Maintenance of the WHO 2022 Verbal Autopsy Instrument and Documentation
Maintenance of the WHO 2022 Verbal Autopsy Instrument and Documentation. This repository is the public one for keeping records of issues and requests. New version of the Instrument and Documentation will be released on this repository. The QbyQ can be downloaded from the official WHO verbal autopsy website
Hi all,
Sharing the email below/attached for two purposes.
First: I’m sharing an inquiry about a possible oversight in missing measles or MMR in the immunization question (10431). Daniel, can you please confirm why the correct list should include and advise if/how this should be updated?
Second, sharing as FYI regarding a concern that arose in CHAMPS on the ability of fieldworkers to correctly capture this question. Attached is an effort to develop a nationally adapted field tool to advise interviewers on what “complete” immunization means for South Africa. I recommend we consider documenting this approach in adaptation guidance.
Kind regards,
Erin
Begin forwarded message:
From: "Morof, Diane (CDC/ONDIEH/NCCDPHP)" [email protected]
To: "Nichols, Erin K. (CDC/OPHSS/NCHS)" [email protected], "Philipsborn, Rebecca" [email protected], "'Jessica Price'" [email protected]
Cc: "Debbie Bradshaw" [email protected], "Francois Bezuidenhout" [email protected], "'Pamela Groenewald'" [email protected], "'Frank Odiambo - CDC/Kenya - Kisumu'" [email protected], "Morof, Diane (CDC/ONDIEH/NCCDPHP)" [email protected]
Subject: immunization info
Hi all,
For the VA there is a check box question to select the vaccine if the entire series has been received.
Question (10431) reads: select EPI vaccines done
Response options are in check box and the below list, exactly as written, is provided:
BCG
DPT 1,2,3
Hep B
HiB
Meningitis
Penta 1,2,3
Pneumo
Polio 1,2,3
Rota
No vaccines
Doesn’t know
Refused to answer
The question by question guidance is “Check all vaccines that are indicated on the card. For vaccines that require multiple doses, only check the box if all doses have been received. This includes for children who died before the final doses were received, even if they had received all vaccines appropriate for their age.”
I drafted a tool to assist with selecting the correct box for South Africa but had some challenges both with the Road To Health changes and the vagaries around the WHO list. Apologies, I have attached all the relevant documents mostly for Becca (see below) not to clutter all of your inboxes.
I have included Becca who works on the CHAMPS program and has been mapping out vaccines for the clinical abstraction so she’s familiar with the schedules etc. Becca—this is for a mortality validation study in South Africa—however, the hope is that this tool may also be useful for CHAMPS.
Can you take a look at it (especially Jessica and Becca) and see what you think—did I align these correctly? Are there corrections to be made? I listed a bunch of comments. You may have to pop out the comments to get to my questions. My main questions are in bold and highlighted.
Erin—also when doing this I realized measles was not included… any idea why is there no measles here? Or MMR?
Thanks all,
Sorry this was not so straightforward.
Diane
A3 Immun Poster Latest 30Jul.pdf
ROADTOHEALTHBOOKA4BOYS.PDF
Vaccine checklist adapted for South Africa.docx
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Aurelio Di Pasquale, PhD
Software Project Coordinator
Public Health Computing group
Swiss Tropical and Public Health Institute
Dept. Epidemiology & Public Health
Socinstrasse 57
CH-4002 Basel
+41-61-284 87 02
[email protected]
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
Question from Kenya:
The tobacco questions (Id10412-Id10416) need clarification. Should there be a skip if the deceased didn�$B!G�(Bt use tobacco(If Id10412�$B!b!I�(BYes�$B!I�(B)
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I agree with Henry that i0377 and associated questions are particularly important for possible stillbirths, but they must not be skipped for confirmed neonatal deaths. That would be an unintended and unhelpful consequence of creating the separate stillbirth section near the top.
Peter
Peter Byass
Professor of Global Health, Umeå University
Honorary Professor, Universities of Aberdeen and the Witwatersrand
In the neonatal questionnaire, id10377, id10379_unit and accompanying id10380 and id10379 are currently in the section for confirmed neonatal deaths. However, these questions are most useful for distinguishing antepartum from intrapartum stillbirths, and therefore should be in the section for confirmed stillbirths. They would be best placed together with id10116 on maceration, which serves the same purpose of differentiating antepartum from intrapartum stillbirths (although there have been several publications recently questioning the utility of reported maceration for this purpose, given the finding of poor agreement both between health providers’ assessment of maceration and time since fetal death and VA respondents’ reports of maceration and fetal movement before or after labor onset; all of which increases the importance of mothers’ reports of fetal movement to make the antepartum/intrapartum determination). These questions could also be kept in the neonatal section if needed by the algorithm (? mixed antepartum/intrapartum-related event/asphyxia ?).
