Eye health of professional drivers of a Nigerian University

BACKGROUND

Safe driving and road traffic accident prevention could be attained through ensuring good condition of vehicles, the road as well as the physical and mental state of the driver among others Objectives: To determine the ocular health status of professional drivers of the University of Ibadan, Nigeria

METHODS

A cross sectional survey of all drivers in the employment of the University of Ibadan, excluding the College of Medicine, was carried out between March and June 2002 at the University Medical Centre and the eye clinic of the University College Hospital, Ibadan.

RESULTS

One hundred and ninety seven all male drivers were screened. Their ages ranged from 31 to 64 years (mean 48.3 +/-5.9yr). Less than satisfactory presenting (functional) binocular visual acuity (< 6/18) was found in 11(5.6%) of the drivers. With refraction no driver had binocular vision of <6/18, but three drivers each had corrected visual acuity in the worse eye of 6/12, 6/18 and 6/36 respectively. The commonest visual problems were presbyopia 100 (50.8%), and refractive errors 38 (19.3%). Other ocular pathologies included pterygium 11 (5.6%), optic atrophy 9 (5.0%), colour vision defects 7 (3.6%) cataract 2 (1.0%), age related macular degeneration 4 (2.0%), glaucoma 3 (1.5%) retinal scar 2 (1.0%), exotropia 1 (0.5%), and pingueculum 1 (0.5%),

CONCLUSION

Periodic screening of driver population of any establishment is a worthwhile task that may help to identify potentially blinding or visually impairing conditions such as glaucoma and refractive-error which can be promptly treated.

Knowledge and practice of universal precautions against blood borne pathogens amongst house officers and nurses in tertiary health institutions in Southeast Nigeria

PURPOSE

To examine the knowledge and practice, as well as factors influencing universal precautions practices amongst Nigerian House officers and Nurses.

METHODS

A Cross-sectional descriptive study. Sample selection was by stratified random sampling. Information was elicited using pretested, structured, self-administered questionnaire. Data were analyzed using EPI-info.

RESULTS

Most Doctors, 66.6%, were aged 26-30 years while the Nurses, 41.1%, were aged 40 years. 57.6% of the Doctors were males, while 85.7% of the nurses were females. Knowledge of universal precautions measures was high for both categories of respondents--97.0% for doctors and 92.0% for nurses, although practice was better for the nurses, 75.0%, compared to the doctors, 15.2%, p < 0.05. The most important factor influencing universal precautions practice is the lack of provision of adequate protective equipments. Other factors, all of which show significant difference between the doctors and nurses (p < 0.05), include carelessness; lack of display of universal precautions guidelines; emergency nature of the procedure; insufficient water supply; patient perceived to be at low risk of blood borne pathogens; pressure of time; and universal precautions equipments interfering with technical skills.

CONCLUSIONS

Although knowledge of universal precautions is high for both house officers and nurses, practice is however better amongst the latter than the former. The effective knowledge and practice of universal precautions amongst hospital workers are of absolute necessity to prevent infections from blood and body fluid pathogens.

Effects of parental involvement in HIV/AIDS preventive education on secondary student knowledge about transmission and prevention in Akwa Ibom State, Nigeria

This study investigated HIV/AIDS preventive health education involving nurses alone (IG1) and another involving both nurses and trained parents/ guardians (IG2) on students' knowledge of HIV/AIDS' transmission and prevention in Akwa Ibom State, Nigeria. Subjects included 339 students selected through a multistage and stratified random sampling technique. A pre-test/post-test intervention design with control group was used. Data were obtained using questionnaire, and analysis involved the use of analysis of covariance, multiple classification analysis, and Scheffe's post-hoc test. Results show that students exposed to parental involvement had significantly better mean scores on knowledge of prevention (IG2: x=7.51; IG1: x=6.96 control: x=3.82). Furthermore, although the male students had significantly higher mean score with intervention involving only nurses, the females had higher mean score with intervention involving parents/guardians. It is recommended that parents/guardians should be trained and involved in HIV/AIDS' preventive education of secondary school students.

Condom use amongst out of school youths in a local government area in Nigeria

BACKGROUND

Reported low condom use amongst out of school requires studying the context in which condom use occurs.

METHODS

A cross sectional study of 350 out-of-school youth aged 15-24 years in a local government area of Nigeria was enrolled using cluster sampling.

