


Did (s)he have mental confusion?

1 1 1 0 0 0 0 1 1 0 This reflects a diagnosis of memory loss or confusion 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 [months]

[0-99] For how long did (s)he have mental confusion?

1 1 1 0 0 0 0 1 1 0 This reflects the period of time lasting the symptoms of mental confusion (e.g. loss of orientation, memory loss, loss of ability to focus attention, hallucinations, paranoia, aggressive behaviour).


≥ 3 months

Did (s)he have mental confusion for 3 months or more?

1 1 1 0 0 0 0 1 1 0 Select this if the mental confusion lasted for 3 months or more.


Was (s)he unconscious for more than 24 hours before death?

1 1 1 1 1 1 0 1 1 1 Select this if there was a coma or unconsciousness for at least the final 24 hours before death, or at an earlier stage of the final illness (possibly with return of consciousness).


Did the unconsciousness start suddenly, quickly (at least within a single day)?

1 1 1 1 1 1 0 1 1 1 This reflects the way the deceased became unconscious.


A2-25


Did (s)he have convulsions?

1 1 1 1 1 1 1 1 1 1 Select this if there were convulsions or fits during 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 [minutes]

[0-60] For how long did the convulsions last?

1 1 1 1 1 1 0 1 1 1 This reflects the approximate duration in minutes of convulsion episodes suffered by the deceased.


< 10 minutes

Did the convulsions last for less than 10 minutes?

1 1 1 1 1 1 0 1 1 1 Select this if the convulsions lasted for less than 10 minutes.


≥ 10 minutes

Did the convulsions last for 10 minutes or more?

1 1 1 1 1 1 0 1 1 1 Select this if the convulsions lasted for 10 minutes or more.


Did (s)he become unconscious immediately after the convulsion?

1 1 1 1 1 1 0 1 1 1 If the "any convulsions or fits" indicator is selected, select this one if the person became unconscious immediately after the convulsions.


A2-26


Did (s)he have any urine problems?

1 1 1 1 1 1 0 1 1 1 Select this if there was any problem relating to urine during the final illness.


Did (s)he pass no urine at all?

1 1 1 1 1 1 0 1 1 1 Select this if "any urine problem" is selected and there was no urine produced during at least part of the final illness.


Did (s)he go to urinate more often than usual?

1 1 1 1 1 0 0 1 1 1 Select this if "any urine problem" is selected and urination was much more frequent than normal during the final illness.


During the final illness did (s)he ever pass blood in the urine?

1 1 1 1 1 1 0 1 1 1 Select this if "any urine problem" is selected and the urine contained blood at any time during the final illness.


Did (s)he have any skin problems?

1 1 1 1 1 1 1 1 1 1 Select this if there was any skin problem during the final illness.


Did (s)he have any ulcers, abscess or sores anywhere except on the feet?

1 1 1 1 1 1 1 1 1 1 If the "any skin problem" indicator is selected, select this one if there were any ulcers or lesions on the skin, except specifically on the feet.


Did (s)he have any ulcers, abscess or sores on the feet that were not also on other parts of the body?

1 1 1 1 1 1 1 1 1 1 If the "any skin problem" indicator is selected, select this one if there were any ulcers or lesions exclusively on the feet.


A2-27


During the illness that led to death, did (s)he have any skin rash?

1 1 1 1 1 1 1 1 1 1 If the "any skin problem" indicator is selected, select this one if there was any kind of skin rash anywhere on the body, which was not specifically described as measles or herpes zoster (shingles).

3B570 Weeks [0-99] For how long did (s)he have the skin rash?

1 1 1 1 1 0 0 1 1 1 This reflects the time period during which the deceased had a skin rash, independent of the type of skin rash.


< 1 week Did (s)he have the skin rash for less than 1 week?

1 1 1 1 1 0 0 1 1 1 Select this if the skin rash lasted less than 1 week.


≥ 1 week Did (s)he have the skin rash for 1 week or more?

1 1 1 1 1 0 0 1 1 1 Select this if the skin rash lasted 1 week or more


Did (s)he have measles rash?

1 1 1 1 1 1 1 1 1 1 If the "any skin problem" indicator is selected, select this one if the skin problem was described as measles rash.


Did (s)he ever have shingles or herpes zoster?

1 1 1 1 1 0 0 1 1 1 If the "any skin problem" indicator is selected, select this one if the skin problem was described as herpes zoster or shingles.


Did (s)he bleed from the nose, mouth or anus?

1 1 1 1 1 1 0 1 1 1 Select this if there was bleeding from the mouth, nose or anus during the final illness.


A2-28


Did (s)he have noticeable weight loss?

1 1 1 1 1 1 0 1 1 1 Select this if weight loss occurred during the final illness.


Was (s)he severely thin or wasted?

1 1 1 1 1 1 0 1 1 1 Select this if "any weight loss" is selected and the extent of the weight loss was sufficiently serious to amount to severe wasting.


Did (s)he have mouth sores or white patches in the mouth or on the tongue?

1 1 1 1 1 1 0 1 1 1 Select this if oral candidiasis (white spots in the mouth) was present during the final illness.


Did (s)he have stiffness of the whole body or was unable to open the mouth?

1 1 1 1 1 1 0 1 1 1 Select this if there was either rigidity of the body (limbs, neck, etc. not able to move) or if it was not possible to open the mouth (lockjaw) during the final illness.


Did (s)he have swelling (puffiness) of the face?

1 1 1 1 1 0 0 1 1 1 Select this if there was facial swelling during the final illness.


Did (s)he have both feet swollen?

1 1 1 1 1 0 0 1 1 1 Select this if both feet or ankles or legs were swollen during the final illness - but NOT if only one was swollen, for example following an accident.


Did (s)he have any lumps?

1 1 1 1 1 1 0 1 1 1 Select this if there was any localised lump or lesion on any part of the body, either at the time of death, or surgically removed prior to death.


A2-29


Did (s)he have any lumps or lesions in the mouth?

1 1 1 1 1 1 0 1 1 1 Select this is "any localised lump or lesion" is selected and the lump or lesion was located in the mouth.


Did (s)he have any lumps on the neck?

1 1 1 1 1 1 0 1 1 1 Select this is "any localised lump or lesion" is selected and the lump or lesion was located in the neck.


Did (s)he have any lumps on the armpit?

1 1 1 1 1 1 0 1 1 1 Select this is "any localised lump or lesion" is selected and the lump or lesion was located in the armpit(s).


Did (s)he have any lumps on the groin?

1 1 1 1 1 0 0 1 1 1 Select this is "any localised lump or lesion" is selected and the lump or lesion was located in the groin or genitals.


Did she have an ulcer or swelling in the breast?

1 1 1 0 0 0 0 0 1 0 Select this is "any localised lump or lesion" is selected and the lump or lesion was located in the breast - only applies to adult females.


Did (s)he have paralysis of one side of the body?

1 1 1 1 0 0 0 1 1 1 Select this if there was some degree of paralysis or weakness on one side of the body - possibly affecting the face (maybe causing difficulties in swallowing or talking) or arms/hands or legs/feet.


A2-30


Did (s)he have difficulty or pain while swallowing liquids?

1 1 1 1 0 0 0 1 1 1 Select this if there was difficulty or pain in swallowing liquids during the final illness.


Did (s)he have yellow discoloration of the eyes?

1 1 1 1 1 1 0 1 1 1 Select this if the white parts of the deceased's eyes had turned distinctly yellow in colour (and possibly yellow soles of the feet for small babies).


Did her/his hair colour change to reddish or yellowish?

1 1 1 1 1 0 0 1 1 1 Select this if there was an abnormal change in hair colour - possibly becoming reddish or paler - during the final illness.


Did (s)he look pale (thinning/lack of blood) or have pale palms, eyes or nail beds?

1 1 1 1 1 0 0 1 1 1 Select this if either blood test results indicated anaemia or low haemoglobin levels, or if the person was unusually pale (inner eyelids, palms of hands, soles of feet) during the final illness.


Did (s)he have sunken eyes?

0 0 0 0 1 1 0 1 1 0 Select this if the eyes were unusually sunken into the face during the final illness.


Did (s)he drink a lot more water than usual?

1 1 1 1 1 0 0 1 1 1 Select this if the person drank a lot more water than usual during the final illness.


A2-31


Did she have excessive vaginal bleeding in between menstrual periods?

0 0 1 1 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had vaginal bleeding in between menstrual periods.


Did her vaginal bleeding stopped naturally during menopause?