Best regards,
Henry
For interview instances with external related symptoms like a road accident or fatal injuries, when there is a yes check on a maternal question, the instrument still goes through all maternal death related questions which do not contribute in any way to the final COD. In my view, there should be some form of skip pattern once it’s a fatal injury involving for example a pregnant woman, then there is no need to go through all the maternal question.
Regards
James
The WHO 2016 questionnaire downloaded from the WHO Verbal Autopsy Standards website has the filename 08_1_WHOVA2016_v1_5_1_XLS_form_for_ODK. XLSForm Online fails because of the following error:
Error: The name '08_1_WHOVA2016_v1_5_1_XLS_form_for_ODK' is an invalid xml tag.
Names must begin with a letter, colon, or underscore, subsequent characters
can include numbers, dashes, and periods.
This issue can easily be fixed by renaming the file, but I would suggest removing the number from the beginning of the filename.
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Dear All,
It would be great to provide countries with a set of VA cases that should be used following localization of the questionnaire to validate that the algorithms still perform as expected.
Kind regards,
Martin
______________________________________________________________________________
Martin W. Bratschi
Deputy Director, Technical Implementation
Public Health Programs, CRVS Improvement
M +65 9836 6421 | Skype martinbratschi
Vital Strategies
Building Public Health Systems Globally
-–
We envision a world where everyone is protected by a strong public health system.
Sent by Martin Bratschi ([email protected]). Created by fire.
Dear All,
To enable tracking of individual VAs and to allow for the linking of the VA results to other records for a particular death, a “uniqueID” field should be introduced into the WHO 2016 VA questionnaire.
This should be a text field and the Hint should indicate that implementers should use a robust method to obtain a unique ID for each VA and preferably the unique ID should be the same as is used in other records regarding the particular death (e.g. death registration number), thereby allowing for the linkage between the VA results and other records about the death.
Thank you for your help.
Kind regards,
Martin
______________________________________________________________________________
Martin W. Bratschi
Deputy Director, Technical Implementation
Public Health Programs, CRVS Improvement
M +65 9836 6421 | Skype martinbratschi
Vital Strategies
Building Public Health Systems Globally
-–
We envision a world where everyone is protected by a strong public health system.
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
Re maternal death section updates and 10305
From: Peter Byass [email protected]
Sent: Friday, September 7, 2018 11:31 AM
To: Nichols, Erin K. (CDC/OPHSS/NCHS) [email protected]; [email protected]; 'Daniel Chandramohan' [email protected]; Jakob Robert ([email protected]) [email protected]
Subject: RE: Proposed updates to maternal section of WHO VA questionnaire
Dear Erin and colleagues,
I have gone through the proposed changes to WHO 2016 outlined in your document of 10th August and made changes to InterVA-5 accordingly. A few points for next week’s meeting:
WHO describes pregnancy as “the nine months or so for which a woman carries a developing embryo and foetus in her womb” which is obviously still true during labour (http://www.who.int/topics/pregnancy/en/)
Therefore the clarified version of question 10305 should be “Was she pregnant (including in labour) at the time of death?” and the Q by Q should follow that – I have no idea how the excluding phrase “before the development of any labour pains or onset or completion of delivery” came into the Q by Q , and it was certainly not part of earlier VA standards.
Having updated InterVA-5 against your list of issues 1 to 13 with proposed changes, I re-ran a population-based data file containing 16,087 VA records, and all that happened was that the cause for one case moved from 09.07 Anaemia of pregnancy to 09.04 Obstetric haemorrhage. So, although it is obviously important to get these details right, we shouldn’t anticipate it making a huge overall difference to outcomes.
Hope this is helpful for next week’s discussion.
Best wishes,
Peter
Peter Byass
Professor of Global Health, Ume� University
Honorary Professor, Universities of Aberdeen and the Witwatersrand
From: Nichols, Erin K. (CDC/OPHSS/NCHS) [mailto:[email protected]]
Sent: 10 August 2018 16:29
To: [email protected]; Peter Byass <[email protected]>; 'Daniel Chandramohan' <[email protected]>; Jakob Robert ([email protected]) <[email protected]>; 'Henry Kalter' <[email protected]>
Subject: Proposed updates to maternal section of WHO VA questionnaire
Hello all,
Following various discussions this week, please see attached a summary of the review, comments, and proposed updates of issues reported concerning the maternal death section of the questionnaire (version 1.5.1).