RESULTS

Those who had ever had sexual intercourse were 74.9%. Of these, 56.5% used no protection while 29.0% used condoms. Up to 78.6% have had sex within the preceding 12 months with 38.9% condom use. The commonest reason for non-condom use was that it reduces sexual enjoyment. Those who believed a single unprotected sexual exposure may result in HIV infection reported more condom use than those who believed otherwise (42% vs 27.2%, P<0.05). Those who had prior discussion with their partners on HIV/AIDS reported more condom use compared to those who had not (50% vs 25%, P<0.05). Also, those who had sexual intercourse occurring as a spontaneous event reported less condom use compared to those who have previously discussed about the possibility of having sex (68.0% vs 51.8%, P<0.05).

CONCLUSION

Condom use is likely to occur within relationships where opportunity exists for discussion on sexual matters. Thus, further studies are needed on communication and condom use within sexual partnerships.

Effects of school health nursing education interventions on HIV/AIDS-related attitudes of students in Akwa Ibom State, Nigeria

PURPOSE

One of the greatest challenges facing school nurses is that of identifying and using appropriate strategies to meet the health education needs of adolescents in regard to prevention of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). This study examined the effects of HIV/AIDS preventive health education with parental involvement on students' attitude toward HIV/AIDS prevention in Akwa Ibom State, Nigeria.

METHODS

The study population comprised students from three of nine secondary schools in the study area. The three schools were randomly assigned as Intervention Group 1 (IG1), involving nurses only; Intervention Group 2 (IG2), involving both nurses and parents (IG2); and a control group. A pretest/post-test intervention design was used. A 29-item, validated questionnaire was the instrument for data collection. Sampling involved multistage and stratified random technique to select 120 subjects from each of the three selected schools, with a total of 360 subjects representing 8.3% of the study population. From this number, 339 (94.2%) provided sufficient data for analysis. Data analysis involved analysis of covariance and the Scheffé post hoc test determined at the .05 significance level.

RESULTS

Results show significant effect of intervention on students attitudes toward preventive measures (F = 234.27, p < .001 *). The intervention that involved nurses only was found to be a more potent strategy in providing favorable attitudes toward HIV/AIDS prevention (IG1 mean, 20.59; IG2 mean, 19.20; control mean, 12.34). Attitudes were influenced by older age but not by gender.

CONCLUSION

Health education efforts aimed at improving HIV/AIDS-related attitudes should not only focus on children but also on parents so that they in turn could assist to improve on health workers' efforts in educating the children.

The prevalence of occupational asthma and rhinitis among woodworkers in south-eastern Nigeria

Wood dusts are known to cause respiratory disorders like rhinitis and asthma. This study was therefore done to determine the magnitude of the problem among woodworkers in south-eastern Nigeria exposed to high level of wood dust. Five hundred and ninety one woodworkers were selected using a stratified random sampling. The prevalence of woodwork-related rhinitis and asthma were then observed in the study population. Also the peak expiratory flow rate (PEFR) of each woodworker was obtained. The prevalence of occupational rhinitis was 78%, while that of asthma was 6.5%. As period of woodwork increased the prevalence of rhinitis and asthma increased (rhinitis: chi2 trend = 53.015, df = 1, P = 0.000). For asthma, chi2 trend = 19.721, df = 1, P = 0.000). Also the PEFR significantly became low with increasing years of exposure to woodwork (chi2 trend = 75.965, df = 1, P = 0.000). In conclusion the prevalence of rhinitis and asthma in woodworkers was high and significantly increased with years of working as a woodworker.

Ocular findings seen among the staff of an institution in Lagos, Nigeria

BACKGROUND

The degree to which ocular morbidity affects workers productivity in the developing countries has not been studied adequately. A federal government research institute based in Lagos introduced an annual health screen for all its workers, which included eye tests. This provided an opportunity to study the pattern of ocular conditions among workers who were 30 years and above, and to determine the effect of eye diseases on the workers productivity.

STUDY DESIGN

Detailed eye examination including refraction, was done on every respondent at the institution's clinic by an ophthalmologist. A questionnaire on ocular health status and occupational history was administered independently by an ophthalmic nurse. Sickness absenteeism, use of the clinic were obtained from clinic records, and the results were analysed.

RESULTS

The common ocular conditions were uncorrected or poorly corrected refractive error, uncorrected or poorly corrected presbyopia and allergic. conjunctivitis. Glaucoma, maculopathy and optic atrophy were causes of severe visual impairment or blindness in 1.9 % of the subjects. Absenteeism and clinic use were more common in subjects with ocular morbidity than those with non-ocular morbidity. Subjects with ocular morbidity had more illnesses, absenteeism and used the clinic more.