1 1 1 0 0 0 0 0 1 0 Select this for a woman (probably aged 40 years or over) whose normal vaginal bleeding (menstrual periods) had stopped naturally.


Did she have vaginal bleeding after menopause?

1 1 1 0 0 0 0 0 1 0 Select this for a woman (probably aged 40 years or 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 select Yes/No/DontKnow=1/0/9

only one of the questions 3C100-130 can be answered with "yes"

Was she neither pregnant, nor delivered, within 6 weeks of her death?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was reported not to have been pregnant or to have delivered within 6 weeks of her death


A2-32



Was she pregnant at the time of death?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was reported to have been pregnant at the time of her death. This means that a foetus, either at an early stage of pregnancy or nearer full term, remained inside her body at the time of death. This includes a woman who dies undelivered during labour.



Did she die within 6 weeks of giving birth?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was reported to have delivered a baby within 6 weeks of her death. This means one or more potentially viable babies, born either dead or alive, were delivered in the previous 6 weeks.



Did she die within 6 weeks of a pregnancy that lasted less than 6 months?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was reported to have been at an early stage (first 6 months) of pregnancy within 6 weeks of her death, but the pregnancy had ended in a spontaneous or induced abortion at a stage before the foetus was viable.


A2-33

3C200 Yes/No/DontKnow=1/0/9

Did she die within 24 hours after delivery?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was reported to have delivered a baby and then died within 24 hours of the delivery.


Did she die during labour, but undelivered?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was reported to have been pregnant at the time of her death, who had gone into labour, and who died before a baby was delivered.


Was she breastfeeding at death?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was reported to have been breast-feeding her youngest child at the time of her final illness.

3C230 Number [births]

[0-99] How many births, including stillbirths, did she/the mother have before this baby?

0 0 1 0 0 0 0 0 1 1 Record the number of births this woman had before the present one (twins count as one birth in this context)

3C230A Calculated (Y/N/DNK)

0 (first pregnancy)

Was this the woman's first pregnancy?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was reported to have been pregnant for the first time.


A2-34

3C230B Calculated (Y/N/DNK)

≥4 (4 or more previous pregnancies)

Did she have four or more births, including stillbirths, before this pregnancy?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who before any current pregnancy had 4 (including stillbirths) or more pregnancies, or who died during her current pregnancy, or within 6 weeks of her current pregnancy ending.


Did she have any previous Caesarean section?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had delivered a baby by Caesarean section in any of her previous pregnancies.


Did she die during or after a multiple pregnancy?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who died while pregnant with twins (or triplets, etc.) or within 6 weeks of a multiple pregnancy ending.


During pregnancy, did she suffer from high blood pressure?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was diagnosed with high blood pressure specifically during her pregnancy.


Did she have foul smelling vaginal discharge during pregnancy or after delivery?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was known to have had a foul-smelling vaginal discharge, either during pregnancy, or after delivery.


A2-35


During the last 3 months of pregnancy, did she suffer from convulsions?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was known to have had fits specifically during her pregnancy.


During the last 3 months of pregnancy did she suffer from blurred vision?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was known to have had blurred vision specifically during her pregnancy.


Did she give birth to a live, healthy baby within 6 weeks of death?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was reported to have delivered a live, healthy baby within 6 weeks of her death.


Was there excessive vaginal bleeding during pregnancy or after delivery?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who experienced excessive vaginal bleeding around pregnancy and delivery.


Was there vaginal bleeding during the first 6 months of pregnancy?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years with excessive vaginal bleeding during the first 6 months of pregnancy.


Was there vaginal bleeding during the last 3 months of pregnancy but before labour started?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had excessive vaginal bleeding before labour started.


A2-36


Was there excessive vaginal bleeding during labour?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had excessive vaginal bleeding during labour.


Was there excessive vaginal bleeding after delivering the baby?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had excessive vaginal bleeding after the delivery of a baby.


Was the placenta not completely delivered?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was known to have had problems delivering her placenta after her baby was born, with part or all of the placenta remaining inside.


Did she deliver or try to deliver an abnormally positioned baby?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had recently delivered or tried to deliver an abnormally positioned baby, e.g. a breech presentation.


Was she in labour for unusually long (more than 24 hours)?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was known to have had well-established labour for 24 hours or more, irrespective of the final outcome of that labour.


A2-37


Did she attempt to terminate the pregnancy?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was known to have been recently pregnant and had attempted, with or without succeeding, to terminate her pregnancy.


Did she recently have a pregnancy that ended in an abortion (spontaneous or induced)?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was known to have been recently pregnant and had the pregnancy terminated, via a spontaneous abortion or an induced abortion.


Did she give birth in a health facility?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was delivered or delivered recently at a health facility. This question is repeated for neonatal deaths with a slightly different wording.


Did she give birth at home?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was 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


Did she give birth elsewhere, e.g. on the way to a facility?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who was delivered or delivered 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.


Did she receive professional assistance during the delivery?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had delivered recently and been attended by a medical professional (doctor, nurse or midwife).


Did she have an operation to remove her uterus shortly before death?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had a hysterectomy, probably as an emergency obstetric intervention, shortly before she died.


Did she have a normal vaginal delivery?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 who had a normal delivery, without the assistance of forceps/vacuum or through a caesarean section.


Did she have an assisted delivery, with forceps/vacuum?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had delivered recently with assistance by means of forceps or a vacuum device.


A2-39


Did she deliver by Caesarean section?

0 0 1 0 0 0 0 0 1 1 Select this for a woman aged 12-50 years who had delivered recently by means of a Caesarean section.


Was the baby born more than one month early?

0 0 1 0 0 0 0 0 1 1 Select this for a woman age 12-50 years who delivered a baby a month or more before the expected date.

3D Section Neonatal/child history, signs and symptoms

3D100 Yes/No/DontKnow=1/0/9

Was the child part of a multiple birth?

0 0 0 0 0 1 1 1 1 0 Select this for a baby who was born as one of a multiple pregnancy.


Was the child born in a complicated delivery?

0 0 0 0 0 1 1 1 1 0 Select this for a baby who was born in a complicated delivery, for example lasting a long time or needing special assistance.


Was the baby born 24 hours or more after the water broke?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate that was born more than 24 hours after the mother's waters broke.


Did the baby stop moving in the womb before labour started?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate if the mother could feel that her baby had stopped moving inside her womb before the time her labour began.


Was baby born in a normal vaginal delivery?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who was born in a normal vaginal delivery.


A2-40


Was baby born with forceps/vacuum?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who was born with assistance by means of forceps or a vacuum device.


Was baby delivered by Caesarean section?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who was born by means of a Caesarean section.


Did the baby's bottom, feet, arm or hand come into the vagina before its head?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate that was born from an abnormal (e.g. breech) position. The abnormally 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.


Was the baby of abnormal size?

0 0 0 0 0 1 1 1 1 0 Select this for a neonate or infant that seemed to be of abnormal size and weight at birth.


Was the baby smaller than normal, weighing under 2.5 kg?

0 0 0 0 0 1 1 1 1 0 Select this for a neonate and child under 1 year of age that seemed very small, or was weighed and found to be less than 2.5 kg, at birth.


A2-41


Was the baby larger than normal, weighing over 4.5 kg?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate that was too big for an uncomplicated deliver, or was weighed and found to be more than 4.5 kg, at birth.

3D210 Number [weeks]

[0-52] How many weeks was the pregnancy when the baby was born?

0 0 0 0 0 1 1 1 1 0 This reflects the duration of the pregnancy from which the dead child was born.

3D210A Calculated (Y/N/DNK)

< 34 weeks

Had the pregnancy lasted less than 34 weeks when the baby was born?

0 0 0 0 0 1 1 1 1 0 Select this for a pregnancy which lasted for less than 34 weeks.

3D210B Calculated (Y/N/DNK)

34-37 weeks

Had the pregnancy lasted between 34 and 37 weeks when the baby was born?

0 0 0 0 0 1 1 1 1 0 Select this for a pregnancy which lasted between 34 and 37 weeks.

3D210C Calculated (Y/N/DNK)

> 37 weeks

Had the pregnancy lasted more than 37 weeks when the baby was born?

0 0 0 0 0 1 1 1 1 0 Select this for a pregnancy which lasted more than 37 weeks, i.e. nearly or at full term for the birth.


Was the umbilical cord wrapped several times (more than once) around the neck of the child at birth?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate that was born with its cord wrapped several times (more than once) around its neck.


A2-42


Did the baby/the child have any noticeable malformation?

0 0 0 0 1 1 1 1 1 0 Select this for a baby or young child who was born with obvious malformations of any kind - this may include diagnosed malformations of internal organs, for example heart defects.


