BMC Public Health 2005, 5:58 http://www.biomedcentral.com/1471-2458/5/58 Table 1: Algorithm used for the diagnoses of cause of death, in Meskan and Mareko district, Ethiopia. 2000. Algorithm Diagnosis Duration of illness < 30 days + Accidents (intentional or unintentional) Injuries Female sex + (Pregnant or In labor or in the puerperal period) Maternal causes Duration of illness > 30 days + Cough + Weight loss + (Bloody sputum or Fever or Ascites) + no diarrhea Tuberculosis Duration of illness > 30 days + Cough + Diarrhea + Fever + Weight loss AIDS Duration of illness > 15 days + (Edema of legs or Ascites) + Jaundice Liver diseases Duration of illness < 15 days + Abdominal swelling + Repeated vomiting + No diarrhea Acute abdomen Duration of illness > 30 days + cough + Dyspnea + Wheezing + No bloody sputum Chronic obstructive lung diseases Duration of illness < 30 days + Diarrhea + No cough Diarrheal diseases Duration of illness < 15 days + Fever + Headache Acute febrile illness Duration of illness < 15 days + Fever + Headache + Neck stiffness Meningitis Duration of illness < 30 days + Cough + Fever + (Dyspnea or Chest pain) Pneumonia Duration of illness < 30 days + Dyspnea + Palpitation + (Edema of legs or Ascites) Cardio Vascular diseases 49 was selected for this study in order to identify the causes of premature adult death, since life expectancy at birth in Ethiopia is 53 years for females and 50.9 years for males [17,23]. Data were collected using a simplified verbal autopsy questionnaire administered to relatives of the deceased. The questionnaire for this study was developed based on the WHO questionnaire for identifying cause of death in children and modified to address adult signs and symp- toms of diseases [8]. It was initially prepared in English and then translated to Amharic (the national language). The first part of the questionnaire has questions on the socio-demographic characteristics of the subjects such as area of residence, age, sex, marital status, education, eco- nomic status, health service usage; and their personal hab- its such as smoking and alcohol drinking. The second part has questions on circumstances surrounding mortality such as signs and symptoms of illness, duration of illness, health care seeking, medications used, and admission to a health facility. The interview on average took about 20 minutes. The VA questionnaire used in this study is short and simplified. That was done for the following reasons: to develop a less complicated questionnaire that can be used by lay interviewers with minimal training; to get ade- quate response to all questions from rural and illiterate people; to make the questionnaire suitable for annexing into routine surveillance systems in the future; to facilitate the development of an uncomplicated algorithm for iden- tifying broad categories of cause of death; and to obtain fairly complete information about each death. Data col- lectors and supervisors were recruited from the study area. The data collectors were all high school graduates with good experience in a similar type of fieldwork. Data col- lectors went house to house to collect information about the deceased person identified from the study base. In the event respondents were not available on first visit, repeated visits were arranged on at least two occasions. Data entry and analysis were done using Epi Info version 6.04 statistical package. Causes of death were analyzed using an expert algorithm programmed into a computer. The algorithm does not include cancer as one category mainly because health records did not show cancer as major causes of either hospital admission or hospital death for adults in Ethiopia [17,23]. The second reason is that because of the varied manifestations for different types of cancers, it would be difficult to accommodate deaths due to cancer into the simple questionnaire and algorithm used in this study. The algorithms used are shown in Table 1. Results A total of 819 adult (15–49 years) deaths were identified from the BRHP computer database for the period 1995– 1999. In the field appropriate respondents (family mem- bers and close relatives) were identified for 515 (63%) of the deceased persons. The reasons for not identifying the rest include out-migration of the entire family of the deceased person, unavailability of relatives on repeated visits, wrong recorded information about the deceased, and double recording. The highest proportion of the missed cases (59.7%) was for those who died in the initial one and half years of the study. From those who died in the last one and half years of the study only 19.4% of the cases were missed. Communicable diseases accounted for 60.8% of the deaths, non-communicable for 24.1%, maternal causes 7%, injuries 1.7%, and undetermined causes consisted of 6.4%. The highest number of deaths was due to acute febrile illnesses (AFI) comprising 25.2% of all causes. AFI, diarrheal diseases, tuberculosis, AIDS, and liver diseases together accounted for 64.7% of the deaths (Table 1). AFI was the cause for 28% and 25.5% of Page 3 of 7 (page number not for citation purposes)