CONCLUSION

Ocular problems which reduce worker's productivity are prevalent among the staff of the institution studied. They are mostly unrecognised.

Pulmonary functions of wheat flour mill workers and controls in Ibadan, Nigeria

BACKGROUND

The impact of grain dust exposure on lung functions of grain handlers in Nigeria has remained largely undocumented. Lung functions of wheat flourmill workers and control subjects were assessed, and the prevalence of lung function abnormalities was compared among the occupational groups.

METHODS

Study subjects consisted of 91 flour-millers, 30 matched internal controls from the maintenance unit of the same flourmill factory and 121 matched external controls. A cross-sectional analytical design is utilized; data were collected using structured interviews, anthropometric measurements, spirometry, and area dust sampling.

RESULTS

The flour-millers recorded significantly lower mean lung functions compared with control subjects (P < 0.05), for FEV(1) and FVC, when observed values were expressed as percentages of predicted normal values. Furthermore, 29% of flour-millers, compared with 15% of external controls and 10% of internal controls, presented with at least one abnormal test result of ventilatory function.

CONCLUSIONS

The study concluded that wheat flour-mill workers in Nigeria are at an increased risk of developing abnormalities of lung functions compared with control subjects, and the dominant pattern of respiratory disease among them is airway obstruction.

Job satisfaction and psychological health of doctors at the University of Benin Teaching Hospital

BACKGROUND

Studies on job satisfaction and health have mainly been carried out among Caucasian populations. Similar studies are lacking in Nigeria.

AIM

To investigate the level of job satisfaction and its relationship to psychological disorder amongst Nigerian doctors.

METHODS

All 190 doctors at the University of Benin Teaching Hospital were invited to participate in a cross-sectional study. The respondents completed two self-administered questionnaires, a specifically designed (25-item) questionnaire and a standard instrument--the General Health Questionnaire (GHQ 28).

RESULTS

One hundred and fifty-two doctors responded, giving a response rate of 80%. Twenty-one (14%) doctors had a GHQ score of 4 and above, and were at increased likelihood of having a psychological disorder. Fifty-four per cent were either very dissatisfied or dissatisfied with their jobs, while 30% were very satisfied or satisfied with their jobs. The proportion of doctors with GHQ scores of 4 or above increased with the level of dissatisfaction although this was not statistically significant. The crude odds ratio of psychological disorder (GHQ score 4 and above) in dissatisfied respondents compared to satisfied respondents was 2.2 (95% confidence interval = 0.6-8.4). The odds ratio remained non-significant after controlling for the presence of adolescent children, stress outside work and length of service.

CONCLUSION

This study showed a high rate of job dissatisfaction among Nigerian doctors compared to their European and North American counterparts. The reason for this is not altogether obvious. Further research is needed to determine the causes of job dissatisfaction amongst Nigerian doctors.

Using verbal autopsy to identify and proportionally assign cause of death in Ibadan, southwest Nigeria

Reliable and accurate data remain scarce on the cause and rates of mortality among adults in sub-Saharan Africa. The Idikan Adult Mortality Study, a prospective community-based study was initiated in order to obtain the overall as well as cause-specific mortality data for a community of adults (15 years and above). Standardised verbal autopsy questionnaire was used to investigate and assign the mode and cause of death. There were 232 reported deaths in the baseline population of 4127 adults over 5 years, giving an unadjusted death rate of 11.2 per 1000 per year. Thirty-nine (16.8% ) of these death occurred suddenly. The commonest known cause of death was due to cardiovascular disease, which was responsible for 43 (18.5% ) of all deaths. It was also the commonest known cause of sudden death accounting for 30.8% of such deaths. Infection was responsible for 28 (12.1% ) deaths while injury accounted for 7 (2.6% ) deaths. Subjects, 50 years and above were more likely to die and also die suddenly than were the younger subject (p<0.0001, p<0.0001) and significantly more death occurred in males than females (6.9% versus 4.7% ) (P<0.01). Deaths were also more likely to have occurred at home and outside the hospital, increasing the probability of these deaths being underreported. Following multivariate logistic regression analysis, respondents between the age of 20 -49 years had significantly reduced risk of dying (p=0.029), while cigarette smoking significantly increased the risk of dying (p=0.012). In the absence of the urgently needed vital statistics, use of verbal autopsies is a potentially useful investigative method for identifying and assigning cause of adult deaths in a community.