Did the baby/the child have a swelling/defect on the back?

0 0 0 0 1 1 1 1 1 0 Select this if "any congenital malformations" is selected and there is any swelling or defect on the baby's back.


Did the baby/the child have a very large head?

0 0 0 0 1 1 1 1 1 0 Select this if "any congenital malformations" is selected and the baby was born with a very large head.


Did the baby/the child have a very small head?

0 0 0 0 1 1 1 1 1 0 Select this if "any congenital malformations" is selected and the baby was born with a very small head.


Was the baby/the child not growing normally?

0 0 0 0 1 1 0 1 1 0 Select this for a baby or young child who did not seem to be growing and developing in a way that was normal for his or her age.


Was the baby blue in colour at birth?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who was blue in colour, cyanosed.


A2-43


Did the baby cry after birth, even if only a little bit?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who cried, even if just a little, after birth.


Did the baby breathe after birth, even a little?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who was able to breath after birth.


Was the baby given assistance to breathe at birth?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who needed assistance to breath after birth.


If the baby did not cry or breathe, was it born dead?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate that never cried, moved or breathed after it was delivered - and so was stillborn.


Was the dead baby macerated, that is, showed signs of decay?

0 0 0 0 0 0 1 1 1 0 Select this for a stillborn baby whose skin was puffy or mushy.


Was the baby able to suckle or bottle-feed within the first 24 hours after birth?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who was healthy and feeding within the first 24 hours from birth.


Did the baby stop suckling or bottle feeding 3 days after birth?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who initially fed well, but stopped sucking 3 days or more after birth.


A2-44


Did the baby have convulsions starting within the first day of life?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who had convulsions in the first 24 hours after birth.


Did the baby have convulsions starting on the second day or later after birth?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who had convulsions 48 hours or more after birth.


Did the baby's body become stiff, with the back arched backwards?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who became rigid and whose back was bent backwards.


Did the child have a bulging or raised fontanelle?

0 0 0 0 0 1 1 1 1 0 Select this for a baby whose fontanelle (soft spot on top of the head) was raised or bulging during the final illness.


Did the child have a sunken fontanelle?

0 0 0 0 0 1 1 1 1 0 Select this for a baby whose fontanelle (soft spot on top of the head) was sunken or depressed during the final illness.


Did the baby become unresponsive or unconscious soon after birth (within less than 24 hours)?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who became unconscious or unresponsive after less than 24 hours from birth.


A2-45


Did the baby become unresponsive or unconscious more than 1 day after birth?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who became unconscious or unresponsive after more than 1 day from birth.


Did the baby become cold to the touch before it died?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who felt very cold before death.


Did the baby have redness or discharge from the umbilical cord stump?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who had red or pussy signs of infection around the umbilicus before death.


Did the baby have yellow palms or soles?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who had yellowing of the skin of their palms or soles.


Did the mother NOT receive tetanus toxoid (TT) vaccine?

0 0 0 0 0 0 1 1 1 0 Select this if the baby's mother had not been vaccinated against tetanus during or before her pregnancy.

3D500 Number [births]

[0-99] How many births, including stillbirths, did the baby's mother have before this baby?

0 0 0 0 0 0 1 1 1 0 Record the number of previous pregnancies for the neonate's mother

3D500A Calculated (Y/N/DNK)

0 (first pregnancy)

Was this baby born from the mother's first pregnancy?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died, and who was born from the mother's first pregnancy.


A2-46

3D500B Calculated (Y/N/DNK)

≥4 (4 or more previous pregnancies)

Did the mother have 4 or more births before this baby was born?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died, and whose mother had had four or more previous pregnancies.


During pregnancy, did the baby's mother suffer from high blood pressure?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died, and whose mother was diagnosed with high blood pressure during her pregnancy.


Did the baby's mother have foul smelling vaginal discharge during pregnancy or after delivery?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died, and whose mother was known to have had a foul-smelling vaginal discharge, either during pregnancy, or after delivery.


During the last 3 months of pregnancy, did the baby's mother suffer from convulsions?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died, and whose mother was known to have had fits specifically during her pregnancy.


During the last 3 months of pregnancy did the baby's mother suffer from blurred vision?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died, and whose mother was known to have had blurred vision specifically during her pregnancy.


A2-47


Did the baby's mother have vaginal bleeding during the last 3 months of pregnancy but before labour started?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died, and whose mother had excessive vaginal bleeding before her labour started.


Was the child born in a health facility?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died after being delivered at a health facility.


Was the child born at home?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died after being delivered at home.


Was the child born somewhere else, e.g. on the way to a facility?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died after being delivered somewhere other than at a health facility or at home, for example while travelling to seek care.


Did the mother receive professional assistance during the delivery?

0 0 0 0 0 0 1 1 1 0 Select this for a neonate who died, and whose delivery was attended by a medical professional (doctor, nurse or midwife).

3E Section History of injuries/accidents

3E100 Yes/No/DontKnow=1/0/9

Did (s)he suffer from any injury or accident that led to her/his death?

1 1 1 1 1 1 1 1 1 1 Select this if there was any kind of injury or accident associated with the final illness.


A2-48


Was it a road traffic accident?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and it occurred in a road accident of some kind (e.g. as passenger, driver, cyclist, pedestrian).


Was (s)he injured as a pedestrian/walking?

1 1 1 1 1 1 0 1 1 1 Select this if "recent injury or accident" is selected and if "road traffic accident" is also selected and it occurred while the deceased was walking.


Was (s)he injured as an occupant of a car vehicle?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and if "road traffic accident" is also selected and it occurred while the deceased was inside a vehicle/car.


Was (s)he injured as an occupant of a bus or heavy transport vehicle?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and if "road traffic accident" is also selected and it occurred while the deceased was inside a vehicle (bus, heavy transport).


Was (s)he injured as a driver or passenger of a motorcycle?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and if "road traffic accident" is also selected and it occurred while the deceased was on a motorcycle either as the driver or a passenger.


A2-49


Was (s)he injured as a pedal cyclist?

1 1 1 1 1 0 0 1 1 1 Select this if "recent injury or accident" is selected and if "road traffic accident" is also selected and it occurred while the deceased was riding a bike.


Do you know anything about the counter-part that was hit during the road traffic accident?

1 1 1 1 1 1 1 1 1 1 Do you know anything about the counter-part that was hit during the road traffic accident?


Was it a pedestrian?

1 1 1 1 1 1 1 1 1 1 Was it a pedestrian?


Was it a stationary object?

1 1 1 1 1 1 1 1 1 1 Was it a stationary object?


Was it a car vehicle?

1 1 1 1 1 1 1 1 1 1 Was it a car vehicle?


Was it a bus or heavy transport vehicle?

1 1 1 1 1 1 1 1 1 1 Was it a bus or heavy transport vehicle?


Was it a motorcycle?

1 1 1 1 1 1 1 1 1 1 Was it a motorcycle?


Was it a pedal cycle?

1 1 1 1 1 1 1 1 1 1 Was it a pedal cycle?


Was it something else?

1 1 1 1 1 1 1 1 1 1 Was it something else?


A2-50


Was (s)he Injured in a non-road transport accident?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and it occurred in a road transport accident NOT on a road (boat, train, aeroplane, etc.).


Was (s)he Injured in a fall?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and it occurred as a result of falling (but NOT falling into water and drowning, and NOT falling into a fire and burning).


Did (s)he die of drowning?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and it occurred as a result of drowning in water.


Did (s)he suffer from burns?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and it occurred as a result of being burnt in a fire or otherwise exposed to extreme heat.


Did (s)he suffer from any plant/ animal/insect bite or sting that led to her/his death?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and it occurred as a result of being bitten or stung by a poisonous animal (snake, scorpion, etc.).


A2-51


Was it a dog? 1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and if "animal/insect bite" is selected and it occurred as a result of being bitten/attacked by a dog.


Was it a snake? 1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and if "animal/insect bite" is selected and it occurred as a result of being bitten/attacked by a snake.


Was it an insect?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and if "animal/insect bite" is selected and it occurred as a result of being bitten/stung by an insect.


Was (s)he injured by a force of nature?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and it occurred as a result of an external event (earthquake, volcano, flood, etc.).


A2-52


Was there any poisoning?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and 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.


Was (s)he subject to violence/assault?

1 1 1 1 1 1 1 1 1 1 Select this if "recent injury or accident" is selected and 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.


Was the injury intentionally inflicted by someone else?

