UCL GRAND CHALLENGE OF
GLOBAL HEALTH
Verbal Autopsy (VA) with mobile phones
Ethical issues in giving cause of death information after VA in rural Nepal
Lead: Dr Joanna Morrison
Main Collaborator: Dr James Wilson
Additional Collaborators: Dr Dharma Manandhar
Dr Ed Fottrell & Dr Jon Bird
Background
• Births and deaths of two-thirds of the
world’s population go unrecorded,
making public health planning difficult.
• Mobile InterVA (MIVA) is a new low-cost
mobile system for recording probable
cause of death in resource-poor settings.
• For the first time, cause of death
information can be processed and made
immediately available after a VA.
Institute for Global Health
Centre for Philosophy, Justice and Health
MIRA, Nepal
Institute for Global Health
Findings
• VA is upsetting, but advice and
information from interviewers is helpful.
• Family ability to act on the basis of
information is restricted by access and
quality of health services, and poverty.
Research questions
• How feasible and acceptable is it to
conduct VA with mobile phones?
• What are the ethical issues in giving
cause of death information to families
immediately after the VA?
Activities
• 1 focus Group Discussion with VA
interviewers
• 29 interviews and group interviews using
vignettes with community members who
have had a family death
• 4 interviews with Nepali policy level
stakeholders
Cross-disciplinary approach
Our research brings together computer
science, ethics and public health expertise
to address this cross-disciplinary question.
• Discrepancy between VA and Doctor
diagnosis would be problematic.
• Trust in interviewer and skills of
interviewer are very important.
• Interviewers would use their own
ethical judgment in giving cause of
death if it would cause family upset.
• Policy makers were cautious and
would
prefer
cause
of
death
information was given only at an
aggregate level.
Further activity and outputs
• Discussion with international ethics and
public health stakeholders to discuss
implications for scale-up of MIVA.
• Publication in peer reviewed ethics and
public health journals.
• Joint funding proposal
development.