Estimation of AIDS adult mortality by verbal autopsy in rural Malawi

Doctor, Henry V.; Weinreb, Alexander

doi:10.1097/00002030-200311210-00014

Cited by 31 publications

(29 citation statements)

References 17 publications

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“…We first reviewed several pediatric and adult AIDS case validation studies. Then applied major clinical criteria of WHO’s pediatric AIDS case definition in combination with selected available common criteria used in a few adult AIDS case definitions with good validity [28,32–34]. Our final AIDS case definition included any of the following conditions: 1) jaundice; 2) chronic diarrhea lasted for more than 1 month; 3) chronic fever lasted for more than 1 month; 4) wasting, defined as having at least 1 of the following symptoms – paleness, hair color change, edema legs, dry scaly skin; and 5) cough or trouble breathing lasting 3 to 27 days with fever but without a recent diagnosis of tuberculosis.…”

Section: Methodsmentioning

confidence: 99%

Deriving causes of child mortality by re–analyzing national verbal autopsy data applying a standardized computer algorithm in Uganda, Rwanda and Ghana

Liu¹,

Li²,

Cummings³

et al. 2015

Journal of Global Health

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BackgroundTo accelerate progress toward the Millennium Development Goal 4, reliable information on causes of child mortality is critical. With more national verbal autopsy (VA) studies becoming available, how to improve consistency of national VA derived child causes of death should be considered for the purpose of global comparison. We aimed to adapt a standardized computer algorithm to re–analyze national child VA studies conducted in Uganda, Rwanda and Ghana recently, and compare our results with those derived from physician review to explore issues surrounding the application of the standardized algorithm in place of physician review.Methods and FindingsWe adapted the standardized computer algorithm considering the disease profile in Uganda, Rwanda and Ghana. We then derived cause–specific mortality fractions applying the adapted algorithm and compared the results with those ascertained by physician review by examining the individual– and population–level agreement. Our results showed that the leading causes of child mortality in Uganda, Rwanda and Ghana were pneumonia (16.5–21.1%) and malaria (16.8–25.6%) among children below five years and intrapartum–related complications (6.4–10.7%) and preterm birth complications (4.5–6.3%) among neonates. The individual level agreement was poor to substantial across causes (kappa statistics: –0.03 to 0.83), with moderate to substantial agreement observed for injury, congenital malformation, preterm birth complications, malaria and measles. At the population level, despite fairly different cause–specific mortality fractions, the ranking of the leading causes was largely similar.ConclusionsThe standardized computer algorithm produced internally consistent distribution of causes of child mortality. The results were also qualitatively comparable to those based on physician review from the perspective of public health policy. The standardized computer algorithm has the advantage of requiring minimal resources from the health care system and represents a promising way to re–analyze national or sub-national VA studies in place of physician review for the purpose of global comparison.

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Section: Methodsmentioning

confidence: 99%

Deriving causes of child mortality by re–analyzing national verbal autopsy data applying a standardized computer algorithm in Uganda, Rwanda and Ghana

Liu¹,

Li²,

Cummings³

et al. 2015

Journal of Global Health

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“…AIDS-related symptomatology was measured via response to Verbal Autopsy, a questionnaire developed to identify symptoms of AIDS in areas with over 20% HIV prevalence and where data on cause of death or illness is unavailable or unreliable 21 , 22 . Verbal Autopsy is increasingly used for determining AIDS mortality in generalized epidemics 21 , 23 , 24 and recent research found it to have 75% – 83% sensitivity and 74% – 79% specificity among adult subjects 25 . The ART use and CD4 count criteria were based on South Africa’s ART eligibility guidelines at the time of the survey 26 .…”

Section: Methodsmentioning

confidence: 99%

Medical Pluralism Predicts Non-ART Use among Parents in Need of ART: A Community Survey in KwaZulu-Natal, South Africa

et al. 2014

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Despite documented common use of traditional healers and efforts to scale up ART in sub-Saharan Africa, evidence on whether medical pluralism predicts ART use is inconclusive and restricted to clinic settings. This study quantitatively assesses whether medical pluralism predicts ART use among parents in need of ART in South Africa. 2477 parents or primary caregivers of children were interviewed in HIV-endemic communities of KwaZulu-Natal. Analysis used multiple logistic regression on a subsample of 435 respondents in need of ART, who reported either medical pluralism (24.6%) or exclusive public healthcare use (75.4%). Of 435 parents needing ART, 60.7% reported ART use. Medical pluralism emerged as a persistent negative predictor of ART utilization among those needing it (AOR [95% CI]= .556 [.344 – .899], p=.017). Use of traditional healthcare services by those who need ART may act as a barrier to treatment access. Effective intersectoral collaboration at community level is urgently needed.

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“…It does not permit the assignment of a precise cause of death, but instead helps to indicate the most likely cause of death given the available information [22]. In the context of AIDS, verbal autopsy has been used to estimate the distribution of AIDS and non-AIDS deaths in rural Africa with sufficient confidence but has never been used to identify causes of death among HIV patients receiving HAART [23]. Therefore, the results presented here must be interpreted with caution.…”

Section: Causes Of Deathmentioning

confidence: 96%

“…In 60 cases (64%) the likely causes of death were abstracted from hospital charts. Twenty verbal autopsies were done (18 deaths at home plus two deaths in a hospital and a remote health structure) with a median recall period of 21 months (IQR, [16][17][18][19][20][21][22][23][24][25][26][27][28]. Half needed a consensus.…”

Section: Likely Underlying Causes Of Deathmentioning

confidence: 99%

Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7-year cohort study

Etard¹,

Ip²,

Thierry-Mieg³

et al. 2006

Aids

250

199

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Estimation of AIDS adult mortality by verbal autopsy in rural Malawi

Cited by 31 publications

References 17 publications

Deriving causes of child mortality by re–analyzing national verbal autopsy data applying a standardized computer algorithm in Uganda, Rwanda and Ghana

Deriving causes of child mortality by re–analyzing national verbal autopsy data applying a standardized computer algorithm in Uganda, Rwanda and Ghana

Medical Pluralism Predicts Non-ART Use among Parents in Need of ART: A Community Survey in KwaZulu-Natal, South Africa

Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7-year cohort study

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