The validity of verbal autopsies for assessing the causes of institutional maternal death

This report presents data from a study carried out in three African countries to assess the validity of verbal autopsies-based on information about symptoms and signs observed antemortem by relatives or associates of deceased individuals-for determining the causes of institutional maternal death. The validity of the verbal autopsy was assessed for each cause of death, and for groups of "direct" and "indirect" maternal causes, by comparing the verbal autopsy diagnoses with the reference diagnoses and calculating their sensitivity, specificity, and posit ive predictive value. Verbal autopsies were found to be highly specific (98 percent specificity for all causes of maternal death) but not very sensitive (less than or equal to 60 percent sensitivity for all causes except ante/postpartum hemorrhage). Verbal autopsy estimates of cause-specific mortality were comparable to expected values for most of the causes. The study shows that certain direct causes of hospital-based maternal mortality call be determined by means of verbal autopsies with a reasonable level of confidence.