A COMPARISON OF 3 VERBAL AUTOPSY METHODS TO ASCERTAIN LEVELS AND CAUSES OF MATERNAL DEATHS IN MATLAB, BANGLADESH

Background Verbal autopsies have been widely used iu determine the lev els and causes of maternal death but few studies have assessed the rel iability of various methods, Methods We compared the levels and causes of maternal mortality in three data sources from Matlab, Bangladesh: (1) maternal deaths identified through a unique demographic surveillan ce system (DSS); (2) maternal deaths identified as a result of a previ ous detailed investigation into the levers and causes of maternal mort ality: and (3) maternal deaths identified in the current special study . All studies used lay reporting, but differed in terms of the nature of the study, the sex of the interviewer, the format of the questionna ire and the procedure to derive the diagnosis. Results There were subs tantial disagreements between the routine reporting and the special st udies. The DSS identified 67.2% of all deaths occurring during pregnan cy or within 42 days postpartum (82.3% of direct obstetric deaths, 70. 0% of deaths due to induced abortions ansi 42.4% oi indirect obstetric deaths). Extending the definition of maternal deaths to 90 days postp artum increased the numbers of maternal deaths between 1987 and 1993 f rom 174 to 196. The two special studies also disagreed in the ascertai nment of the causes of maternal deaths and yielded different cause of death distributions; the proportion of direct obstetric deaths (exclud ing abortion) was 50.4% in the current system compared to 44.5% previo usly (P = 0.001). Conclusions This study confirms the known difficulti es in the ascertainment of the levels and causes of maternal mortality . The large disparities in the levels and causes of maternal mortality using three different methods of lay reporting in a population with a n almost complete vital registration system add to the growing concern about the inaccuracies in the measurement of maternal mortality.