Validation of Postmortem Interviews to Ascertain Selected Causes of Death in Children

Abstract

In developing countries, diagnoses of diseases associated with deaths in children are frequently derived from retrospective maternal interviews. To determine the validity of this methodology, and to define sensitive and specific diagnostic algorithms, we compared symptoms and signs reported by mothers using structured questionnaires, with selected physician diagnoses for 164 deaths among hospitalized children on the Philippine island of Cebu. The 164 decreased children had 256 physician diagnoses of acute lower respiratory infections (ALRI) (100), diarrhoeas (92), measles (48), and neonatal tetanus cases (16). Forty-three per cent of children had multiple illnesses. An algorithm for tetanus (age at death less than or equal to 30 days with convulsion or spasm) was 100% sensitive, but specificity could not be estimated due to the small number of comparison neonatal deaths. An algorithm for measles (age greater than or equal to 120 days, with rash and fever for at least three days) had 98% sensitivity and 90% specificity. Diagnosis of ALRI was more difficult, cough and dyspnoea alone yielding 86% sensitivity but low specificity, whereas prolonged cough and dyspnoea provided 93% specificity but low sensitivity (41%). Diarrhoea diagnoses based on frequent loose or liquid stools had high sensitivity (78-84%) and specificity (79%), irrespective of whether the child died with diarrhoea alone or in combination with other illnesses. However, maternal reports of moderate/severe dehydration had low specificity. We conclude that, in this setting, verbal autopsies can diagnose major illnesses contributing to death in children with acceptable sensitivity and specificity.

Verbal autopsy

“…Sevt t eral studies suggest that wellttrained lay people can obtain accurate information when using culturally and linguistically appropriate questionnaires. 18,21,22 Large numbers of interviewers may produce diverse results, and the interviewer's gender and ethnic background in relat t tion to respondents can also influence the outcome. 20 The choice of interviewer should be adapted to the local commut t nity, but the characteristics and training of interviewers used in various sites should be standardized.…”

“…The validity of physician review of VA has been tested in children and adults, and shown to have reasonable sensitivity and specificity for selected causes of death. 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.…”

“…14,17,21,22,25,27,35 All validation studies except one have used causes of death based on medical records as the "gold standard". 25 Most studies have estimated the sensitivity and specificity of VA, but few studies have ast t sessed the agreement in the causetspecific mortality fraction (CSMF) between the gold standard and VA diagnoses.…”

Utilizing digital health applications as a means to diffuse knowledge to improve family planning outcomes in Bangladesh

“…Verbal autopsy is a method of assessing the cause of death based on an interview with the next of kin or other caregivers who were present at the time of death or who are knowledgeable about the events leading up to the death. Verbal autopsies have been used previously in Bangladesh to provide important data on causes of child death (Chen et al, 1980;Zimicki et al, 1985;D'Souza, 1985;Bhatia, 1989;Fauveau et al, 1994;Snow et al, 1992;Kalter et al, 1990;Kamal et al, 1989;Salway et al, 1994;Baqui et al, 1998). …”

Alterações metabólicas em ratos desnutridos em resposta ao treinamento de endurance.

“…Somente em 2001, 54% da mortalidade infantil mundial pôde ser atribuída, direta ou indiretamente, à desnutrição (WHO, 2007). A principal causa de morte de desnutridos está associada a doenças infecciosas, sendo a pneumonia e a diarréia as mais freqüentes (KALTER et al, 1990). A desnutrição em si é capaz de desencadear doenças devido à supressão da função do sistema imunológico (CUNHA et al, 2003;KEUSCH, 2003).…”