Participatory operational research of the dynamics of the primary health care programme in Fiji

To review the history of primary health care (PFIC) in Fiji, to find out the present PHC policy situation at all the management levels as well as the dynamics of community mobilization and PHC service extension. Findings are to be used to propose the strengthening of the implementation of PHC in the country as the case may be. This is a mail questionnaire study of managers at all three levels of the health services for the historical study and those at the district health system for the PHC implementation. Fiji has had a very active primary health care programme. Community mobilization and health service extension was initially very active and health status indices improved greatly. However, this momentum has dropped due to reduction in following the initial directives for this purpose as at the early part of the programme. It is recommended that the programme of community health service extension be restored as a matter of a national written policy. The medical officers in charge of PHC should be trained in community medicine as before, in order to regain the lost momentum.

Prevalence of respiratory symptoms among wheat flour mill workers in Ibadan, Nigeria

BACKGROUND

While investigations into occupational health problems of various groups of workers have been conducted in Nigeria, so far, very little attention has been paid to the health status of workers in the grain industry. The prevalence of respiratory symptoms among wheat flour mill workers and control groups in a medium size industrial setting in Nigeria was studied.

METHODS

The study employed a cross-sectional analytical design. Data were collected using structured interviews, work-site observations, and physical examination. Respondents consisted of 91 flour-millers, 30 matched internal controls from the maintenance unit of the same flour mill factory, and 121 matched external controls.

RESULTS

Fifty-four percent of the flour-millers reported at least one respiratory symptom compared with 30% of the internal controls (P < 0.05) and 19% of the external controls (P < 0.001). Most symptoms were significantly more prevalent among the flour-millers compared with control subjects, and this trend was more evident amongst non-smokers than ex-smokers.

CONCLUSIONS

The study concluded that wheat flour mill workers in Nigeria, like grain workers elsewhere, were at an increased risk of developing both pulmonary and non-pulmonary symptoms compared with control subjects. The result has implications for improved dust control measures in the grain industry in Nigeria.

Structured and unstructured abstracts in journal articles: a review

Abstracts in journals are important paragraphs in review or original articles, which help one to decide if such articles are worth reading. The layout and the content of abstracts have undergone tremendous changes over the years from traditional, unstructured to structured, informative format. Many journal editors abroad are moving fast with time in the adoption of the innovation, allowing only articles with structured abstracts to appear in their journals. Journals in Africa especially in Nigeria are lagging behind in this respect. This review article examines the relative advantage of structured abstracts over unstructured abstracts as documented by various reports on the subject and makes a recommendation for structuring abstracts in articles appearing in Nigerian Journals.

Hospital workers' opinions on the predisposing factors to blood-related work accidents in Central Hospital, Benin City, Edo State, Nigeria

INTRODUCTION

Hospital workers are prone to accidental injuries during their day-to-day activities at work. These accidental injuries are of importance because many of these predispose the workers to blood-borne infections.

METHODS

A total of 242 hospital workers at Central Hospital, Benin City, Edo State participated in a cross-sectional study carried out between June and August 1999 aimed at finding out the predisposing factors to blood-related work accidents. The study group consisted of 53 doctors, 34 laboratory workers and 155 nurses. All doctors and laboratory workers at Central Hospital were involved in the study, while 50% of the nursing population were involved in the study. The nurses were selected using a stratified random sampling method. The respondents completed a pretested self-administered questionnaire.

RESULTS

The results showed that the four main factors responsible for accidents among the hospital workers were: non-availability of protective measures; desire to hasten the procedure; type of procedure; and use of inadequate/inappropriate equipment. The major factor responsible for accidents at work among hospital workers was non-availability of protective measures.

RECOMMENDATIONS

It is therefore recommended that adequate materials and equipment should be provided. This study could be further validated using a qualitative study design (focus group discussions).

Knowledge and practice of universal precautions among nurses in central hospital, Benin-City, Edo State, Nigeria

Nurses are faced with professional hazards such as needle pricks and blood-borne infections in their day to day activities in the work place. This study is aimed at finding out the knowledge and practice of universal precautions among nurses at the Central Hospital, Benin City, Edo State, Nigeria. One hundred and fifty-five (155) nurses participated in the cross-sectional study. The nurses were selected using the stratified random sampling method. The nurses had a poor knowledge about universal precautions as only 34.2% of nurses had heard about universal precautions. There was also a poor observance of universal precautions. Knowledge of measures to be taken after the occurrence of occupational accidents/ injuries was also poor, as only 26(16.8%) nurses would report puncture injuries to the clinic, only 13(8.4%) nurses would screen patients for HIV antibody after consent when they sustain work related accident/injuries. Twelve (7.7%) nurses would screen patient to determine hepatitis B status of patient while only 8(5.2%) nurses would go for medical check-up/immunisation with hepatitis B vaccine.