Jordana will be including these in a log of other proposed updates that will be put forth for review by the WHO VA Working Group in the coming weeks.
Peter and Henry, your careful review and agreement with these proposed updates and issues is highly appreciated.
Please let me know if you have any questions.
Thanks and kind regards,
Erin
Added logic to make sure date parameters are with the current calendar. Specifically in the following areas:
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
Response options for 10173_a should be yes, no, dk, ref (YES_NO_DK_REF2) not wheezing, no, dk, ref (select_502)
Question (Id10431) Select EPI vaccines done;
In cases where the child/neonate received only one or two of the vaccine group i.e Polio_123, which is complete vaccination according to the age. In this case, it requires interviewers to key In "no" since not all of the vaccine group was issued which is wrong. The question needs to be reviewed and also hint corrected and Q by Q updated if there is a correction.
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
10328-10332 are about labor and delivery, so should not be asked if the woman died while pregnant and not yet in labor ( ** If 10305=1);** currently, these are asked.
I have just learned that one of Azza Badr's colleagues here has done an Arabic translation of the Neonatal and Child questionnaires, and Azza is ready to do the adult. I think there may also be an Afghan Persion translation. I will check.
Don de Savigny
Dear Aurelio,
Not sure if I am using GitHub correctly by positing here.....
I just wanted to mention that XLS Form (https://opendatakit.org/downloads/download-info/xlsform-for-windows/) does not appear to be able to convert the Excel file to the XML questionnaire if the file name starts with a number (i.e. the way the files are currently and how they are published on the WHO website). just a minor issue.
Cheers,
Martin
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Dear All,
Based on various discussion and for the integration with DHIS2 it is critical to introduce a standardized field for geographic information in the WHO 2016 questionnaire.
This field could be called something like “geography” and would be a calculated field that takes free text. The field should be calculated as geographic units and the desired degree of geographic resolution (e.g. to region or to health facility) will vary from country to country. The “calculation” for the “geography” field would copy the lowest level of required geographic information. The openVA Pipeline can use the standardized “geography” field to get the geographic information associated with the VA. The Hint for the question should indicate to people this calculation as well as the fact that they should introduce cascading-selection to get the geographic information and that people should use geographic information as used in the HIS to which the VA data is to be linked, e.g. DHIS2 Organizational Units.
Thanks for your help.
Kind regards,
Martin
______________________________________________________________________________
Martin W. Bratschi
Deputy Director, Technical Implementation
Public Health Programs, CRVS Improvement
M +65 9836 6421 | Skype martinbratschi
Vital Strategies
Building Public Health Systems Globally
-–
We envision a world where everyone is protected by a strong public health system.
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The current formula is:
if(${Id10232_units}='days', ${Id10232_a} div 30,${Id10232_b})
but Id10232_a is days and the Id10232 label is:
(Id10232) For how many days did the ulcer on the foot ooze pus?
The formula should be:
if(${Id10232_units}='days', ${Id10232_a},${Id10232_b} div 30)
since Id10232_b is measured in months
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
Suggestion to ask 10127 (diagnosis of AIDS) before HIV test positive, and possibly skip/autofill HIV test positive if there was a Dx of AIDS
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
Issue described below with suggested updates, approved by Robert Jakob 8/22, noted. Updated document to be sent to Jordana to include in updated manual and guidelines for application and use, targeting release by December 2018.
From: Mswia, Robert [mailto:[email protected]]
Sent: Tuesday, April 25, 2017 9:25 AM
To: Loraine West (CENSUS/POP FED) <[email protected]>; [email protected]; Nichols, Erin K. (CDC/OPHSS/NCHS) <[email protected]>; [email protected]; [email protected]
Cc: Reynolds, Zahra <[email protected]>
Subject: RE: Questions on the WHO 2016 VA questionnaires
Dear all
Just to add to Loraine’s comments below, we also found few code-overlapping issues with the Appendix 1 – the cause of death list for verbal autopsy with corresponding ICD-10 codes. There seems to be overlap with IC D-10 codes being grouped into more than one 2016 category
Examples below
a) VAs-01.99 - Unspecified infectious disease : ICD-10 code range (A20-A38) is included. This range also include A33 (Neonatal tetanus) A34-A35 (Tetanus), and A37 (Pertussis)
� Should become: A20-A33, A36, A38
b) VAs-01.99 - Unspecified infectious disease : ICD-10 code range (B00-B19) is included here. The range includes B05 which is for measles, classified elsewhere
� Should become: B00-B04; B06-B19
c) VAs-98 – Other and unspecified non-communicable disease :
a. ICD-10 code range (D55-D89) is included. But D55-D64 is for severe Anemia. D57 which is also in this range is code for Sickle cell disease.
