The field survey conducted in Matlab DSS area to collect data for this study involved asking questions of respondents of both sexes regarding whether any of their sisters had died from causes related to pregnancy or delivery. Respondents were also asked to provide information on the circumstances surrounding, and the symptoms leading up to their sister's death. Because of the nature of the questions and the prevailing cultural situation in the Matlab study area, which is not congenial to male strangers collecting such information by
interacting with women, it was felt essential that female respondents would be interviewed only by female interviewers. Numerous previous studies on various research topics conducted in Matlab over nearly the last three decades suggested that, irrespective of the nature of the study, female interviewers can collect necessary information from male respondents with a fairly high degree of accuracy without facing any major difficulty. In view of these facts, it was thought best to use only female interviewers. The nature of the questions used in the survey also required that the interviewers must be married and preferably have experience of giving birth so that they would better understand the process of childbirth; this would give them confidence in asking questions about pregnancy-related deaths.
Applications were sought from local married, female candidates for recruitment as interviewers. Twelve candidates applied and did well in the written examination; nine of them appeared before a board of selectors for an oral examination. The five candidates judged best on the basis of both written and oral examinations were selected. Three of the selected interviewers, of whom two had no
interviewing experience as interviewers, had 14 years of education; another one, who was experienced in interviewing, had 12 years of education. The other had a 10th grade education and a vast experience of working as an
interviewer for about 12 years. Since all the interviewers were from the local villages, they were familiar with the
local people, culture and language.
In order to ensure high-quality data, extreme care was taken in the training of the field workers. Training was given by the investigator and a specially trained female health assistant who had been involved with collecting necessary information for identifying maternal deaths in the DSS area. The interviewers' training was held for three days and involved role-play in the class-room and intensive practice interviews. In the first day, they were briefly introduced to the DSS census volumes, relevant record books, and the numbering system so that they could understand the meaning of various identification numbers written on the cover page of each questionnaire.
Interviewers were told about common field strategies and exposed to the questionnaires in the same day. The meaning of verbal autopsy, and the purpose of its use were explained to them. Each of them was asked to read the questions separately to see whether they had any difficulty in understanding any question or asking any question and making it understandable to respondents. After they had finished reading, each of them was asked to act as an instructor and discuss every question in front of the other interviewers, the field supervisor and the investigator.
This role-play and discussion continued to the next day and was found to be very useful in making the interviewers thoroughly familiar with the questionnaire, as it is very important for them to check during interviews that the answers given to various questions are consistent with each other.
In the last one-and-a-half days of the training program, each interviewer was told to select another from the interviewing team and interview her in the class room under the close supervision of the field supervisor and the investigator. This time, some were asked to play the role of respondents as if each of them had a sister who died of causes related to pregnancy or delivery, and others were asked to play respondents with a sister who died of non- maternal causes. During this process of trial interviews, the interviewers were instructed to ask questions in the same way as they needed to be asked of the real respondents; this was to ensure that the interviewers did not alter the wording of the questions, which can also alter their meaning and thereby influence the answer. The investigator, supervisor and other interviewers kept notes of each interview on issues that were felt to be difficult or unclear, which were discussed and clarified immediately after each interview. These trial interviews greatly helped the interviewers to benefit from each other and to gain confidence to get the job done. The interviewers had no
difficulty in asking verbal autopsy questions. To minimize interviewer bias, the interviewers were not told the objectives of the study.
The key to ensuring high-quality data in any survey is intensive field supervision. To ensure this, special care was taken to have an experienced and efficient supervisor for the field survey. The co-ordinator, Matlab office, allowed me to take one of the senior male staff members as a supervisor. This staff member had a long experience in working with different investigators on many different research studies as an interviewer-supervisor, and he was well known in the Matlab office for his skill and friendly manner. He was required to accompany the interviewing team every day and was responsible for the overall management of the field work.