150 (63.6) 66 (28.0) 25 (10.6) 23 (9.7) 20 (8.5) 14 (5.9) 2 (0.8) 56 (23.7) 26 (11.1) 13 (5.5) 14 (5.9) 3 (1.3) 19 (8.1) 6 (2.5) 5 (2.1) 236 (100) 126 (60.6) 53 (25.5) 27 (13.0) 21 (10.1) 10 (4.8) 10 (4.8) 5 (2.4) 48 (23.1) 24 (11.5) 13 (6.3) 9 (4.3) 2 (0.9) 14 (6.7) 1 (0.5) 19 (9.1) 208 (100) Total No. (%) 313 (60.8) 130 (25.2) 57 (11.1) 50 (9.7) 38 (7.4) 28 (5.4) 10 (1.9) 124 (25.4) 58 (11.3) 32 (6.2) 27 (5.2) 7 (1.4) 36 (7.0) 9 (1.7) 33 (6.4) 515 (100.0) BMC Public Health 2005, 5:58 http://www.biomedcentral.com/1471-2458/5/58 Table 2: Possible verbal autopsy based causes of death by area of residence in Meskan and Mareko district, Ethiopia. 1995–1999. Rural highland No. (%) Rural lowland No. (%) Possible cause I. Communicable Diseases Acute Febrile illnesses Diarrheal diseases All forms of tuberculosis HIV/ AIDS Pneumonia Meningitis II. Non-communicable Diseases Liver diseases Cardio-vascular diseases Chronic obstructive lung diseases Acute abdomen conditions III. Maternal causes IV. Injuries Undetermined Total Urban No. (%) 37 (52.1) 11 (15.5) 5 (7.0) 6 (8.5) 8 (11.3) 4 (5.6) 3 (4.2) 20 (28.2) 8 (11.3) 6 (8.5) 4 (5.6) 2 (2.8) 3 (4.2) 2 (2.8) 9 (12.7) 71 (100) the deaths in the rural highland, and lowland areas respectively, while it accounted to only 15.5% of the urban deaths. Diarrheal diseases accounted for 7% of the deaths in the urban area, 10.6% in the rural highland and 13% in the rural lowland. However, HIV/AIDS in the urban area accounted for 11.3% in contrast to 8.5% and 4.8% in the rural highland and lowland (Table 2). In general, deaths from communicable diseases was greater in males (62.8%) than in females (58.7%); while deaths from non-communicable diseases was greater in females (35.4%) than in males (26.8%). Maternal mortal- ity accounted for 7% of all deaths, and 14.2% of the female deaths (Table 3). Of the 36 women identified to have died from maternal causes; 17 (47.2%) had fever, 10 (27.8%) had prolonged labor, and 4 (11.1%) had hemorrhage. Since a large proportion of the deaths that occurred in the first one and half year of the study were missed, analysis of cause of death was also made for the deaths excluding the initial one and half year. There were a total of 422 cases found in this category. Communicable diseases accounted for 59.2% of the deaths, non-communicable 25.4%, maternal causes 6.9%, injuries 0.9% and undeter- mined causes were 7.6% (Table 4). Discussion This study has attempted to identify the causes of death at a district level based on a simplified verbal autopsy proce- dure. Although information of this type is recognized to be very important for health planning and decision mak- ing it is largely nonexistent in developing countries, espe- cially in rural settings. In the study area the major causes of death were acute febrile illnesses, liver diseases, diarrheal diseases, tuberculosis and HIV/AIDS. Maternity related causes accounted for 14.2% of the total female deaths. The questionnaire was made short and easily understandable to enhance its application on illiterate rural respondents by lay interviewers. The simplification has narrowed the possibilities of making very specific diagnoses that are claimed to be achieved using a more elaborate questionnaire. On the other hand, it would have been impossible to obtain complete data using elaborated questionnaire administered by lay interviewers, especially for the deaths that occurred long ago. In rural areas it is very difficult, if not impossible, to find interviewers with fairly high level of education that can administer and record an elaborate open ended questionnaire. In this study no major problem was detected on the completed questionnaires that can be attributed to the data collec- tor's incompetence. Information was collected as far back as five years. We observed that the loss of the beloved is unforgettable in Page 4 of 7 (page number not for citation purposes)