Determining causes of mortality in children enrolled in a vaccine field trial in a rural area in the Western Cape Province of South Africa
Determining causes of mortality in children enrolled in a vaccine field trial in a rural area in the Western Cape Province of South Africa
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DOI：
10.1111/j.1440-1754.2007.01039.x
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发表时间：
2007-03-01
影响因子：
1.7
通讯作者：
Hussey, Gregory D.
中科院分区：
文献类型：
--
作者：
Moyo, Sizulu;Hawkridge, Tony;Hussey, Gregory D.
目的：开发了一个死亡率监测系统，以确定和记录在南非参加结核病疫苗实地试验的儿童的死亡原因。本研究的目的是描述一项比较皮内和经皮给药Bacille Calmette Guerin的IV期试验中儿童的死亡原因，并将死亡证明上记录的死亡原因与临床记录回顾结合尸检（CR/VA）获得的死亡原因进行比较。方法：对死亡儿童，将经证实的死亡原因与CR/VA确定的死亡原因进行比较。结果：在纳入的11677名儿童中，4年内报告了177例死亡。死亡率为6.8/1000人年。随访时间为0.03 ~ 35.3个月（中位4个月，四分位数范围1.4 ~ 8.5）。婴儿死亡率为12.5/1000活产，新生儿死亡率为3/1000活产。肺炎、肠胃炎和败血症是两种方法导致死亡的主要原因。根据CR/VA，“突然原因不明”和“不明原因”是死亡的主要原因，而结核病和“自然原因”是死亡证明上的主要原因。由CR/VA导致死亡的重要潜在原因包括艾滋病毒/艾滋病、早产/低出生体重和营养不良。在47%的死亡中，对直接死亡原因的看法是一致的。如果把“自然死亡”和“原因不明的突然死亡”计算在内，这一比例上升到54%。结论：该队列的死亡率主要是由传染病引起的。虽然CR/VA提供了关于大多数死亡的额外信息，但这并不总是足以确定具体的死亡原因。
Aim: A mortality surveillance system was developed to identify and document causes of death among children enrolled in a tuberculosis vaccine field trial in South Africa. The aims of this study were to describe causes of mortality in children enrolled in a phase IV trial comparing intradermal with percutaneous administration of Bacille Calmette Guerin, and to compare causes of mortality recorded on death certificates with those obtained by clinical record review combined with verbal autopsies (CR/VA).Methods: For children who died, certified causes of death were compared with those determined by CR/VA.Results: Among 11 677 children enrolled, 177 deaths were notified over 4 years. The incidence rate of death was 6.8/1000 person-years. Follow-up time ranged from 0.03 to 35.3 months (median 4 months; interquartile range 1.4-8.5). The infant mortality rate was 12.5/1000 live births and the neonatal mortality was 3/1000 live births. Pneumonia, gastroenteritis and septicaemia were among top causes of mortality by both methods. 'Sudden unexplained' and 'ill-defined' causes were among top causes of mortality based on CR/VA, while tuberculosis and 'natural causes' were among top causes based on death certificates. Important underlying causes of mortality by CR/VA include HIV/AIDS, prematurity/low birth weight and malnutrition. In 47% of deaths there was agreement on immediate causes of death. This increased to 54% when 'natural causes' and 'sudden unexplained deaths' were included.Conclusion: In this cohort mortality was largely due to infectious diseases. While CR/VA provided additional information on most deaths, this was not always sufficient to assign specific causes of death.