Evaluation of rational prescribing practices of doctors and medical students at the Igbo-Ora Comprehensive Hospital, Nigeria

This study was done to determine the level of rational drug prescribing practices by doctors and medical students as well as to assess the impact of the teaching of rational drug use on the prescribing skills of students. A checklist, developed according to the key indices of a rational prescription, was used to rate prescriptions obtained from randomly selected case notes in the period 1975, 1985 and 1995 by means of a scoring system. Mean score of students increased from 5.5(out of 10) in 1975 to 7.7 in 1985(p < 0.001) but showed a significant decline to 6.8 in the period 1995(p = 0.117). Mean score of doctors was 7.1 in 1975, 6.8 in 1985(p = 0.616) and 6.8 in 1995(p = 0.910). Comparison of mean scores of doctors and students for each period revealed a significant difference only in 1975(p = 0.012) The teaching of rational drug use had improved the rational prescribing practices of medical students. There is need for a sustained effort to maintain rational drug prescribing by students and doctors in Igbo-ora hospital. Similar efforts should be made in other places in the country.

Prevalence of cardiovascular risk factors in an African, urban inner city community

With the epidemiological transition phenomenon, more countries are expected to move from a disease pattern dominated by infectious diseases to one characterised by non-communicable diseases. Many developing countries are contending with infectious diseases as well as non-communicable diseases, yet little is known about the prevalence of cardiovascular risk factors in poor urban communities in developing countries. The objective of this community based study was to determine the prevalence of selected cardiovascular risk factors in an urban inner city community which had been followed up prospectively from 1993 to 1998. Results show that the prevalence of hypertension (Blood Pressure BP > 160/95 mm Hg) was 12.4 percent with an age-adjusted rate of 7.4 percent. This is higher than what is found in the rural parts of the country but much lower than what is generally observed in industrialized countries of the world. Though there was no significant difference in the proportion with hypertension by gender (P > 0.05), the mean systolic BP was significantly higher for men (123.9 +/- 23.9) mm Hg) than for women (120.6 +/- 26.8 mg Hg) t = 2.93, p < 0.01. The mean diastolic BP was similarly higher for men (75.8 +/- 14.9) mm Hg than women (74.0 +/- 14.9) mm Hg t = 2.76 p < 0.01). Eight percent of the study population were obese (BMI > 30), and generally, more women than men were obese. However, at ages 15-19 significantly more males than females were obese (X2 = 73, p < 0.01). Both mean systolic and diastolic BP increased with increasing weight. When adjusting for gender, the association between hypertension and other CVD risk factors remained similar for males and females and gender was not a modifier of the factors. Of the CVD risk factors studied, Age > 40 years and obesity, were significantly associated with the presence of hypertension in this community (P < 0.0001 and P < 0.0001), smoking, alcohol intake and gender were not (P > 0.05). It is necessary to implement a national plan for the control of cardiovascular diseases in order to reduce and keep to minimum cardiovascular diseases and its complications in the country.

Onchocerciasis: the clinical and epidemiological burden of skin disease in Africa

