Validation and application of verbal autopsies in a rural area of South Africa
Validation and application of verbal autopsies in a rural area of South Africa
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DOI：
10.1046/j.1365-3156.2000.00638.x
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发表时间：
2000-11-01
影响因子：
3.3
通讯作者：
Gear, JSS
中科院分区：
文献类型：
--
作者：
Kahn, K;Tollman, SM;Gear, JSS
目的对南非农村阿金库尔区近3年(1992~1995年)人口与健康年度监测期间的所有死亡病例进行口头尸检(VAS)，以验证单一尸检仪对所有年龄段人群的死亡情况。受过培训的现场工作人员使用当地语言编写的综合问卷，从剂量照顾者那里获得晚期疾病的迹象和症状。问卷由三名临床医生进行盲法评估，他们使用逐步共识的过程指定了可能的死因。验证过程包括将VA诊断与地区医院死亡患者的医院参考诊断进行比较，并计算5岁以下儿童和15岁及以上成人的灵敏度、特异度和阳性预测值(PPV)。结果共有127例医院诊断符合纳入参考诊断的标准。对于传染病，儿童VA诊断的敏感度为69%，特异度为96%，PPV为90%；成人为89%，93%和76%。非传染性疾病的数值较低：儿童为75%、91%和86%；为50%和80%。大多数错误分类发生在类别本身。儿童因意外或暴力死亡的敏感度为100%，特异度为97%，细小病毒感染为80%；成人为75%、98%和60%。由于死亡原因主要与年龄有关，成人和儿童的敏感度、特异度和PPV几乎没有差异。基于VAS的死因频率分布与用于验证的医院记录的频率分布非常接近。结论VA结果需要验证，才能应用于地区卫生规划。在阿金库尔，一个单一的口头尸检工具对成人和儿童的死因频率提供了合理的估计。研究结果可以可靠地用于为当地卫生规划和评估提供信息。
OBJECTIVE To validate the causes of death determined with a single verbal autopsy instrument covering all age groups in the Agincourt subdistrict of rural South Africa.METHODS Verbal autopsies (VAs) were conducted on all deaths recorded during annual demographic and health surveillance over a 3-year period (1992-95) in a population of about 63 000 people. Trained field-workers elicited signs and symptoms of the terminal illness from a dose caregiver, using a comprehensive questionnaire written in the local language. Questionnaires were assessed blind by three clinicians who assigned a probable cause of death using a stepwise consensus process. Validation involved comparison of VA diagnoses with hospital reference diagnoses obtained for those who died in a district hospital; and calculation of sensitivity, specificity and positive predictive value (PPV) for children under 5 years, and adults 15 years and older.RESULTS A total of 127 hospital diagnoses satisfied the criteria for inclusion as reference diagnoses. For communicable diseases, sensitivity of VA diagnoses among children was 69%, specificity 96%, and PPV 90%; among adults the values were 89, 93 and 76%. Lower values were found for non-communicable diseases: 75, 91 and 86% among children; and 64, 50 and 80% among adults. Most misclassification occurred within the category itself. For deaths due to accidents or violence, sensitivity was 100%, specificity 97%, and PPV 80% among children; and 75, 98 and 60% among adults. Since causes of death were largely age-specific, few differences in sensitivity, specificity and PPV were found for adults and children. The frequency distribution of causes of death based on VAs closely approximated that of the hospital records used for validation.CONCLUSION VA findings need to be validated before they can be applied to district health planning. In Agincourt, a single verbal autopsy instrument provided a reasonable estimate of the frequency of causes of death among adults and children. Findings can be reliably used to inform local health planning and evaluation.