1 1 1 1 1 1 1 1 1 1 Select this if the deceased suffered from an injury intentionally infection by someone else.


Was (s)he injured by a fire arm?

1 1 1 1 1 1 1 1 1 1 Select this if the deceased suffered from an injury caused by a fire arm (e.g. pistols and rifles).


Was (s)he injured from a stab, cut or pierce?

1 1 1 1 1 1 1 1 1 1 Select this if the deceased suffered from a stab, cut or pierce wound.


A2-53


Was (s)he injured by machinery?

1 1 1 1 1 1 1 1 1 1 Select this if the deceased suffered from an injury caused by machines or parts of a machine.


Was (s)he struck by an animal or object?

1 1 1 1 1 1 1 1 1 1 Select this if the deceased suffered from an injury caused by an animal or object thrown at them.


Do you think (s)he committed suicide?

1 1 1 1 0 0 0 1 1 1 Select this if "recent injury or accident" is selected and 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 factors3F100 Yes/No/D

ontKnow=1/0/9

Did (s)he drink alcohol?

1 1 1 0 0 0 0 1 1 0 Select this if the person who died was a regular and sometimes excessive drinker of alcohol up to the time of the final illness.

3F110 Yes/No/DontKnow=1/0/9

Did (s)he smoke tobacco (cigarette, cigar, pipe, etc.)?

1 1 1 0 0 0 0 1 1 0 Select this if the person who died was a regular smoker up to the time of the final illness. (make sure you ask for cigarette, cigar, pipe, etc. and not just "smoking").

3G Section Health service utilisation


A2-54

3G100 Yes/No/DontKnow=1/0/9

Was (s)he adequately vaccinated?

1 1 1 1 1 1 1 1 1 1 Select this if the person who died had been 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.


Did (s)he receive any treatment for the illness that led to death?

1 1 1 1 1 1 1 1 1 1 Select this if the person who died obtained treatment from a health facility during their final illness (either out-patient or admitted).


Did (s)he receive oral rehydration salts?

1 1 1 1 1 1 1 1 1 1 Select this if "treatment for final illness" is selected and the person who died had been given oral rehydration therapy during their final illness.


Did (s)he receive (or need) intravenous fluids (drip) treatment?

1 1 1 1 1 1 1 1 1 1 Select this if "treatment for final illness" is selected and the person who died had received treatment through an IV drip during their final illness.


A2-55


Did (s)he receive (or need) a blood transfusion?

1 1 1 1 1 1 1 1 1 1 Select this if any blood transfusion was recommended, prescribed 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.


Did (s)he receive (or need) treatment/food through a tube passed through the nose?

1 1 1 1 1 1 1 1 1 1 Select this if "treatment for final illness" is selected and the person who died had received treatment through an IV drip during their final illness.


Did (s)he receive (or need) injectable antibiotics?

1 1 1 1 1 1 1 1 1 1 Select this if any intravenous (e.g. by drip or injection) or intramuscular (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.


Did (s)he have (or need) an operation for the illness?

1 1 1 1 1 1 1 1 1 1 Select this if "treatment for final illness" is selected and any surgical procedures were performed during the course of the final illness.


A2-56


Did (s)he have the operation within 1 month before death?

1 1 1 1 1 1 0 1 1 1 Select this if any surgical procedures were performed during the last month of the final illness.


Was (s)he discharged from hospital very ill?

1 1 1 1 1 1 1 1 1 1 Select this if the person had been admitted to hospital during the final illness, and was then sent home in the expectation that they would not recover.

4 Section Background and context


In the final days before death, did (s)he travel to a hospital or health facility?

1 1 1 1 1 1 1 1 1 1 Select this if the person who died travelled to a hospital ( or health facility offering a 24-hour service) 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.


A2-57


Did (s)he use motorised transport to get to the hospital or health facility?

1 1 1 1 1 1 1 1 1 1 Select this if the person who died travelled to a hospital or health facility by means of motorised transport (car, truck, tractor, motorcycle, scooter or ambulance) during the final illness.


Were there any problems during admission to the hospital or health facility?

1 1 1 1 1 1 1 1 1 1 Select this if the person who died travelled to a hospital or health facility, and then had problems on arrival (delays, paperwork, queues, no staff).


Were there any problems with the way (s)he was treated (medical treatment, procedures, inter-personal attitudes, respect, dignity) in the hospital or health facility?

1 1 1 1 1 1 1 1 1 1 Select this if the person who died travelled to a hospital or health facility, and then had problems with how they were treated (medical treatment, procedures, inter-personal attitudes, respect, dignity).


A2-58


Were there any problems getting medications, or diagnostic tests in the hospital or health facility?

1 1 1 1 1 1 1 1 1 1 Select this if the person who died travelled to a hospital or health facility, and then had problems obtaining essential items (drugs, medications or other prescriptions, blood products, and/or diagnostic tests such as lab tests and x-rays, either within the facility or needing to be bought elsewhere).


Does it take more than 2 hours to get to the nearest hospital or health facility from the deceased's household?

1 1 1 1 1 1 1 1 1 1 Select this if the person who died lived in a household from where it would reasonably take more than 2 hours to reach the nearest 24-hour health facility by the means of transport available to the household members.


In the final days before death, were there any doubts about whether medical care was needed?

1 1 1 1 1 1 1 1 1 1 Select this if there were doubts among those assisting in the final illness (family members, etc.) about whether the final illness was sufficiently serious to need treatment at a health facility.


A2-59


In the final days before death, was traditional medicine used?

1 1 1 1 1 1 1 1 1 1 Select this if a major part of treatment for the final illness was provided by any kind of traditional or alternative practitioner (herbal remedies, massages, drinks, foods, amulets, spells or blessings provided by traditional healers, witch doctors or shaman).


In the final days before death, did anyone use a telephone or cell phone to call for help?

1 1 1 1 1 1 1 1 1 1 Select this if a telephone of any kind (working landline, or cell phone charged and with credit) was used by those assisting in the final 24 hours of the illness for example to call for help or arrange transportation.


Over the course of illness, did the total costs of care and treatment prohibit other household payments?

1 1 1 1 1 1 1 1 1 1 Select this if the total costs incurred in the final illness were sufficiently great to mean that other kinds of household expenses (food, fuel, travel, education etc.) could not be met, or caused debt or sale of household assets.

5A Section Optional open narrative


A2-60

5A100 Text Any comments that may provide additional information.

1 1 1 1 1 1 1 1 1 1 Recording this information may be helpful to assess the diagnosis in cases 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 childUnder 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 INTERVIEWDAY

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? FATHERMOTHERSIBLINGOTHER RELATIVE

(SPECIFY)NO RELATION

2A115 Did you live with the deceased in the period leading to her/his YESdeath? 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? MALEFEMALE

1A200 Is date of birth known? YES

NO

1A210 + When was the deceased born? DAY

MONTH

YEAR

1A220 Is date of death known? YESNO

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 BIRTHNATURALIZED CITIZ.ALIENDON'T KNOW



1A510 What was her/his ethnicity? ETHNICITY AETHNICITY BETHNICITY COTHER (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 URBANRURAL

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



DON'T KNOW



1A550 Where did death occur?




DON'T KNOW



1A560 What was the site of death? HOSPITALOTHER HEALTH FACILITYHOMEOTHER (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 MONTHRECORD '9998' IF DON'T KNOW YEAR

YEAR



1A720 Place where the death is registered:




4 Urban/RuralURBANRURAL

5 Name of local registrarSurname

Name

DON'T KNOW

1A730 National identification number of deceased



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



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 birthand 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 WEEKSDON'T KNOW

3D510 During the pregnancy did the baby's mother suffer from YEShigh blood pressure? NO

DON'T KNOW

3D550 Did the baby's mother have vaginal bleeding during the last 3 months YESof pregnancy but before labour started? NO

DON'T KNOW

3D520 Did the baby's mother have foul smelling vaginal discharge during YESpregnancy and/or after delivery? NO

DON'T KNOW

3D540 During the last 3 months of pregnancy did the baby's mother suffer YESfrom blurred vision? NO

DON'T KNOW

3D530 During the last 3 months of pregnancy did the baby's mother suffer YESfrom convulsions? NO

DON'T KNOW

3D100 Was the child part of a multiple birth? YESNODON'T KNOW

3D110 Was the child born in a complicated delivery? YESNODON'T KNOW

SECTION 5. DELIVERY HISTORY

3D560 Was the child born in a health facility? YESNODON'T KNOW

3D570 Was the child born at home? YESNODON'T KNOW

3D580 Was the child born somewhere else (e.g. on the way to a health facility)? YESNODON'T KNOW

