Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Feb 5;5(1):e000961.
doi: 10.1136/bmjpo-2020-000961. eCollection 2021.

Added value of an open narrative in verbal autopsies: a mixed-methods evaluation from Malawi

Patricia Loh  1 , Edward Fottrell  1 , James Beard  1 , Naor Bar-Zeev  2   3 , Tambosi Phiri  4 , Masford Banda  4 , Charles Makwenda  5 , Jon Bird  6 , Carina King  1   7
Affiliations
Randomized Controlled Trial

Added value of an open narrative in verbal autopsies: a mixed-methods evaluation from Malawi

Patricia Loh et al. BMJ Paediatr Open. .

Abstract

Background: The WHO standardised verbal autopsy (VA) instrument includes closed questions, ascertaining signs and symptoms of illness preceding death, and an optional open narrative. As VA analyses increasingly use automated algorithms, inclusion of narratives should be justified. We evaluated the role of open narratives on VA processes, data quality and respondent's emotional stress.

Methods: A mixed-methods analysis was conducted using VA data for child deaths (0-59 months), between April 2013 and November 2016 in Mchinji district, Malawi. Deaths were prospectively randomised to receive closed questions only or open narrative followed by closed questions. On concluding the VA, interviewers self-completed questions on respondents' emotional stress. Logistic regression was used to determine associations with visible emotional distress during VAs. A group discussion with interviewers was conducted at the project end, to understand field experiences and explore future recommendations; data were coded using deductive themes.

Results: 2509 VAs were included, with 49.8% (n=1341) randomised to open narratives. Narratives lasted a median of 7 minuntes (range: 1-113). Interviewers described improved rapport and felt narratives improved data quality, although there was no difference in the proportion of deaths with an indeterminate cause using an automated algorithm (5.3% vs 6.1%). The majority of respondents did not display visible emotional stress (81%). Those with a narrative had higher, but not statistically significant, odds of emotional distress (adjusted OR: 1.20; 95% CI: 0.98 to 1.47). Factors associated with emotional stress were: infant deaths versus neonates; deaths at a health centre or en-route to hospital versus home; and higher socioeconomic status. Non-parental respondents and increased time between death and interview were associated with lower odds of emotional distress.

Conclusion: Conducting an open narrative may help build rapport, something valued by the interviewers. However, additional time and emotional burdens should be further justified, with quality and utility of narratives promoted through standardised recommendations.

Keywords: data collection; ethics; mortality; qualitative research.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Verbal autopsy inclusion (Consolidated Standards of Reporting Trials diagram).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Thomas L-M, D'Ambruoso L, Balabanova D. Verbal autopsy in health policy and systems: a literature review. BMJ Glob Health 2018;3:e000639. 10.1136/bmjgh-2017-000639 - DOI - PMC - PubMed
    1. World health statistics . 2018: monitoring health for the SDGs, sustainable development goals. Geneva: World health statistics, 2018.
    1. D'Ambruoso L, Kahn K, Wagner RG, et al. . Moving from medical to health systems classifications of deaths: extending verbal autopsy to collect information on the circumstances of mortality. Glob Health Res Policy 2016;1:2. 10.1186/s41256-016-0002-y - DOI - PMC - PubMed
    1. Fottrell E, Byass P. Verbal autopsy: methods in transition. Epidemiol Rev 2010;32:38–55. 10.1093/epirev/mxq003 - DOI - PubMed
    1. Murray CJL, Lozano R, Flaxman AD, et al. . Using verbal autopsy to measure causes of death: the comparative performance of existing methods. BMC Med 2014;12:5. 10.1186/1741-7015-12-5 - DOI - PMC - PubMed

Publication types