Study shows lack of reported ethical practices while conducting verbal autopsy research

Researchers from The George Institute for Global Health conducted a systematic review to understand and analyse the ethical standards reported in peer-reviewed verbal autopsy studies. The results of this systematic review show that although there has been an increase in ethical reporting for verbal autopsy studies, there still remains a large gap in reporting.

The study was led by Associate Professor Rohina Joshi, Senior Research Fellow, The George Institute for Global Health, Australia and published in the International Journal of Epidemiology.

The study focused on 3 key areas while extracting and analysing the data:

  • Institutional Review Board (IRB) clearance and consenting process
  • Data collection and management procedures, including: time between death and interview, training and education of interviewer, confidentiality of data and data security
  • Declarations of funding and conflict of interest

A total of 288 papers were included in the systematic review, out of which 49 papers were from India. The review found that:

  • 48% of all the studies reported having Institutional Review Board (IRB) clearance or obtaining consent of participants.
  • The interviewer training and education levels were reported in 62% and 21% of the articles, respectively.
  • Confidentiality of data was reported for 14% of all studies.
  • 18% did not report the type of respondent interviewed.
  • 51% reported time between death and the interview for the verbal autopsy.
  • Data security was reported in 8% of all studies.
  • Funding was declared in 63% of all studies. and
  • Conflict of interest was declared in 42%.of all studies.

Speaking of the study, Associate Professor Rohina Joshi, said:

“We encourage the verbal autopsy researchers to recognize the number of ethical issues that arise with the nature of work and to describe in detail the measures taken to address such issues. At a minimum, a published paper should report IRB approval, informed consent, confidentiality during interview, data security, relevant training for interviewers, funding sources and conflict of interest. The ethical approval section of a paper can be more than a ‘box-ticking exercise’ and instead provide a basis for critical assessment of the paper on ethical grounds.”

The study also concluded that verbal autopsy methods have improved significantly over the past decade, with validated questionnaires and automated cause-of-death analysis. Unfortunately, there has not been an equal engagement with the ethical issues involves in verbal autopsy research.

The systematic review recommends that researchers use the ethical principles of research to design, implement and monitor verbal autopsy studies and report them, at a minimum, in accordance with ICMJE standards.