1. Introduction Title Verbal autopsy (VA) ascertains probable causes-of-death (CoD) through interviews carried out with caretakers of the deceased or witnesses of deaths. The method uses questionnaires to elicit information on signs, symptoms and circumstances leading to death, generically described as indicators, which are subsequently interpreted into CoD. The questionnaire data can be interpreted by either physicians (physician certified VA- PCVA) or by software (computerized coding of VA). The method is most useful for application in surveillance sites and household surveys, and as a routine part of civil registration and vital statistics (CRVS) systems. The proliferation of different VA instruments has limited the comparability and consistency of CoD information across populations and over time. Due to these challenges and needs, WHO has produced the 2014 WHO VA instrument, that now includes indicators from the automated methods currently in use, such as the Tariff, InterVA and Random Forest methods. Verbal Autopsy – Next Generation 2014 WHO Verbal Autopsy Instrument Abstract. Verbal autopsy (VA) is an approach used to ascertain probable CoD via interviews with the relatives or caretakers of the deceased. The 2012 WHO VA instrument was revised to enable the collection of information needed for multiple automated diagnosing software in a single platform that is still feasible for application in civil registration and vital statistics (CRVS) systems. To enable countries to adopt, integrate and implement VA into their civil registration, detailed guidance on the best ways to implement VA in routine systems, such as in Sample vital registration. 11-17 October 2014 Barcelona, Spain Poster Number WHO/CTS to insert WHO - FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK ANNUAL MEETING 2014 Authors: Jordana Leitao, Robert Jakob WHO Title Methods & Materials Acknowledgements Results- The 2014 WHO VA instrument Figure 1- Process development of the 2014 WHO VA instrument Application in Vital Registration The 2012 WHO VA instrument was developed from experience with the use with existing VA instruments, include those from WHO, INDEPTH Network, InterVA and the Population Health Metrics Research Consortium (PHMRC). Feedback from the field- testing of the 2012 WHO VA instrument in Kenya and the need to have an international VA instrument that collects the information needed for multiple methods in a single platform, guided the development of the 2014 WHO VA instrument. To make the necessary amendments to the instrument, an international working group was created with experts and users of VA from WHO, INDEPTH Network, InterVA, PHMRC, and various countries that have interest in the application of VA in their CRVS systems. The resulting instrument comprises a total of 350 CoD-related indicators to certify 63 CoD mapped onto ICD-10. The instrument was specifically developed for automated ascertainment of CoD, and has a skip pattern embedded that embraces all age groups. Note that only a small subset of questions is usually asked. The resulting instrument has 6 sections: 1.Personal information 2.Information on the respondent 3.Cause of death related indicators Medical history General signs and symptoms Signs and symptoms associated with pregnancy Neonatal and child history, signs and symptoms History of injuries and accidents Risk factors Health service utilization 4.Background and context 5.Optional open narrative text field 6.Death certification and health record (optional for use outside routine VA, e.g. for research environments) Table 1- Number of entry-level questions by age group: (in brackets maximum number of questions) Verbal autopsy can be used to complement routine cause of death registration. In view of the resources needed, Verbal Autopsy may be applied to samples, only. Censuses can be used as sampling. Another option is to select people using multi-stage cluster sampling after stratification. Currently, best sampling practice is being discussed. For matters of sustainability, and for comparability of the results is seems that a Verbal Autopsy system should have a permanent structure, with dedicated human and technical resources. The work would not have been possible without the contributions of the WHO Working Group for Verbal Autopsy: Shams El Arifeen, International Centre for Diarrhoeal Disease Research (ICDDR); Dr Peter Byass, Umea Centre for Global Health; Dr Daniel Chandramohan, London School of Hygiene & Tropical Medicine; Dr Samuel Clark, University of Washington; Dr Edward Fottrell, University College London; Dr Bernardo Hernandez Prado, Institute for Health Metrics and Evaluation/UW; Dr Abraham Flaxman; Institute for Health Metrics and Evaluation/UW; Dr Henry Kalter, Johns Hopkins Bloomberg School of Public Health; Dr Soewarta Kosen, National Institute of Health Research and Development Indonesia; Dr Erin Nichols, National Center for Health Statistics, USA; Dr Arvind Pandey, National Institute of Medical Statistics of India; Dr Chalapati Rao, The University of Queensland; Dr Ian Riley, The University of Queensland; Dr Osman Sankoh, INDEPTH Network Field testing Cognitive testing Suitability for Tariff Indicators essential for the functioning of the shortened Tariff method that were not included in the 2012 WHO VA instrument were added; Differently phrased questions were aligned and combined to become more comprehensive and clear; Added questions to certain age groups that are not separate in the Tariff; Adjustments were made to the level and sequence of questions to accommodate suggestions for improvement of the logical flow of the interview; Split complex questions into two or more to make the questions more understandable; Changed questions with a negative phrasing into positive ones to make them more understandable Format and wording of indicators were edited to improve understanding, retrieval, judgment and response of the question; =132 more questions overall modulePerinatalChildAdult Medical history associated with final illness 19 General signs and symptoms associated with final illness 11 (26) 35 (113) 34 (102) Signs and symptoms associated with pregnancy and women section 4 (42) Neonatal and child history, signs and symptoms 43 (68) 16 (24) 1 History of injuries/accidents1 (19) Risk factors2 (4) Sum55 (113) 71 (176) 61 (189) Increase compared to 2012 (maximum) +9+75+59 The questionnaire is available in different formats. 1.Excel: readable and easily understandable 2.Formated for paper based input 3.Open Data Kit (ODK) compatible to facilitate and standardize implementation in electronic environments