Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana
Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana
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DOI：
10.1111/j.1365-3016.2008.00962.x
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发表时间：
2008-09-01
影响因子：
2.8
通讯作者：
Kirkwood, Betty R.
中科院分区：
文献类型：
--
作者：
Edmond, Karen M.;Quigley, Maria A.;Kirkwood, Betty R.
这项研究评估了口头尸检(VA)工具在确定加纳农村地区死产和新生儿死亡原因方面的诊断准确性，并嵌套在基于社区的孕妇维生素A补充试验(ObaapaVitA试验)中。预期纳入2003年1月1日至2004年6月30日期间的所有死产和新生儿死亡病例。在死亡后6个月内进行社区VAS，并由3名有经验的儿科医生将其归类为主要死因。研究对象为研究地区4家地区医院的儿科医生，研究对象中有20317例分娩、661例死产和590例新生儿死亡，诊断为VA。共有311名死产和191名新生儿死亡同时接受了VA和医院参考标准诊断。VA在诊断死产方面表现不佳，如先天性异常和母体出血。产中产科并发症和产前母体疾病的准确率较高。对于新生儿死亡，对所有主要原因的敏感度为>；60%；对出生窒息的特异度为76%，对早产和感染的特异度为85%。总体而言，在非洲农村地区，VA诊断准确率高于预期。我们的分类系统是基于个人死因对公共卫生的预期重要性、对干预的不同影响以及在资源匮乏的情况下区分个人原因的能力。我们相信，该系统比传统方法更容易使用，并产生了高精度和准确度。然而，需要进一步简化，以允许在常规儿童健康方案中使用世界卫生组织退伍军人事务部。VA工具的诊断准确性也应在其他地区和多中心研究中进行评估。
This study evaluated the diagnostic accuracy of a verbal autopsy (VA) tool in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana and was nested within a community-based maternal vitamin A supplementation trial (ObaapaVitA trial). All stillbirths and neonatal deaths between 1 January 2003 and 30 June 2004 were prospectively included. Community VAs were carried out within 6 months of death and were classified with a primary cause of death by three experienced paediatricans. The reference standard diagnosis was obtained by the study paediatrician in 4 district hospitals in the study area.There were 20 317 deliveries, 661 stillbirths and 590 neonatal deaths with a VA diagnosis in the study population. A total of 311 stillbirths and 191 neonatal deaths had both a VA and a hospital reference standard diagnosis. The VA performed poorly for stillbirth diagnoses such as congenital abnormalities and maternal haemorrhage. Accuracy was higher for intrapartum obstetric complications and antepartum maternal disease. For neonatal deaths, sensitivity was >60% for all major causes; specificity was 76% for birth asphyxia but >85% for prematurity and infection. Overall, VA diagnostic accuracy was higher than expected in this rural African setting. Our classification system was based on the expected public health importance of the individual causes of death, differing implications for intervention and the ability to distinguish between the individual causes in low-resource settings. We believe this system was easier to use than traditional approaches and resulted in high precision and accuracy. However, further simplifications are needed to allow use of the World Health Organisation VA in routine child health programmes. The diagnostic accuracy of the VA tool should also be assessed in other regions and in multicentre studies.