An attempt was made to assess the true public-health importance of onchocercal skin disease throughout the African region and hence provide an objective basis for the rational planning of onchocerciasis control in the area. The seven collaborative centres that participated in the study (three in Nigeria and one each in Ghana, Cameroon, Tanzania and Uganda) were all in areas of rainforest or savannah-forest mosaic where onchocercal blindness is not common. A cross-sectional dermatological survey was undertaken at each site following a standard protocol. At each site, the aim was to examine at least 750 individuals aged 5 years and living in highly endemic communities and 220-250 individuals aged 5 years and living in a hypo-endemic (control) community. Overall, there were 5459 and 1451 subjects from hyper-and hypo-endemic communities, respectively. In the highly endemic communities, the prevalence of itching increased with age until 20 years and then plateaued, affecting 42% of the population aged 20 years. There was a strong correlation between the prevalence of itching and the level of endemicity (as measured by the prevalence of nodules; r=0.75; P<0.001). The results of a multivariate logistic regression analysis showed that, at the individual level, the presence of onchocercal reactive skin lesions (acute papular onchodermatitis, chronic papular onchodermatitis and/or lichenified onchodermatitis) was the most important risk factor for pruritus, with an odds ratio (OR) of 18.3 and 95% confidence interval (CI) of 15.19-22.04, followed by the presence of palpable onchocercal nodules (OR=4.63; CI=4.05-5.29). In contrast, non-onchocercal skin disease contributed very little to pruritus in the study communities (OR=1.29; CI=1.1-1.51). Onchocercal skin lesions affected 28% of the population in the endemic villages. The commonest type was chronic papular onchodermatitis (13%), followed by depigmentation (10%) and acute papular onchodermatitis (7%). The highest correlation with endemicity was seen for the prevalence of any onchocercal skin lesion and/or pruritus combined (r=0.8; P<0.001). Cutaneous onchocerciasis was found to be a common problem in many endemic areas in Africa which do not have high levels of onchocercal blindness. These findings, together with recent observations that onchocercal skin disease can have major, adverse, psycho-social and socio-economic effects, justify the inclusion of regions with onchocercal skin disease in control programmes based on ivermectin distribution. On the basis of these findings, the World Health Organization launched a control programme for onchocerciasis, the African Programme for Onchocerciasis Control (APOC), that covers 17 endemic countries in Africa.

Epidemiological applications: a case report of a village epidemic of gastroenteritis

This is a case report of an epidemic of gastroenteritis which was investigated and controlled by epidemiological methods only, before laboratory investigations could be done to confirm the original epidemiological conclusions--from contaminated home made ice-cubes. The case and process are reported in order to encourage similar uses of epidemiology by field public health practitioners, especially within the district or primary health care systems and particularly in places where laboratory support are difficult to avail. The case is used also to discuss the equipments and facilities that ought to be part of the support system for every modern field public health practitioner. These should include computers, modern communication facilities and epidemiological support systems, especially senior epidemiologists; as such senior personnel are available to junior colleagues in the other areas of specialist medical practice.

Teenage pregnancies in the Rewa medical sub-division, Fiji

To assess the magnitude of teenage pregnancies in the Rewa Medical Sub-division as well as the socio-demographic characteristics of the affected teenagers so as to provide a baseline for tackling the problem. The study was a 5 year retrospective study (1994-1998) of the medical records of the Nausori Maternity Unit, the only unit for these purposes in the entire Subdivision. Pregnancies that were intentionally terminated were not included, as no such data was available from these our public health services. An average of 11.1% of the 5319 obstetric patients attended to at the centre for the 5 years were teenagers. Their age range was 13 to 19 years. Proportionately more Fijians had such teenage pregnancies than their Indo-Fijian counterparts. The same was true of their being unmarried or being VDRL positive. A larger percentage of the Indian teenagers received assisted deliveries than the Fijians, but this was not statistically significant, being 6% and 4% respectively. Low birth weight was 19% among these teenagers (compared with 5.9% overall). Efforts are needed in the area of family life education to improve on aspects of teenage pregnancies. Since this is an area of education that has many conflicting values in the modern world, it is advocated that parents as well as many agencies as possible should be targets as well as join in this task in order meet the needs as due. Such education should cover and respect all the values concerned.

The Idikan adult mortality study

The Idikan adult mortality study is designed to explore the usefulness of the verbal autopsy methodology in the determination of cause-specific adult mortality. Such data have been largely unavailable in developing countries. Members of a stable urban community (4333 adults) were registered in their family units and followed up every 3 months to ascertain deaths, exits and new entries to the study population. Deaths were investigated by means of a verbal autopsy, which was administered by a trained interviewer to the relative closest to the decedent. Two physicians independently studied the results and assigned a cause of death, and these were then confirmed or resolved by a senior physician colleague. Hospitals where deaths occurred were visited and assignable cause of death was obtained where available and compared with the cause assigned by verbal autopsy. Only 8 of the 60 investigated deaths were confirmed to have occurred in a hospital in the first 2 years of the study. The cause of death assigned by verbal autopsy agreed moderately both between the independent coders as well as with the hospital assigned cause of death using the Kappa statistics for agreement beyond chance. We therefore concluded that verbal autopsies appear moderately useful for adult death statistics (Kappa = 0.23 to 0.1). Accumulation of more hospital deaths is needed, however, to make more definite conclusions about the validity of the technique.