Daijiworld Media Network - New Delhi

New Delhi, Jul 9: Verbal autopsy, a scientific method of analyzing causes of death through structured interviews with relatives of the deceased, is proving to be a vital tool in India’s ongoing battle against tuberculosis (TB), said Dr. Kavita Vasudevan of Indira Gandhi Medical College and Research Institute (IGMC&RI), Puducherry.

Dr. Vasudevan, who is from the college’s Community Medicine Department, explained that the verbal autopsy approach offers a comprehensive way to trace the root causes behind TB-related mortality, especially when medical records alone are insufficient to determine the exact reasons for death.

“A holistic approach is essential to combat TB, which includes not only quality diagnostics and effective treatment but also an understanding of the delays and systemic failures that contribute to TB deaths,” she told IANS. “Verbal autopsies provide critical insights into such gaps.”

What is a Verbal Autopsy?

Verbal autopsy is a method where caregivers or close relatives of a deceased person are interviewed using a structured questionnaire to uncover symptoms, healthcare-seeking behavior, delays in diagnosis or treatment, and other contextual factors that led to the death.

According to Dr. Vasudevan, this model blends quantitative analysis of clinical records with qualitative inputs from interviews with family members and healthcare workers under the National Tuberculosis Elimination Programme (NTEP).

“Verbal autopsy helps trace both patient-level delays and health system inefficiencies, and also explores social and financial hurdles, treatment access issues, and perceptions of the healthcare system,” she said.

This tool is especially important in cases where clinical documentation is incomplete, and helps uncover the real-world challenges patients face, often hidden behind numbers and statistics.

National Efforts and the MINErVA Initiative

India has been employing verbal autopsies as part of its Sample Registration System since 2001 to strengthen cause-of-death data. In 2017, AIIMS New Delhi, in collaboration with state partners, launched the MINErVA (Mortality in India Established through Verbal Autopsy) platform to enhance the national mortality surveillance system.

Under NTEP, a verbal autopsy is mandated for every death reported among TB patients, with the aim of using the findings to refine service delivery, improve diagnosis timelines, and reduce preventable deaths.

TB Mortality in India: A Continuing Challenge

TB continues to be one of the top 10 causes of death globally, and is the second leading infectious killer after COVID-19, surpassing HIV. As per recent estimates, TB causes 23 deaths per lakh population in India.

Under India’s National Strategic Plan aligned with the WHO’s End TB Strategy, one of the key goals is to reduce TB-related deaths by 90% by 2025.

Recognizing this, the World Health Organization has advocated for the use of verbal autopsies as a tool to understand the early symptoms, diagnosis timelines, and treatment disruptions that often go unnoticed.

Insights from Puducherry

At the local level, Dr. Vasudevan and her team at IGMC&RI are currently analyzing the causes behind 160 TB deaths reported in Puducherry in 2024 using verbal autopsy methods.

“Preliminary findings indicate that a majority of deaths occur within seven days of TB diagnosis, suggesting serious delays in patients accessing health care,” she revealed.

She also noted a unique trend — a significant number of the deceased were from neighboring Tamil Nadu districts but sought treatment in Puducherry, sometimes providing inaccurate local addresses, which complicates follow-up and record verification.

“These insights are essential for identifying weak points in the triage and referral systems,” said Vasudevan. “By uncovering patterns of treatment delay, we can design better interventions and ultimately save lives.”

As India intensifies its efforts to eliminate TB, experts believe that tools like verbal autopsy will be indispensable in turning data into action and making healthcare more responsive to those most at risk.