Investigating Febrile Deaths in Tanzania (INDITe)

坦桑尼亚热病死亡调查 (INDITe)

• 批准号: 9007867
• 负责人: John Andrew Crump
• 金额: $ 58.71万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9007867
• 关键词: Adolescent; Adult; Africa South of the Sahara; Algorithms; Area; Autopsy; Award; Behavior; Biometry; Caregivers; Case Management; Cause of Death; Cessation of life; Child; Childhood; Clinical; Clinical Management; Cohort Studies; Communicable Diseases; Communities; Developing Countries; Development; Diagnosis; Diagnostic; Diagnostic tests; District Hospitals; Enrollment; Etiology; Evaluation; Failure; Family; Family member; Fatal Outcome; Fever; Goals; Guidelines; Health; Health Personnel; Health Services Accessibility; Health Status; Health care facility; Health system; Healthcare; Healthcare Systems; Histopathology; Hospital Mortality; Hospitalization; Hospitals; Immunohistochemistry; Infection; Infectious Diseases Research; Institutes; Intervention; Lead; Life; Mission; Participant; Pathology; Patients; Performance; Persons; Preventive Intervention; Principal Investigator; Protocols documentation; Research; Research Infrastructure; Research Personnel; Resources; Risk Factors; Signs and Symptoms; Specific qualifier value; Surveys; Syndrome; Tanzania; Techniques; Tissues; United States National Institutes of Health; Work; World Health Organization; base; care seeking; clinical Diagnosis; design; disability; health care availability; improved; innovation; instrument; minimally invasive; mortality; neglect; novel; novel strategies; pathogen; point-of-care diagnostics; programs; prospective; public health relevance; social; targeted treatment; treatment strategy

 DESCRIPTION (provided by applicant): The objective of 'Investigating febrile Deaths In Tanzania (INDITe)' is to identify actionable patient management and health system interventions that could avert fatal outcomes among patients with severe febrile illness in low-resource areas. Fever is among the most common reasons for seeking health care in less developed countries and hospitalized patients with fever have high case fatality ratios. However, there is an incomplete picture of the causes of severe fever illness, especially among patients with fatal outcomes. Gaining a more complete picture of why persons with fever die is essential to design patient management strategies and health systems that improve survival. Doing so is consistent with the US National Institutes of Health's mission to enhance health, lengthen life, and reduce illness and disability. The specific aims of the INDITe study are to: 1). Determine the microbiologic etiologies of fatal febrile illness among children and adults in northern Tanzania using full and minimally invasive autopsy combined with innovative pathogen discovery approaches; 2). Assess the performance of clinical diagnosis and verbal autopsy against diagnostic autopsy for determining cause of death among febrile patients; and 3). Determine the contribution of non-biologic factors to in-hospital mortality of febrile illness among children and adults in northern Tanzania. Aim 1 will be achieved using a prospective febrile illness cohort study in children and adults that employs an expanded pre-mortem clinical diagnostic evaluation for all participants enrolled, and in the case of fatal outcomes, a pre-specified infectious diseases pathology evaluation algorithm with innovative pathogen discovery approaches to identify neglected, non-neglected, and novel pathogens in tissues obtained via minimally-invasive autopsy. Aim 2 will be achieved by collecting diagnoses in life assigned by World Health Organization (WHO) Integrated Management of Childhood Illnesses (IMCI) and Integrated Management of Adolescent and Adult Illness (IMAI) district hospital syndromic management algorithms; MD-level clinician diagnoses; and cause of death assigned by WHO verbal autopsy instruments and comparing these with the findings of diagnostic autopsy. Aim 3 will be achieved by adapting retrospective, community-based social autopsy surveys to the prospective, hospital- based, pre-mortem setting in order to assess potential risk factors such as failure by patients or families to recognize severe signs of illness, delays in care-seeking, lack f appropriate healthcare resources, and inadequate case management by healthcare providers.

 描述（由申请人提供）：“坦桑尼亚发热死亡调查 (INDITe)”的目标是确定可行的患者管理和卫生系统干预措施，以避免资源匮乏地区患有严重发热疾病的患者出现致命后果。发烧是欠发达国家就医的最常见原因之一，发烧住院患者的病死率很高。然而，对于严重发烧疾病的原因尚不完全了解，特别是对于致命的患者。更全面地了解发烧者死亡的原因对于设计提高生存率的患者管理策略和卫生系统至关重要。这样做符合美国国立卫生研究院增强健康、延长寿命、减少疾病和残疾的使命。 INDITe 研究的具体目标是： 1)。使用全面和微创尸检结合创新的病原体发现方法，确定坦桑尼亚北部儿童和成人致命发热性疾病的微生物病因； 2）。评估临床诊断和口头尸检与诊断性尸检的表现，以确定发热患者的死因；和3）。确定非生物因素对儿童发热性疾病住院死亡率的影响 坦桑尼亚北部的成年人。目标 1 将通过一项针对儿童和成人的前瞻性发热性疾病队列研究来实现，该研究对所有参加者进行扩大的尸前临床诊断评估，如果出现致命结果，则采用预先指定的传染病病理学评估算法，采用创新的病原体发现方法来识别组织中被忽视的、未被忽视的和新型病原体 微创尸检。目标 2 将通过收集世界卫生组织 (WHO) 儿童疾病综合管理 (IMCI) 和青少年和成人疾病综合管理 (IMAI) 地区医院症状管理算法指定的生活诊断来实现； MD级临床医生诊断；世界卫生组织口头尸检工具确定的死亡原因，并将其与诊断性尸检结果进行比较。目标 3 将通过将基于社区的回顾性社会尸检调查适应基于医院的前瞻性尸检环境来实现，以评估潜在的风险因素，例如患者或家属未能识别严重疾病体征、延迟寻求护理、缺乏适当的医疗资源以及医疗保健提供者的病例管理不足。