The limitations of verbal autopsy in a malaria-endemic region

Todd, Jim; Andrés, Felipe; O’Dempsey, Timothy; Greenwood, Brian

doi:10.1080/02724936.1994.11747689

Cited by 89 publications

(77 citation statements)

References 15 publications

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“…This misclassification may have led to the overestimation of the overall pneumonia mortality. However, our estimates of seasonal risk are likely to be robust, because we do not expect the specificity of assigning pneumonia as the cause of death to vary across seasons, as is the case for malaria, 34 because pneumonia has very distinct signs and symptoms.…”

Section: Discussionmentioning

confidence: 99%

Seasonal Pattern of Pneumonia Mortality among Under-Five Children in Nairobi’s Informal Settlements

Yé

Zulu

Mutisya

et al. 2009

The American Journal of Tropical Medicine and Hygiene

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Abstract. Using longitudinal data from the Nairobi Urban and Demographic Surveillance System (NUHDSS), we examined the seasonal pattern of pneumonia mortality among under-five children living in Nairobi's slums. We included 17,787 under-five children resident in the NUHDSS from January 1, 2003 to December 31, 2005 in the analysis. Four hundred thirty-six deaths were observed and cause of death was ascertained by verbal autopsy for 377 of these deaths. Using Poisson regression, we modeled the quarterly mortality risk for pneumonia. The overall person-years (PYs) were 21,804 giving a mortality rate of 20.1 per 1,000 PYs in the study population. Pneumonia was the leading cause of death contributing 25.7% of the total deaths. Pneumonia mortality was highest in the second quarter (risk ratio [RR] = 2.3, confidence interval [CI]: 1.2-4.2 compared with the fourth quarter). The study provides evidence that pneumonia-related mortality among under-fives in Nairobi's slums is higher from April to June corresponding to the rainy season and the beginning of the cold season.

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Section: Discussionmentioning

confidence: 99%

Seasonal Pattern of Pneumonia Mortality among Under-Five Children in Nairobi’s Informal Settlements

Yé

Zulu

Mutisya

et al. 2009

The American Journal of Tropical Medicine and Hygiene

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“…2,11,14,17,21,22,[25][26][27] However, the repeatability of causes of death derived by physician review is low. 28 Although intertobserver agreement is shown to be high in some studies, this may simply reflect consistency in physicians' prior knowledge of the local epidemiology. 28 This technique tends to reach a single cause even if a death is very likely due to multiple causes.…”

Section: Analytical Challenges Deriving Causes Of Death From Verbal Amentioning

confidence: 97%

“…28 Although intertobserver agreement is shown to be high in some studies, this may simply reflect consistency in physicians' prior knowledge of the local epidemiology. 28 This technique tends to reach a single cause even if a death is very likely due to multiple causes. Only a minority of VAs (13%) assigned more than one cause of death by physicians, while 25% of these deaths had two causes recorded in host t pital.…”

Section: Analytical Challenges Deriving Causes Of Death From Verbal Amentioning

confidence: 97%

Verbal autopsy

Soleman¹

2006

Bull World Health Organ

254

108

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Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems. In some regions of the world it is the only method available to obtain estimates on the distribution of causes of death. Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia. In this paper, we present an overview of the VA process and the results of a review of VA tools and operating procedures used at demographic surveillance sites and sample vital registration systems. We asked for information from 36 field sites about field-operating procedures and reviewed 18 verbal autopsy questionnaires and 10 cause-of-death lists used in 13 countries. The format and content of VA questionnaires, field-operating procedures, cause-of-death lists and the procedures to derive causes of death from VA process varied substantially among sites. We discuss the consequences of using varied methods and conclude that the VA tools and procedures must be standardized and reliable in order to make accurate national and international comparisons of VA data. We also highlight further steps needed in the development of a standard VA process.Keywords Autopsy/methods; Interviews/methods; Questionnaires; Cause of death; Developing countries (source: MeSH, NLM). Mots clés Autopsie/méthodes; Entretien/méthodes; Questionnaires; Cause décès; Pays en développement (source: MeSH, INSERM). Palabras clave Autopsia/métodos; Entrevistas/métodos; Cuestionarios; Causa de muerte; Países en desarrollo (fuente: DeCS, BIREME). Voir page 244 le résumé en français. En la página 244 figura un resumen en español.

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“…It is important to note that the techniques used to describe malaria-speci¢c mortality, using interviews with bereaved relatives, have been shown to lack both sensitivity and speci¢city (Snow et al 1992;Todd et al 1994), and that entomological measures of transmission intensity have inherent problems of sensitivity, particularly in areas of low vector abundance (Dye & Hasibeder 1986;Mbogo et al 1995). These quali¢ers and the paucity of data illustrate how di¤cult it is to tackle this question.…”

Section: T H E E Pi De M Iolo Gy O F S Ev E R E M a L A R I A L Mor Bmentioning

confidence: 99%

Host—parasite interaction and morbidity in malaria endemic areas

Marsh

Snow

1997

Phil. Trans. R. Soc. Lond. B

121

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Severe morbidity due to Plasmodium falciparum is a major health problem in African children. The patterns of morbidity in endemic areas are modi¢ed by the immune response, and vary markedly with transmission intensity. Severe disease falls into three overlapping syndromes: coma, respiratory distress, and severe anaemia. Recently, it has become clear that metabolic acidosis plays a major role in the pathogenesis of severe disease and is particularly important in the overlap between the di¡erent clinical syndromes. We propose that the di¡erent manifestations of severe malarial morbidity arise from the interaction of a limited number of pathogenic processes: red cell destruction, toxin-mediated activation of cytokine cascades, and infected cell sequestration in tissue microvascular beds. The pattern of severe morbidity varies with age within any one endemic area, with severe anaemia predominating in the youngest children and coma having its highest incidence in older children. Between endemic areas there is a marked variation in mean age of children with severe malaria, and therefore in the importance of di¡erent clinical syndromes. The shift in mean age is due to a combination of increased challenge and more rapid development of immunity at higher levels of transmission. Recent comparative studies indicate that at higher levels of transmission the net e¡ect of these shifts may be a paradoxical reduction in total severe malarial morbidity.

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The limitations of verbal autopsy in a malaria-endemic region

Cited by 89 publications

References 15 publications

Seasonal Pattern of Pneumonia Mortality among Under-Five Children in Nairobi’s Informal Settlements

Seasonal Pattern of Pneumonia Mortality among Under-Five Children in Nairobi’s Informal Settlements

Verbal autopsy

Host—parasite interaction and morbidity in malaria endemic areas

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