3D590 Did the mother receive professional assistance during the delivery? YESNODON'T KNOW

3D120 Was the baby born 24 hours or more after the water broke? YESNODON'T KNOW

3D130 Did the baby stop moving in the womb before labour started? YESNODON’T KNOW

3D140 Was baby born in a normal vaginal delivery? YESNO

DON’T KNOW

3D150 Was baby born with forceps/vacuum? YESNODON’T KNOW

3D160 Was baby delivered by caesarean section? YESNODON’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? YESNODON'T KNOW

3D190 + Was the baby smaller than normal, weighing under YES + 2.5 kg? NO

DON'T KNOW



3D200 + Was the baby larger than normal, weighing over 4.5 kg? YESNODON'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? YESNODON'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? YESNODON'T KNOW

3D260 + Did the baby have a very small head? YES

NODON'T KNOW

3D280 Was the baby blue in colour at birth? YESNODON'T KNOW

3D300 Did the baby breathe after birth, even a little? YESNODON'T KNOW

3D310 Was the baby given assistance to breathe at birth? YESNODON'T KNOW

3D290 Did the baby ever cry after birth, even if only a little bit? YESNODON'T KNOW

3D320 If the baby did not cry or breathe, was it born dead? YESNODON'T KNOW

3D330 + Was the dead baby macerated, that is, showed signs of decay? YESNODON'T KNOW

SECTION 7. HISTORY OF INJURIES/ACCIDENTS

3E100 Did the baby suffer from any injury or accident YESthat led to her/his death? NO

DON'T KNOW

3E110 + Did the baby suffer from a road traffic accident? YESNODON'T KNOW

3E120 + + Was the baby injured as a pedestrian? YESNODON'T KNOW

3E130 + + + Was the baby injured as an occupant of a car vehicle? YESNODON'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? YESNODON'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? YESNODON'T KNOW

3E210 + + + Was it a stationary object? YESNODON'T KNOW

3E220 + + + Was it a car vehicle? YESNODON'T KNOW

3E230 + + + Was it a bus or heavy transport vehicle? YESNODON'T KNOW



3E240 + + + Was it a motor cycle? YESNODON'T KNOW

3E250 + + + Was it a pedal cycle? YESNODON'T KNOW

3E260 + + + Was it something else? YES (specify) ------------------------------------- NODON'T KNOW

3E300 + Was the baby injured in a non-road transport accident? YESNODON'T KNOW

3E310 + + Was the baby injured in a fall? YESNODON'T KNOW

3E320 + + Did the baby die of drowning? YESNODON'T KNOW

3E330 + + Did the baby suffer from burns? YESNODON'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? YESNODON'T KNOW

3E410 + + + Was it a snake? YESNODON'T KNOW

3E420 + + + Was it an insect? YESNODON'T KNOW

3E500 + + Was the baby injured by a force of nature? YESNODON'T KNOW

3E510 + + Was there any poisoning? YESNODON'T KNOW

3E520 + Was the baby subject to violence or assault? YESNODON'T KNOW

3E530 + Was the injury or accident intentionally inflicted by someone else? YESNODON'T KNOW

3E600 + + Was the baby injured by a fire arm? YESNODON'T KNOW

3E610 + + Was the baby injured from a stab, cut or pierce? YESNODON'T KNOW

3E620 + + Was the baby injured by machinery? YESNODON'T KNOW

3E630 + + Was the baby struck by an animal or object? YESNODON'T KNOW

SECTION 8. NEONATAL ILLNESS HISTORY

3A280 Did the baby die during the wet season? YESNODON'T KNOW

3A290 Did the baby die during the dry season? YESNODON'T KNOW

3A300 For how long was the baby ill before s/he died? NUMBER OF HOURSNUMBER OF DAYSDON'T KNOW



3A310 Did the baby die suddenly? YESNODON'T KNOW

3D340 Was the baby able to suckle or bottle-feed within first 24 hours YESafter birth? NO

DON'T KNOW

3D350 + Did the baby stop suckling of bottle feeding 3 days after birth? YESNODON'T KNOW

3B460 Did the baby have convulsions? YESNODON'T KNOW

3D360 + Did the baby have convulsions starting within the first day of life? YESNODON'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? YESNODON'T KNOW

3D390 Did the child have bulging or raised fontanelle? YESNODON'T KNOW

3D400 Did the child have a sunken fontanelle? YESNODON'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? YESNODON'T KNOW

3D430 Did the baby become cold to the touch before it died? YESNODON'T KNOW

3B130 Did the baby have a cough? YESNODON'T KNOW

3B170 + Did the baby make a whooping sound when coughing? YESDEMONSTRATE NO

DON'T KNOW

3B180 Did the baby have any breathing problem? YESNODON'T KNOW

3B190 + Did the baby have fast breathing? YESNODON'T KNOW

3B210 + Did the baby have breathlessness? YESNODON'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? YESNODON'T KNOW

3B300 + At any time during the final illness was there blood in the stools? YESNODON'T KNOW

3B310 Did the baby vomit? YESNODON'T KNOW

3B320 + Did the baby vomit "coffee grounds" or bright red/blood? YESNODON'T KNOW



3B360 + Did the baby have a more than usual protruding abdomen? YESNODON'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? YESNODON'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? YESNODON'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? YESNODON'T KNOW

3D450 Did the baby have yellow palms or soles? YESNODON'T KNOW

3D460 Did the mother receive tetanus toxoid (TT) vaccine? YESNODON'T KNOW


DEATH OF A CHILD AGED UNDER 4 WEEKS (28 DAYS)


SECTION 9 TREATMENT AND HEALTH SERVICE USE FOR THE FINAL ILLNESS

3G100 Was s/he adequately vaccinated? YESNODON'T KNOW

3G110 Did s/he receive any treatment for the illness that led to death? YESNODON'T KNOW

3G120 + Did s/he receive oral rehydration salts? YES

NODON'T KNOW

3G130 + Did s/he receive (or needed) intravenous fluids (drip) treatment? YES

NODON'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? NODON'T KNOW

3G160 + Did s/he receive (or needed) injectable (IV or IM) antibiotics? YESNODON'T KNOW

3G170 + Did s/he have (or needed) an operation for the illness? YESNODON'T KNOW

3G190 + Was s/he discharged from the hospital very ill? YESNODON'T KNOW

SECTION 10. BACKGROUND

4A100 In the final days, did the baby travel to a hospital or health facility? YESNODON'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 YESmedical care was needed? NO

DON'T KNOW

4A170 In the final days before death, was traditional medicine used? YESNODON'T KNOW

4A180 In the final days before death, did anyone use a telephone or cell phone YESto call for help? NO

DON'T KNOW

4A190 Over the course of illness, did the total costs of care and treatment YESprohibit other household payments? NO

DON'T KNOW


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:




Death of a childaged 4 weeks to 14 years


2012 WHO VERBAL AUTOPSY [FORM 2]DEATH OF A CHILD AGED 4 WEEKS (29 DAYS) TO 14 YEARS




Surname

Name

2A140 RECORD THE DATE OF INTERVIEW

DAY

MONTH

YEAR


MORNING =1 HOUR

EVENING=2

MINUTES

2A100 Name of verbal autopsy respondent

Surname

Name

2A110 What is your relationship to the deceased? FATHERMOTHERSPOUSESIBLINGOTHER RELATIVE


2A115 Did you live with the deceased in the period leading YESto her/his death? NO



Surname

Name

1A110 Was the deceased female or male? FEMALEMALE


NO


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 YEARS1A250

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 YESafter being pregnant or delivering a baby? NO

DON'T KNOW


NO. QUESTIONS AND FILTERS CODING CATEGORIES1A500 What was her/his citizenship/nationality? CITIZEN BY BIRTH

NATURALIZED CITIZ.

ALIENDON'T KNOW






DON'T KNOW







DON'T KNOW



1A540 What was her/his place of normal residence 1 to 5 years before death?




DON'T KNOW







DON'T KNOW




1A600 What was her/his marital status? NEVER MARRIEDMARRIED/LIVING WITH A PARTNERWIDOWEDDIVORCEDSEPARATEDDON'T KNOW

1A610 What was the date of marriage? DAY

RECORD '98' IF DON'T KNOW DAY OR MONTHRECORD '9998' IF DON'T KNOW YEAR MONTH

YEAR




Surname

Name


Surname

Name

1A640 What was her/his highest level of schooling? NO FORMAL EDUCATIONPRIMARYSECONDARYHIGHERDON'T KNOW

1A650 Was s/he able to read and write? YESNODON'T KNOW

1A660 What was her/his economical activity status in year prior to death? USUALLY ECONOMICALLY ACTIVE MAINLY EMPLOYED MAINLY UNEMPLOYED

NOT ECONOMICALLY ACTIVEHOME-MAKERSTUDENTPENSIONOTHER (specify)DON'T KNOW

1A670 What was her/his occupation, that is, what kind of work did s/he mainlydo?





