Revealing the burden of maternal mortality: a probabilistic model for determining pregnancy-related causes of death from verbal autopsies.
Revealing the burden of maternal mortality: a probabilistic model for determining pregnancy-related causes of death from verbal autopsies.
复制标题
揭示了孕产妇死亡率的负担：一个概率模型，用于确定与妊娠有关的言语尸检的死亡原因。
DOI：
10.1186/1478-7954-5-1
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发表时间：
2007-02-08
影响因子：
3.3
通讯作者：
Graham, Wendy J
中科院分区：
文献类型：
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作者：
Fottrell, Edward;Byass, Peter;Ouedraogo, Thomas W;Tamini, Cecile;Gbangou, Adjima;Sombie, Issiaka;Hogberg, Ulf;Witten, Karen H;Bhattacharya, Sohinee;Desta, Teklay;Deganus, Sylvia;Tornui, Janet;Fitzmaurice, Ann E;Meda, Nicolas;Graham, Wendy J
千年发展目标5(千年发展目标5)要求大幅降低孕产妇死亡率，因此假定孕产妇死亡率是可衡量的。一个关键的困难是确定发展中国家许多在没有援助的情况下死亡的妇女的死因。口头尸检(VA)可以推断死亡情况，但数据需要可靠和一致地解释，才能作为全球指标。本文针对妊娠相关死亡的具体情况，对VA解释的概率模型的最新发展进行了调整和评估。开发了InterVA-M概率VA解释模型的初步版本，并利用来自几个来源的成年女性VA数据进行了改进，然后与来自布基纳法索的另外258次VA访谈进行了评估。将该模型产生的可能死因与当地医生之前确定的死因进行了比较。在退伍军人事务部的访谈中，对自由文本数据和封闭问题数据进行了区分，以评估自由文本材料对模型输出的附加值。在对模型和医生的解释进行合理化后，特定原因的死亡率比例大体相似。该模型与任何评审医生之间的个案符合率达到约60%，当另一名医生评审有差异的病例时，这一符合率上升至约80%。心血管疾病和疟疾在两种方法中显示出最大的差异，与怀孕有关的感染的归属也不同。该模型估计，30%的死亡与怀孕有关，其中一半是直接原因。来自自由文本的数据并没有产生明显的差异。InterVA-M是一种以有效、一致和标准化的方式衡量孕产妇死亡率的潜在有价值的新工具。计划进行进一步的开发、改进和验证。它可以成为研究和服务环境中的常规工具，在这些环境中，需要衡量与妊娠有关的死亡水平和变化，例如在评估实现千年发展目标-5的进展时。
Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5), thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA) can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output. Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference. InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine tool in research and service settings where levels and changes in pregnancy-related deaths need to be measured, for example in assessing progress towards MDG-5.