title: Deaths due to injury, including violence among married Nepali women of childbearing age: a qualitative analysis of verbal autopsy narratives.
abstract: OBJECTIVE
  Self-harm and interpersonal violence are important causes of death among women in Nepal. We analysed prospectively collected data to investigate the extent and nature of injury-related deaths among married women aged 15-49 years, recorded through verbal autopsy in rural Sarlahi District, Nepal.
  
  
  METHODS
  Verbal autopsies were systematically collected on all deaths of married women of reproductive age (15-49 years) over a 3-year period (1994-1997) as part of a randomised community-based trial of maternal vitamin A and β-carotene supplementation. This analysis included a three-way comparison of verbal autopsy data: qualitative free-response narratives, closed-ended responses, and physician-assigned consensus cause of death.
  
  
  RESULTS
  We focused on 46 of 559 deaths (8.2%) that were determined to be injury-related. Of the 46, 28% were identified as intentionally self-inflicted, and 11% as intentionally inflicted by another. Inconsistencies were noted between verbal autopsy reports of causes of deaths and physician assessments. Conflicts within the family figured prominently in the narratives. Women with unstable family situations and suffering from mental illness were often described as having experienced violent deaths.
  
  
  CONCLUSIONS
  Findings highlight that intervention efforts might be necessary especially in situations where there are poor family dynamics or mental health issues in order to prevent potential intrafamily violence and possible death. Results also point to the need for further documentation of violent deaths in rural Nepal.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Kiely T
authors.initials: KT
authors.lastname: Houston
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Wu
authors.affiliation: Sarvanga Swasthya Sadan (Sarvanga Hospital), Lalitpur, Nepal.
authors.forename: Sanu M
authors.initials: SM
authors.lastname: Dali
authors.affiliation: Nepal Nutrition Intervention Project-Sarlahi (NNIPS), Nepal Netra Jyoti Sangh, Nepal Eye Hospital Complex, Kathmandu, Nepal.
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011159:Population Surveillance; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality*; D055815:Young Adult