� Should become D65-D89
b. Additionally, the same category includes ICD-10 code range K40-K93. However, K70-K76 which is in the range are codes for Liver cirrhosis
� Should become K40-K69; K77-K76
d) VAs-02.99 – Other and unspecified neoplasms :
a. Includes the range C60 to D48. But C60-C63 are classified elsewhere - codes for male reproductive neoplasms.
� Should become C64-D48
b. Also C91-C95 is included in this range. However, these are codes for Leukemia, which are already classified in another category
� This was corrected in latest version of table; leukemia was removed from specific cause and moved to Other and unspecified neoplasms already.
If countries adopt this proposed tabulation list without double checking the categories for any overlap, they will not have correct causes of death
--Robert
Need to confirm if there are codes for the upper ends of these ranges
(Id10273) Did the baby stop suckling?
This question is causing confusion during data collection. In the sense that it is mistaken to mean when the baby stopped breastfeeding. Alot of responses sent through VA denotes duration of baby stopping to breastfeed which is normal. Please update Q by Q and also add hint or rephrase the question to collect accurate data on this.
Sent by Martin Bratschi ([email protected]). Created by fire.
Dear All,
For countries to be able to localize / customize the questionnaire it is very important to know which questions can be modified.
It would therefore be very useful to release the list of questions used by the various algorithms for managers to know what cannot be modified. In addition to the questions needed by the algorithm it may be useful to have a column of “highly recommended” questions which countries should also not modify.
Kind regards,
Martin
______________________________________________________________________________
Martin W. Bratschi
Deputy Director, Technical Implementation
Public Health Programs, CRVS Improvement
M +65 9836 6421 | Skype martinbratschi
Vital Strategies
Building Public Health Systems Globally
-–
We envision a world where everyone is protected by a strong public health system.
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This is to test if an email can open an issue
Martin W. Bratschi
Deputy Director, Technical Implementation
Public Health Programs, CRVS Improvement
M +65 9836 6421 | Skype mbratschi
Vital Strategies
Building Public Health Systems Globally
We envision a world where everyone is protected by a strong public health system.
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
Hello,
Minor correction to report for the constraint message after Id10173_nc:
For 10173_nc (During illness….did his/her breathing sound like any of the following):
---Constraint message correctly shows if you select “DK or Ref” with any other options; however, it should also show if you click “no”. Constraint message and programming should be updated to:
(Id10173_check) It is not possible to select “No,” “Don’t know,” or “Refused to answer” together with other options. Please go back and correct the selection.
Thanks,
Erin
Erin K. Nichols PhD, MPH
CDR, USPHS
International Statistics Program
National Center for Health Statistics
Centers for Disease Control and Prevention
3311 Toledo Rd., MS P08
Hyattsville, MD 20782
Office: (301) 458-4426, Mobile: (301) 364-7655
Fax: (301) 458-4022
Email: [email protected]
Sent by Henry Kalter ([email protected]). Created by fire.
Dear Daniel, Robert, Erin and Jordana,
As we discussed during last month’s phone call, please find attached a table of modifications of the 2016 WHO VA needed to accommodate the expert algorithm method of analyzing neonatal and child causes of death. I’ve also attached the article we published onvalidation of the EAVA method.
Best regards,
Henry
Attachments:
Sent by Martin Bratschi ([email protected]). Created by fire.
Dear All,
For all of the following questions, terminology needs to be adjusted to use “medical certification of cause of death” instead of death certificate to clarify the difference between the MCCOD and the Death Certificate issues by the civil registrar.
Kind regards,
Martin
Id10462
Id10463
Id10464
Id10465
Id10466
Id10467
Id10468
Id10469
Id10470
Id10471
Id10472
Id10473
______________________________________________________________________________
Martin W. Bratschi
Deputy Director, Technical Implementation
Public Health Programs, CRVS Improvement
M +65 9836 6421 | Skype martinbratschi
Vital Strategies
Building Public Health Systems Globally
-–
We envision a world where everyone is protected by a strong public health system.
(Id10273) Did the baby stop suckling?
This question is causing confusion during data collection. In the sense that it is mistaken to mean when the baby stopped breastfeeding. Alot of responses sent through VA denotes duration of baby stopping to breastfeed which is normal. Please update Q by Q and also add hint or rephrase the question to collect accurate data on this.
