title: Validation of verbal autopsy tool for ascertaining the causes of stillbirth.
abstract: OBJECTIVE
  To assess performance of the WHO revised verbal autopsy tool for ascertaining the causes of still birth in comparison with reference standard cause of death ascertained by standardized clinical and supportive data.
  
  
  METHODS
  All stillbirths at a tertiary hospital in Karachi, Pakistan were prospectively recruited into study from August 2006- February 2008. The reference standard cause of death was established by two senior obstetricians within 48 hours using the ICD coding system. Verbal autopsy interviews using modified WHO tool were conducted by trained health workers within 2- 6 weeks of still birth and the cause of death was assigned by second panel of obstetricians. The performance was assessed in terms of sensitivity, specificity and Kappa.
  
  
  RESULTS
  There were 204 still births. Of these, 80.8% of antepartum and 50.5% of intrapartum deaths were correctly diagnosed by verbal autopsy. Sensitivity of verbal autopsy was highest 68.4%, (95%CI: 46-84.6) for congenital malformation followed by obstetric complication 57.6%, (95%CI: 25-84.2). The specificity for all major causes was greater than 90%. The level of agreement was high (kappa=0.72) for anomalies and moderate (k=0.4) for all major causes of still birth, except asphyxia.
  
  
  CONCLUSIONS
  Our results suggest that verbal autopsy has reasonable validity in identifying and discriminating between causes of stillbirth in Pakistan. On the basis of these findings, we feel it has a place in resource constrained areas to inform strategic planning and mobilization of resources to attain Millennium Development Goals.
authors.affiliation: Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Sidrah
authors.initials: S
authors.lastname: Nausheen
authors.forename: Sajid B
authors.initials: SB
authors.lastname: Soofi
authors.forename: Kamran
authors.initials: K
authors.lastname: Sadiq
authors.forename: Atif
authors.initials: A
authors.lastname: Habib
authors.forename: Ali
authors.initials: A
authors.lastname: Turab
authors.forename: Zahid
authors.initials: Z
authors.lastname: Memon
authors.forename: M Imran
authors.initials: MI
authors.lastname: Khan
authors.forename: Zamir
authors.initials: Z
authors.lastname: Suhag
authors.forename: Zaid
authors.initials: Z
authors.lastname: Bhatti
authors.forename: Imran
authors.initials: I
authors.lastname: Ahmed
authors.forename: Rajiv
authors.initials: R
authors.lastname: Bahl
authors.forename: Shireen
authors.initials: S
authors.lastname: Bhutta
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
mesh_terms: D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic / Q000379:methods* / Q000592:standards; D011247:Pregnancy; D012015:Reference Standards; D050497:Stillbirth