Verbal autopsy as a technique to establish causes of infant and child mortality

In order to develop a method for retrospectively establishing causes of paediatric deaths in Mangochi District, Malawi, we translated a verbal autopsy questionnaire into Chichewa and Chiyao. This form was used to interview guardians of 82 children who died in hospital between June 1993 and May 1994. Based on the guardians' answers, we were able to determine the causes of death for these children. According to our experience, verbal autopsy appeared simple to administer and relatively easy to interpret. To test the validity of this method in southern Malawi, we compared its results to hospital diagnosis, using a sample of 36 children who had died in hospital and whose records could be located. In this preliminary validation, we found a high sensitivity and specificity for the most common childhood illnesses in the area. Thus, verbal autopsy appeared a promising method of collecting population-based information about paediatric mortality, the full applicability of which should be tested in larger studies in Malawi.