Investigating Febrile Deaths in Tanzania (INDITe)

 描述(由申请人提供)：“坦桑尼亚发热性死亡调查(INDITe)”的目标是确定可行的患者管理和卫生系统干预措施，以避免低资源地区严重发热性疾病患者的致命后果。在欠发达国家，发烧是寻求医疗保健的最常见原因之一，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，特别是具有致命后果的患者，尚无完整的图景。更全面地了解发烧患者死亡的原因，对于设计提高存活率的患者管理策略和卫生系统至关重要。这样做与美国国立卫生研究院增进健康、延长寿命、减少疾病和残疾的使命是一致的。INDITe研究的具体目的是：1)。使用完整的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相对于诊断尸检在确定发烧患者死亡原因方面的表现；以及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将通过对儿童和成人进行前瞻性发烧疾病队列研究来实现，该研究对所有受试者进行扩大的死前临床诊断评估，在致命结果的情况下，使用预先指定的传染病病理学评估算法和创新的病原体发现方法，以识别通过微创尸检获得的组织中被忽视的、未被忽视的和新的病原体。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；MD级临床医生诊断；以及世卫组织口头尸检工具指定的死因，并将这些与诊断尸检结果进行比较来实现目标2。目标3将通过使以社区为基础的回溯性社会尸检调查适应以医院为基础的预期尸检环境来实现，以评估潜在的风险因素，例如患者或家属未能识别严重的疾病迹象、寻求护理的延误、缺乏适当的医疗资源以及医疗保健提供者对病例管理不力。

 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.