Health Research Program
Focus Areas: VASA

The ongoing 2019 Nigeria Verbal and Social Autopsy (VASA) study is using a mixed methods approach to identify the main causes of under-five deaths in Nigeria and understand the social context and healthcare responses that preceded preventable child deaths. These results will provide a compelling narrative on why Nigerian children die and inform strategies to address preventable deaths.

Watch the 2019 VASA Video

Why Study Child Deaths in Nigeria?

Globally, Nigeria is one of the five leading countries that account for half of the under-five deaths, and has an under-five mortality rate of over 100 per one thousand live births.1 According to trend analysis, under-five mortality declined by 48% between 1990 and 2015.2 However, the pace remains significantly slower than needed to achieve the Sustainable Development Goal (SDG) 3 target of reducing child mortality to 25 death/1,000 live births by 2030.3

Like many Sub-Saharan African countries, Nigeria has historically depended on data modeling by the Child Health Epidemiology Reference Group (CHERG), an indirect method of estimating causes of under-five deaths, to determine the cause distributions of deaths in neonates, infants and children. As part of the country’s effort to accelerate reductions in child mortality, the first Nigerian VASA was conducted in 2014 using households with histories of under-five deaths identified during the 2013 Nigeria Demographic and Health Survey (NDHS). The 2014 VASA provided a primary estimate of causes of under-five deaths as well as information on the sociocultural factors that might have been barriers to caregivers accessing care for their sick children.4

What is Verbal and Social Autopsy?

Qualitative interview
Photo credit: Dr. Michael Kunnuji, CIRCLE Project

Verbal autopsy of deaths uses retrospective interviews with caregivers to document and understand the symptoms and signs of the fatal illness. It is a useful tool to estimate the causes of deaths in a specific population with poor vital registration or medical certification of the causes of deaths.5 Verbal autopsy has been widely used in household surveys, demographic surveillance sites, vital registration systems and special studies. Social autopsy builds on verbal autopsy by studying the setting, and sequence of decisions and events that leads to death. The focus of social autopsy is to understand the decision-making, care-seeking and actual care that preceded death, to provide insight into social determinants of death and how deaths might be prevented.6 



Home behind a tree in Nigeria
Photo credit: CIRCLE Project

The data collection of the 2019 VASA, both the survey and qualitative components, was conducted between October and December 2019. Fifteen survey teams followed up on 3,215  under-five deaths recorded in the NDHS 2018 survey, which were scattered among 1,014 locations in all the 36 states and the Federal Capital Territory.  Qualitative data were collected across 12 states in the six geopolitical zones of Nigeria. A total of 72 in-depth interviews with caretakers, 48 focus group discussions with community leaders, 12 key informant interviews with health providers, and one facility observation in each state, were conducted between October and November, 2019.  Learn more about the VASA study and data collection process by watching this video.

The 2019 VASA approach also includes a strong emphasis on stakeholder engagement. To learn more about the stakeholder engagement activities, see this VASA blog.

The writing and review process of the VASA products was completed in October, 2020. Study findings will be shared in November through national and regional dissemination events, formal reports and a policy implications brief. Please check back for additional updates and information on the 2019 VASA.

Home behind a tree in Nigeria
Photo credit: CIRCLE Project

For more information about the 2019 Nigeria VASA, please contact






  1. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), ‘Levels & Trends in Child Mortality: Report 2017, Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation’, United Nations Children’s Fund, New York, 2017
  2. Mortality Estimation’, United Nations Children’s Fund, New York, 2017 National Population Commission [Nigeria], ORC Macro. Nigeria Demographic and Health Survey. Report, 2013. MEASURE DHS ICF International Calverton, Maryland, USA
  3. Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016;388(10063):3027-3035. doi:10.1016/S0140-6736(16)31593-8.
  4. Adewemimo A, Kalter HD, Perin J, Koffi AK, Quinley J, Black RE (2017) Direct estimates of cause-specific mortality fractions and rates of under-five deaths in the northern and southern regions of Nigeria by verbal autopsy interview. PLoS ONE 12(5): e0178129.
  5. Kalter HD, Roubanatou AM, Koffi A, Black RE. Direct estimates of national neonatal and child cause–specific mortality proportions in Niger by expert algorithm and physician–coded analysis of verbal autopsy interviews. J Glob Health. 2015;5:010415. Medline:25969734 pmid:25969734
  6. Koffi AK, Kalter HD, Loveth EN, Quinley J, Monehin J, Black RE. Beyond the causes of death: The social determinants of deceased children 1–59 months of age in Nigeria from 2009–2013. PLoS ONE. Forthcoming 2017.