Abstract

Community Verbal autopsy (VA) is a systematic retrospective inquiry of the family members about the circumstances, events, symptoms and signs of illness prior to death to help determine the underlying cause of death and to classify the broad patterns of mortality. It is relatively simple and low-cost alternative to obtain valid estimates of causes of death particularly when still significant number of death occurs in community before accessing to any health facilities.

This study tested reliability of the WHO designed adult VA questionnaire revised for identifying the cause of maternal death in Nepalese settings. The modified VA questionnaire was administered visiting the deceased family members for all the maternal deaths that occurred at health facilities in Rupandehi and Surkhet districts. These districts were purposively selected as facility-based maternal death review system has been implemented in both the districts and both the districts were included in Nepal Maternal Mortality and Morbidity Study 2008-09. In total, nine maternal deaths that occurred during 2013 - 2014 AD were included in the study. Two highly qualified and competent Obstetricians/Gynecologists were involved in assigning the cause of maternal death. One of them derived the cause of each maternal death based on the information collected in the respective VA questionnaire while another independently reviewed all the available medical records and assigned the cause of death.

Considering the cause of death derived from hospital documents and maternal death review forms as the gold standard verbal autopsy final diagnosis was compared.

Reliability of the VA questionnaire was measured using inter-reviewer Kappa statistics which indicate good reliability (kappa = .0.65 with standard error of 0.16). However, there were several questions and sections in the VA questionnaire found irrelevant and needs some changes. Thus, it is concluded that the adopted verbal autopsy questionnaire, with some changes, could be capable of providing reasonable cause specific maternal mortality estimates in Nepal.

Keywords: Verbal Autopsy (VA); Maternal Death; Nepal

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