YEAR






5 Name of local registrarSurnameName

DON'T KNOW








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/showedwhen 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? YESNODON'T KNOW

3A110 Was there any diagnosis of HIV/AIDS? YESNODON'T KNOW

3A120 Did s/he have a recent positive test for Malaria? YESNODON'T KNOW

3A130 Did s/he have a recent negative test for Malaria? YESNODON'T KNOW

3A140 Was there any diagnosis of Measles? YESNODON'T KNOW

3A150 Was there any diagnosis of High Blood Pressure? YESNODON'T KNOW

3A160 Was there any diagnosis of Heart Disease? YESNODON'T KNOW

3A170 Was there any diagnosis of Diabetes? YESNODON'T KNOW

3A180 Was there any diagnosis of Asthma? YESNODON'T KNOW

3A190 Was there any diagnosis of Epilepsy? YESNODON'T KNOW

3A200 Was there any diagnosis of Cancer? YESNODON'T KNOW

2012 WHO VERBAL AUTOPSY [FORM 2]DEATH OF A CHILD AGED 4 WEEKS TO 14 YEARS



3A210 Was there any diagnosis of Chronic Obstructive Pulmonary Disease YES(COPD)? NO

DON'T KNOW

3A220 Was there any diagnosis of Dementia? YESNODON'T KNOW

3A230 Was there any diagnosis of Depression? YES

NODON'T KNOW

3A240 Was there any diagnosis of Stroke? YESNODON'T KNOW

3A250 Was there any diagnosis of Sickle Cell disease? YESNODON'T KNOW

3A260 Was there any diagnosis of Kidney disease? YESNODON'T KNOW

3A270 Was there any diagnosis of Liver disease? YESNO

DON'T KNOW

3A280 Did s/he die during the wet season? YESNODON'T KNOW

3A290 Did s/he die during the dry season? YESNODON'T KNOW

3A300 For how long was s/he ill before s/he died? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3A310 Did s/he die suddenly? YESNODON'T KNOW




3E100 Did s/he suffer from any injury or accident that led to her/his death? YESNODON'T KNOW

3E110 + Did s/he suffer from a road traffic accident? YESNODON'T KNOW

3E120 + + Was s/he injured as a pedestrian/walking? YESNODON'T KNOW

3E130 + + Was s/he injured as an occupant of a car vehicle? YESNODON'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? YESNODON'T KNOW

3E160 + + Was s/he injured as a pedal cyclist? YESNODON'T KNOW

3E170 + + Do you know anything about the counter-part that was hit YES during the road traffic accident? NO







3E260 + + + Was it something else? YES (specify)NODON'T KNOW

3E300 + Was s/he injured in a non-road transport accident? YESNODON'T KNOW

3E310 + + Was s/he injured in a fall? YESNODON'T KNOW




3E320 + + Did s/he die of drowning? YES

NO

DON'T KNOW

3E330 + + Did s/he suffer from burns? YESNO

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? YESNO

DON'T KNOW

3E410 + + + Was it a snake? YESNODON'T KNOW

3E420 + + + Was it an insect? YESNO

DON'T KNOW

3E500 + + Was s/he injured by a force of nature? YES

NODON'T KNOW

3E510 + + Was there any poisoning? YES

NO

DON'T KNOW

3E520 + Was s/he subject to violence or assault? YESNODON'T KNOW


3E600 + + Was s/he injured by a fire arm? YESNODON'T KNOW

3E610 + + Was s/he injured from a stab, cut or pierce? YESNODON'T KNOW

3E620 + + Was s/he injured by machinery? YESNODON'T KNOW

3E630 + + Was s/he struck by an animal or object? YESNODON'T KNOW

3E700 + Do you think that s/he committed suicide? YESNODON'T KNOW

CHECK QUESTIONS 1A240 AND 1A250 FOR AGE AT DEATH:

IF UNDER IF ONE YEAR JUMP TO SECTION 8ONE YEAR OR OLDER



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? YESNODON'T KNOW

3D210 How many weeks was the pregnancy when the baby was born? NUMBER OF WEEKSDON'T KNOW

3D390 Did the child have bulging of the fontanelle? YESNODON'T KNOW

3D400 Did the child have a sunken fontanelle? YESNODON'T KNOW



SECTION 8. SYMPTOMS NOTED DURING THE FINAL ILLNESS FOR ALL CHILDREN

3D220 Did the child have any noticeable malformation? YESNODON'T KNOW

3D240 + Did the child have a swelling or defect on the back? YESNODON'T KNOW

3D250 + Did the child have a very large head? YESNODON'T KNOW

3D260 + Did the child have a very small head? YESNODON'T KNOW

3B100 Did s/he have a fever? YESNODON'T KNOW

3B110 + For how long did s/he have a fever? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B120 + Did s/he have night sweats? YESNODON'T KNOW

3B130 Did s/he have a cough? YESNODON'T KNOW

3B140 + For how long did s/he have a cough? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B170 + Did s/he make a whooping sound when coughing? YESNODON'T KNOW

3B150 + Was the cough productive with sputum? YESNODON'T KNOW

3B160 + Did s/he cough out blood? YESNODON'T KNOW

3B180 Did s/he have any breathing problem? YESNODON'T KNOW

3B190 + Did s/he have fast breathing? YESNODON'T KNOW

3B200 + + For how long did s/he have fast breathing? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B210 + Did s/he have breathlessness? YESNODON'T KNOW

3B220 + + For how long did s/he have breathlessness? NUMBER OF DAYSNUMBER OF WEEKSDON'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? YESNODON'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? YESNODON'T KNOW

3B280 Did s/he have diarrhoea? YESNODON'T KNOW

3B290 + For how long did s/he have diarrhoea? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW


3B310 Did s/he vomit? YESNODON'T KNOW

3B320 + Did s/he vomit "coffee grounds" or bright red/blood? YESNODON'T KNOW

3B330 Did s/he have any abdominal problem? YESNODON'T KNOW

3B340 + Did s/he have severe abdominal pain? YESNODON'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? YESNODON'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? YESNODON'T KNOW

3B390 + + For how long did s/he have the lump inside the abdomen? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B400 Did s/he have a severe headache? YESNODON'T KNOW

3B405 Did s/he have a stiff or painful neck? YESNODON'T KNOW

3B410 + For how long did s/he have a stiff or painful neck? NUMBER OF DAYSNUMBER OF WEEKSDON'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 MONTHSDON'T KNOW

3B440 Was s/he unconscious for more than 24 hours? YESNODON'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? YESNODON'T KNOW

3B470 + For how long did s/he have convulsions? NUMBER OF MINUTESDON'T KNOW

3B480 + Did s/he became unconscious immediately after the convulsion? YESNODON'T KNOW

3B490 Did s/he have any urine problems? YESNODON'T KNOW

3B500 + Did s/he pass no urine at all? YESNODON'T KNOW

3B510 + Did s/he go to urinate more often than usual? YESNODON'T KNOW

3B520 + During the final illness did s/he ever pass blood in the urine? YESNODON'T KNOW

3B530 Did s/he have any skin problems? YESNODON'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? YESNODON'T KNOW

3B570 + + For how long did s/he have the skin rash? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B580 + + Did s/he have measles rash? YESNODON'T KNOW

3B590 + + Did s/he ever have shingles/herpes zoster? YESNODON'T KNOW

3B600 Did s/he have bleeding from the nose, mouth, or anus? YESNODON'T KNOW

3B610 Did s/he have noticeable weight loss? YESNODON'T KNOW

3B620 + Was s/he severely thin or wasted? YESNODON'T KNOW




3B630 Did s/he have mouth sores or white patches in the mouth YESor on the tongue? NO

DON'T KNOW

3B640 Did s/he have stiffness of the whole body or was unable to open YESthe mouth? NO

DON'T KNOW

3B650 Did s/he have swelling (puffiness) of the face? YESNODON'T KNOW

3B660 Did s/he have both feet swollen? YESNODON'T KNOW

3B670 Did s/he have any lumps? YESNODON'T KNOW

3B680 + Did s/he have a lumps or lesions in the mouth? YESNODON'T KNOW

3B690 + Did s/he have any lumps on the neck? YESNODON'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

NODON'T KNOW

3B730 Did s/he have paralysis of one side of the body? YESNODON'T KNOW

3B740 Did s/he have difficulty or pain while swallowing liquids? YESNODON'T KNOW

3B750 Did s/he have yellow discoloration of the eyes? YESNODON'T KNOW

3B760 Did her/his hair colour change to reddish or yellowish? YESNODON'T KNOW

3B770 Did s/he look pale (thinning/lack of blood) or have pale palms, YESeyes or nail beds? NO

DON'T KNOW

3B780 Did s/he have sunken eyes? YESNODON'T KNOW

3D270 Was the child not growing normally? YESNODON'T KNOW

3B790 Did (s)he drink a lot more water than usual? YESNODON'T KNOW

CHECK QUESTIONS 1A110, 1A240 AND 1A250 FOR SEX AND AGE AT DEATH:

IF FEMALE IF MALE OR FEMALE JUMP TO SECTION 10BETWEEN 12 - 14 YEARS UNDER 12 YEARS

.




