VERBAL AUTOPSY IN ESTABLISHING CAUSE OF PERINATAL DEATH

Introduction: Perinatal mortality is a sensitive indicator of health status of a community andis also highly amenable to intervention. The causes of perinatal deaths in developingcountries are often difficult to establish. Verbal autopsy has been used in several countriesfor children and adults, but seldom for perinatal cause.Objective: To establish the cause of perinatal deaths using verbal autopsy.Design: Community-based cross-sectional, retrospective study to identify perinatal deathover a one year period from July 1996-June 1997. Comparison was made with hospitalrecords. An algorithm of signs and symptoms was used by trained personnel to identify thecause of perinatal death. The duration of collection of data was six months (August 1996-January 1997).Setting: Hai district of Kilimanjaro region in Tanzania.Subjects: All perinatal deaths within one year.Results: The perinatal mortality was 58 per 1000 (121 deaths and 2088 live births). Verbalautopsy could establish the cause of death in 105 of the 121 deaths. Hospital records showed79 deaths indicating that 42 deaths probably occurred at home. Among the 79 availablehospital records, the cause of death could be established in only 30 (38%). The causes ofpostnatal death were compared between the verbal autopsy and hospital records. There wasa good correlation between the same, however only 18 records were available from hospitalamong the total 31 postnatal deaths. The specificity of determining cause of death usingverbal autopsy was 100% and sensitivity 61%.Conclusion: The commonest causes of perinatal deaths were related to obstetric care,therefore interventions to curb perinatal mortality should be directed to improvement ofobstetric care. Verbal autopsy is a simpler and more sensitive tool in establishing the causeof perinatal death than hospital records in a rural district of Tanzania. Large-scale studiesare needed to validate this