Hello guyz. According to the definition of age categories in the 2016 WHO questionnaire , child is to be upto 11 years whereas Adult is to be above 12 years. In the questionnaire age group calculation:
isChild1 -- if(${ageInDays} >27 and ${ageInDays} <=11365.25, '1', '0')
isAdult1--if(${ageInDays} >11365.25, '1', '0')
This makes any age begining from 11 years 1day to be categorised as Adult??? Is this intentional? I think in order to match definition as per documentation it should be;
isChild1 -- if(${ageInDays} >27 and ${ageInDays} <12365.25, '1', '0')
isAdult1--if(${ageInDays} >=12365.25, '1', '0')
Two errors on the form for choice values exceding 32characters
XForm Parse Warning: choice value [government_health_center_or_clinic] is too long; max.
XForm Parse Warning: choice value [community_based_practitionerinsystem] is too long; max.
This error can be avoided by changing the value name
To optimize use of our electronic data collection platform, we should add range and logic checks for open answers, where relevant. CDC is willing to propose such checks if we can agree on best process.
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
Hello,
I noted that in the neonate questionnaire, ODK does not seem to be following the skip from Id10077 as described in the Q by Q guide. Instead, it is going to the next question, Id10408…
The Q by Q guide says:
Id10077: Did (s)he suffer from any injury or accident that led to her/his death?
This is an opening question to check whether the death was associated with any injury or accident. If the response is “YES”, proceed with the following questions. These questions are generally straightforward and readily understood, with little potential for error in the response, except in the case of stigma or apprehension of involvement with police or other administration.
If the answer is "NO", then skip to Id10351. However, if the answer is "DK/Ref", the interviewer should probe further and continue with the subsequent questions.
I suspect this has to do with the “and” in the relevance coding for 10351, where 10098 would not be asked if 10077 is No:
(selected(${Id10114}, 'no') or ${Id10114} = 'NaN' or string-length(${Id10114}) = 0) and selected(${isNeonatal}, '1') and selected(${Id10098}, 'yes') and not(selected(${Id10099}, 'yes'))
Can you please review?
Thanks,
Erin
Thanks,
Erin
Erin K. Nichols PhD, MPH
CDR, USPHS
International Statistics Program
National Center for Health Statistics
Centers for Disease Control and Prevention
3311 Toledo Rd., MS P08
Hyattsville, MD 20782
Office: (301) 458-4426, Mobile: (301) 364-7655
Fax: (301) 458-4022
Email: [email protected]
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
With the addition of “removal of uterus,” the question is now relevant for all reproductive age women. Therefore, we should remove the hint “If woman was under 40, do not ask and just click No.”
The constraint for a child's age (measured in days) is:
.>27 and .<=60
and it should be
.27 and .<=365.25*11
There is an error with the constraint_message as well
The WHO 2016 questionnaire downloaded from the WHO Verbal Autopsy Standards website only contains the .xlsx form. I would suggest also including the .xml version so that users do not have to use XLSForm Online if they want to use ODK Aggregate.
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
Hello,
There is a minor typo in the ODK section heading for the section on “preset HIV-Malaria.” Please update it to read:
Preset HIV-Malaria mortality and season.
Thank you,
Erin
Erin K. Nichols PhD, MPH
CDR, USPHS
International Statistics Program
National Center for Health Statistics
Centers for Disease Control and Prevention
3311 Toledo Rd., MS P08
Hyattsville, MD 20782
Office: (301) 458-4426, Mobile: (301) 364-7655
Fax: (301) 458-4022
Email: [email protected]
Dear WHO VA 2016,
In the WHO2016 XLSform, I find some errors on the calculation of some signs duration for the following variables :
ODK WHO2016 form_ corrections_made_NanoroHDSS_Apr2019_KDerra.docx
Sent by Nichols, Erin K. (CDC/OPHSS/NCHS) ([email protected]). Created by fire.
Hello,
Not a major issue, but there should be a note in the hint for Id10362 that “This question should be asked only if the child was less than 1 year old when it died.” Perhaps this can be updated in a future revision.
Thanks,
Erin
Erin K. Nichols PhD, MPH
CDR, USPHS
International Statistics Program
National Center for Health Statistics
Centers for Disease Control and Prevention
3311 Toledo Rd., MS P08
Hyattsville, MD 20782
Office: (301) 458-4426, Mobile: (301) 364-7655
Fax: (301) 458-4022
Email: [email protected]
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