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 YESNO

OR DON'T KNOW

3C110 Was she pregnant at the time of death? YESNO

OR DON'T KNOW

3C120 Did she die within 6 weeks of giving birth? YESNO

OR DON'T KNOW

3C130 Did she die within 6 weeks of a pregnancy that lasted less YESthan 6 months? NO

DON'T KNOW

3C200 + Did she die within 24 hours after delivery? YESNODON'T KNOW

3C210 + Did she die during labour, but undelivered? YESNODON'T KNOW

3C220 + Was she breastfeeding at death? YESNODON'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? YESNODON'T KNOW

3C250 + Did she die during or after a multiple pregnancy? YESNODON'T KNOW

3C260 + During pregnancy, did she suffer from high blood pressure? YESNODON'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? YESNODON'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? YESNODON'T KNOW

3C350 + + Was there excessive vaginal bleeding after delivering the baby? YESNO

DON'T KNOW

3C360 + Was the placenta not completely delivered? YESNODON'T KNOW

3C365 + Did she deliver or try to deliver an abnormally positioned baby? YESNODON'T KNOW

3C370 + Was she in labour for unusually long (more than 24 hours)? YESNODON'T KNOW

3C380 Did she attempt to terminate the pregnancy? YESNODON'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? YESNODON'T KNOW

3C420 Did she give birth elsewhere, e.g. on the way to a facility? YESNODON'T KNOW

3C430 + Did she receive professional assistance for the delivery? YESNODON'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? YESNODON'T KNOW

3C460 + Did she have an assisted delivery, with forceps/vacuum? YESNODON'T KNOW

3C470 + Was it a delivery with caesarean section? YESNODON'T KNOW

3C480 + Was the baby born more than one month early? YESNODON'T KNOW



SECTION 10. TREATMENT AND HEALTH SERVICE USE FOR THE FINAL ILLNESS




NODON'T KNOW


NODON'T KNOW


NO

DON'T KNOW





3G180 + + Did s/he have the operation within 1 month before death? YESNODON'T KNOW



4A100 In the final days before death, did s/he travel to a hospital or YEShealth facility? NO

DON'T KNOW


DON'T KNOW


DON'T KNOW



DON'T KNOW


DON'T KNOW


DON'T KNOW






DON'T KNOW


DON'T KNOW


5A100INTERVIEWER'S OBSERVATIONS



ANY OTHER COMMENTS:







Death of a personaged 15 years and above


2012 WHO VERBAL AUTOPSY [FORM 3]DEATH OF A PERSON AGED 15 YEARS AND ABOVE




Surname

Name

2A140 RECORD THE DATE OF INTERVIEWDAY

MONTH

YEAR


MORNING =1 HOUR

EVENING=2

MINUTES

2A100 Name of verbal autopsy respondent:

Surname

Name

2A110 What is your relationship to the deceased? FATHERMOTHERSPOUSESIBLINGOTHER RELATIVE


2A115 Did you live with the deceased in the period leading YESto her/his death? NO



Surname

Name

1A110 Was the deceased female or male? FEMALEMALE


NO


MONTH

YEAR

1A220 Is date of death known? YESNO

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 BIRTHNATURALIZED CITIZ.ALIENDON'T KNOW








DON'T KNOW







DON'T KNOW



1A540 What was her/his place of normal residence 1 to 5 years before death?




DON'T KNOW







DON'T KNOW




1A600 What was her/his marital status? NEVER MARRIEDMARRIED/LIVING WITH A PARTNERWIDOWEDDIVORCEDSEPARATEDDON'T KNOW

1A610 What was the date of marriage? DAY

RECORD '98' IF DON'T KNOW DAY OR MONTHRECORD '9998' IF DON'T KNOW YEAR MONTH

YEAR




Surname

Name


Surname

Name

1A640 What was her/his highest level of schooling? NO FORMAL EDUCATIONPRIMARY

SECONDARYHIGHERDON'T KNOW

1A650 Was s/he able to read and write? YESNO

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 ACTIVEHOME-MAKERSTUDENTPENSIONOTHER (specify)DON'T KNOW

1A670 What was her/his occupation, that is, what kind of work did s/he mainlydo?





YEAR


1 Larger admin area (e.g., province)

2 Smaller admin area (e.g., county)

3 Locality (e.g., city, village)


5 Name of local registrarSurnameNameDON'T KNOW








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/showedwhen 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? YESNODON'T KNOW

3A110 Was there any diagnosis of HIV/AIDS? YESNODON'T KNOW

3A120 Did s/he have a recent positive test for Malaria? YESNODON'T KNOW

3A130 Did s/he have a recent negative test for Malaria? YESNODON'T KNOW

3A140 Was there any diagnosis of Measles? YESNODON'T KNOW

3A150 Was there any diagnosis of High Blood Pressure? YESNODON'T KNOW

3A160 Was there any diagnosis of Heart Disease? YESNODON'T KNOW

3A170 Was there any diagnosis of Diabetes? YESNODON'T KNOW

3A180 Was there any diagnosis of Asthma? YESNODON'T KNOW

3A190 Was there any diagnosis of Epilepsy? YESNODON'T KNOW

3A200 Was there any diagnosis of Cancer? YESNODON'T KNOW




3A210 Was there any diagnosis of Chronic Obstructive Pulmonary Disease YES(COPD)? NO

DON'T KNOW

3A220 Was there any diagnosis of Dementia? YESNODON'T KNOW

3A230 Was there any diagnosis of Depression? YESNODON'T KNOW

3A240 Was there any diagnosis of Stroke? YESNODON'T KNOW

3A250 Was there any diagnosis of Sickle Cell disease? YESNODON'T KNOW

3A260 Was there any diagnosis of Kidney disease? YESNODON'T KNOW

3A270 Was there any diagnosis of Liver disease? YESNODON'T KNOW

3A280 Did s/he die during the wet season? YESNODON'T KNOW

3A290 Did s/he die during the dry season? YESNODON'T KNOW

3A300 For how long was s/he ill before s/he died? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3A310 Did s/he die suddenly? YESNODON'T KNOW




3E100 Did s/he suffer from any injury or accident that led to her/his death? YESthat led to her/his death? NO

DON'T KNOW

3E110 + Did s/he suffer from a road traffic accident? YESNODON'T KNOW

3E120 + + Was s/he injured as a pedestrian/walking? YESNODON'T KNOW

3E130 + + Was s/he injured as an occupant of a car vehicle? YESNODON'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? YESNODON'T KNOW

3E160 + + Was s/he injured as a pedal cyclist? YESNODON'T KNOW

3E170 + + Do you know anything about the counter-part that was hit YES during the road traffic accident? NO







3E260 + + + Was it something else? YES (specify)-------------------------------------------- NODON'T KNOW

3E300 + Was s/he injured in a non-road transport accident? YESNODON'T KNOW

3E310 + + Was s/he injured in a fall? YESNODON'T KNOW




3E320 + + Did s/he die of drowning? YES

NO

DON'T KNOW

3E330 + + Did s/he suffer from burns? YESNODON'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? YESNO

