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）”的目的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结局。发烧是欠发达国家寻求保健的最常见原因之一，发烧住院患者的病死率很高。然而，严重发热疾病的原因并不完整，特别是在具有致命结果的患者中。更全面地了解发烧患者死亡的原因，对于设计患者管理战略和提高生存率的卫生系统至关重要。这样做符合美国国立卫生研究院的使命，即增强健康，延长寿命，减少疾病和残疾。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，确定坦桑尼亚北方儿童和成人致命性发热性疾病的微生物病因; 2）。评估临床诊断和死因推断与诊断性尸检在确定发热患者死因方面的表现;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， 坦桑尼亚北方的成年人。目标1将通过在儿童和成人中进行的前瞻性发热性疾病队列研究来实现，该研究对所有入组的参与者进行了扩展的尸检前临床诊断评价，并且在致命结局的情况下，采用预先指定的传染病病理学评价算法，采用创新的病原体发现方法来识别通过微创尸检获得的组织中被忽视的、非被忽视的和新的病原体。目标2将通过收集世界卫生组织（世卫组织）儿童疾病综合管理和青少年和成人疾病综合管理地区医院综合征管理算法指定的生活诊断; MD级临床医生诊断;以及世卫组织死因推断工具指定的死因，并将其与诊断性尸检结果进行比较。将通过将回顾性、基于社区的社会尸检调查调整为前瞻性、基于医院的尸检前环境来实现目标3，以评估潜在风险因素，例如患者或家属未能识别严重疾病体征、求医延迟、缺乏适当的医疗保健资源以及医疗保健提供者的病例管理不足。

 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.