Published by World Health Organization (Geneva), 2007. ISBN 9789241547215. Contains 117 pages. Price US$20.00

This manual is a consensus of a 3-year effort by an expert group of the World Health Organization (WHO) consisting of researchers, data-users, and others of the Health Metrics Network, to obtain mortality data from Third World regions.

A verbal autopsy is first obtained from family and associates of the recently deceased, by using standard questions for different age groups and types of disease. These templates are to facilitate the classification of deaths according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10). This classification favours recording the underlying factors such as diabetes, war, HIV, etc before the precipitation of death, such as infarct or bullet.

Robust mortality statistics will lead to the better targeting of health funding towards the world’s poor from government and private organisations, e.g. the Gates’ Foundation.

The previous lack of health data was highlighted recently in a Lancet series of reviews The way forward.1 Our system is based on that of Britain, which took three centuries to hone, yet our own champion of diabetes, Professor Don Beaven was dismayed by diabetes not being noted in half of our autopsy reports into death from cardiovascular disease.2 The cause of death ascertained by clinicians with sophisticated diagnostic aids such as scans and biochemistry tests have been shown to vary from autopsy findings in about 30% of cases 3.

I admit bias as an ageing morbid anatomist with pathological paternalism but believe the questions may overwhelm the recently trained worker. The lists are extremely detailed. For a field worker in New Guinea with 400 different languages, the task will be daunting.

Collation of the data involves computers for rapid correlation but this depends on the accuracy of the data, and correlations do not necessarily imply cause and effect.4

Despite my negative feelings as to the immensity of the task, and that the proposed methodology is too detailed, the aim of the exercise is all important in improving World health.

Hopefully pilot studies will test and refine the data collection.

Robin Fraser
Pathologist
Anatomical Pathology
Canterbury Health
Christchurch