DON'T KNOW

3E410 + + + Was it a snake? YES

NODON'T KNOW

3E420 + + + Was it an insect? YESNODON'T KNOW

3E500 + + Was s/he injured by a force of nature? YES

NODON'T KNOW

3E510 + + Was there any poisoning? YESNODON'T KNOW

3E520 + Was s/he subject to violence or assault? YESNODON'T KNOW


3E600 + + Was s/he injured by a fire arm? YESNODON'T KNOW

3E610 + + Was s/he injured from a stab, cut or pierce? YESNODON'T KNOW

3E620 + + Was s/he injured by machinery? YESNODON'T KNOW

3E630 + + Was s/he struck by an animal or object? YESNODON'T KNOW

3E700 + Do you think that s/he committed suicide? YESNODON'T KNOW

CHECK QUESTION 1A110 FOR SEX OF THE DECEASED:

IF FEMALE IF MALE SECTION 9

SECTION 7 AND 8



SECTION 7. SYMPTOMS AND SIGNS ASSOCIATED WITH ILLNESS OF WOMEN

3B720 Did she have an ulcer or swelling in the breast? YESNODON'T KNOW

3B800 Did she have excessive vaginal bleeding in between menstrual YESperiods? NO

DON'T KNOW

3B810 Did her vaginal bleeding stopped naturally during menopause? YESNODON'T KNOW

3B820 Did she have vaginal bleeding after menopause? YESNODON'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 YESNO

OR DON'T KNOW

3C110 Was she pregnant at the time of death? YESNO

OR DON'T KNOW

3C120 Did she die within 6 weeks of giving birth? YESNO

OR DON'T KNOW

3C130 Did she die within 6 weeks of a pregnancy that lasted less YESthan 6 months? NO

DON'T KNOW

3C200 + Did she die within 24 hours after delivery? YESNODON'T KNOW

3C210 + Did she die during labour, but undelivered? YESNODON'T KNOW

3C220 + Was she breastfeeding at death? YESNODON'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? YESNODON'T KNOW

3C250 + Did she die during or after a multiple pregnancy? YESNODON'T KNOW

3C260 + During pregnancy, did she suffer from high blood pressure? YESNODON'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? YESNODON'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? YESNODON'T KNOW

3C350 + + Was there excessive vaginal bleeding after delivering the baby? YESNO

DON'T KNOW

3C360 + Was the placenta not completely delivered? YESNODON'T KNOW

3C365 + Did she deliver or try to deliver an abnormally positioned baby? YESNODON'T KNOW

3C370 + Was she in labour for unusually long (more than 24 hours)? YESNODON'T KNOW

3C380 Did she attempt to terminate the pregnancy? YESNODON'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? YESNODON'T KNOW

3C420 + Did she give birth elsewhere, e.g. on the way to a facility? YESNODON'T KNOW

3C430 + Did she receive professional assistance for the delivery? YESNODON'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? YESNODON'T KNOW

3C460 + Did she have an assisted delivery, with forceps/vacuum? YESNODON'T KNOW

3C470 + Was it a delivery with caesarean section? YESNODON'T KNOW

3C480 + Was the baby born more than one month early? YESNODON'T KNOW

SECTION 10. SYMPTOMS NOTED DURING THE FINAL ILLNESS

3B100 Did s/he have a fever? YESNODON'T KNOW

3B110 + For how long did s/he have a fever? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B120 + Did s/he have night sweats? YESNODON'T KNOW

3B130 Did s/he have a cough? YESNODON'T KNOW

3B140 + For how long did s/he have a cough? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B150 + Was the cough productive with sputum? YESNODON'T KNOW

3B160 + Did s/he cough out blood? YESNODON'T KNOW

3B180 Did s/he have any breathing problem? YESNODON'T KNOW

3B190 + Did s/he have fast breathing? YESNODON'T KNOW

3B200 + + For how long did s/he have fast breathing? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B210 + Did s/he have breathlessness? YESNODON'T KNOW

3B220 + + For how long did s/he have breathlessness? NUMBER OF DAYSNUMBER OF WEEKSDON'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? YESNODON'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? YESNODON'T KNOW

3B280 Did s/he have diarrhoea? YESNODON'T KNOW

3B290 + For how long did s/he have diarrhoea? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW


3B310 Did s/he vomit? YESNODON'T KNOW

3B320 + Did s/he vomit "coffee grounds" or bright red/blood? YESNODON'T KNOW

3B330 Did s/he have any abdominal problem? YESNODON'T KNOW

3B340 + Did s/he have severe abdominal pain? YESNODON'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? YESNODON'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? YESNODON'T KNOW

3B390 + + For how long did s/he have the lump inside the abdomen? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B400 Did s/he have a severe headache? YESNODON'T KNOW

3B405 Did s/he have a stiff or painful neck? YESNODON'T KNOW

3B410 + For how long did s/he have a stiff or painful neck? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B420 Did s/he have mental confusion? YESNODON'T KNOW

3B430 + For how long did s/he have mental confusion? NUMBER OF DAYS

NUMBER OF MONTHSDON'T KNOW

3B440 Was s/he unconscious for more than 24 hours? YESNODON'T KNOW




3B450 Did the unconsciousness start suddenly, YESquickly (at least within a single day)? NO

DON'T KNOW

3B460 Did s/he have convulsions? YESNODON'T KNOW

3B470 + For how long did s/he have convulsions? NUMBER OF MINUTESDON'T KNOW

3B480 + Did s/he became unconscious immediately after the convulsion? YESNODON'T KNOW

3B490 Did s/he have any urine problems? YESNODON'T KNOW

3B500 + Did s/he pass no urine at all? YESNODON'T KNOW

3B510 + Did s/he go to urinate more often than usual? YESNODON'T KNOW

3B520 + During the final illness did s/he ever pass blood in the urine? YESNODON'T KNOW

3B530 Did s/he have any skin problems? YESNODON'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? YESNODON'T KNOW

3B570 + + For how long did s/he have the skin rash? NUMBER OF DAYSNUMBER OF WEEKSDON'T KNOW

3B580 + + Did s/he have measles rash? YESNODON'T KNOW

3B590 + + Did s/he ever have shingles/herpes zoster? YESNODON'T KNOW

3B600 Did s/he have bleeding from the nose, mouth, or anus? YESNODON'T KNOW

3B610 Did s/he have weight loss? YESNODON'T KNOW

3B620 + Was s/he severely thin or wasted? YESNODON'T KNOW

3B630 Did s/he have mouth sores or white patches in the mouth YESor on the tongue? NO

DON'T KNOW

3B640 Did s/he have stiffness of the whole body or was unable to open YESthe mouth? NO

DON'T KNOW




3B650 Did s/he have swelling (puffiness) of the face? YESNODON'T KNOW

3B660 Did s/he have both feet swollen? YESNODON'T KNOW

3B670 Did s/he have any lumps? YESNODON'T KNOW

3B680 + Did s/he have any lumps or lesions in the mouth? YESNODON'T KNOW

3B690 + Did s/he have any lumps on the neck? YESNO

DON'T KNOW

3B700 + Did s/he have any lumps on the armpit? YES

NODON'T KNOW

3B710 + Did s/he have any lumps on the groin? YESNODON'T KNOW

3B730 Did s/he have paralysis of one side of the body? YESNODON'T KNOW

3B740 Did s/he have difficulty or pain while swallowing liquids? YESNODON'T KNOW

3B750 Did s/he have yellow discoloration of the eyes? YESNODON'T KNOW

3B760 Did her/his hair colour change to reddish or yellowish? YESNODON'T KNOW

3B770 Did s/he look pale (thinning/lack of blood) or have pale palms, YESeyes or nail beds? NO

DON'T KNOW

3B780 Did s/he have sunken eyes? YESNODON'T KNOW

3B790 Did (s)he drink a lot more water than usual? YESNODON'T KNOW

.



SECTION 10. TREATMENT AND HEALTH SERVICE USE FOR THE FINAL ILLNESS




NODON'T KNOW


NODON'T KNOW


NO

DON'T KNOW





3G180 + + Did s/he have the operation within 1 month before death? YESNODON'T KNOW


SECTION 11. RISK FACTORS

3F100 Did s/he drink alcohol? YESNODON'T KNOW

3F110 Did s/he smoke tobacco. (cigarette, cigar, pipe, etc.)? YESNODON'T KNOW


4A100 In the final days before death, did s/he travel to a hospital or YEShealth facility? NO

DON'T KNOW


DON'T KNOW


DON'T KNOW



DON'T KNOW





DON'T KNOW


DON'T KNOW



DON'T KNOW


DON'T KNOW


5A100INTERVIEWER'S OBSERVATIONS



ANY OTHER COMMENTS:



INTERNATIONAL SIMPLIFIED VERBAL AUTOPSY [FORM 3]DEATH OF A PERSON AGED 15 YEARS AND ABOVE


Documents

The 2012 WHO verbal autopsy instrument Release Candidate 1