Background: Verbal autopsy (VA), the process of interviewing a deceased’s family or caregiver about signs and
symptoms leading up to death, employs tools that ask a series of closed questions and can include an open
narrative where respondents give an unprompted account of events preceding death. The extent to which an
individual interviewer, who generally does not interpret the data, affects the quality of this data, and therefore the
assigned cause of death, is poorly documented. We aimed to examine inter-interviewer reliability of open narrative
and closed question data gathered during VA interviews.
Methods: During the introduction of VA data collection, as part of a larger study in Mchinji district, Malawi,
we conducted partner interviews whereby two interviewers independently recorded open narrative and
closed questions during the same interview. Closed questions were collected using a smartphone application
(mobile-InterVA) and open narratives using pen and paper. We used mixed methods of analysis to evaluate
the differences between recorded responses to open narratives and closed questions, causes of death assigned, and
additional information gathered by open narrative.
Results: Eighteen partner interviews were conducted, with complete data for 11 pairs. Comparing closed questions
between interviewers, the median number of differences was 1 (IQR: 0.5–3.5) of an average 65 answered;
mean inter-interviewer concordance was 92 % (IQR: 92–99 %). Discrepancies in open narratives were summarized in
five categories: demographics, history and care-seeking, diagnoses and symptoms, treatment and cultural.
Most discrepancies were seen in the reporting of diagnoses and symptoms (e.g., malaria diagnosis); only one
pair demonstrated no clear differences. The average number of clinical symptoms reported was 9 in open
narratives and 20 in the closed questions. Open narratives contained additional information on health seeking
and social issues surrounding deaths, which closed questions did not gather.
Conclusions: The information gleaned during open narratives was subject to inter-interviewer variability and
contained a limited number of symptom indicators, suggesting that their use for assigning cause of death
is questionable. However, they contained rich information on care-seeking, healthcare provision and social
factors in the lead-up to death, which may be a valuable source of information for promoting accountable
health services.