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Mahesh BPK, Hart JD, Acharya A, Chowdhury HR, Joshi R, Adair T, Hazard RH. Validation studies of verbal autopsy methods: a systematic review. BMC Public Health 2022; 22:2215. [PMID: 36447199 PMCID: PMC9706899 DOI: 10.1186/s12889-022-14628-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/14/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Verbal autopsy (VA) has emerged as an increasingly popular technique to assign cause of death in parts of the world where the majority of deaths occur without proper medical certification. The purpose of this study was to examine the key characteristics of studies that have attempted to validate VA cause of death against an established cause of death. METHODS A systematic review was conducted by searching the MEDLINE, EMBASE, Cochrane-library, and Scopus electronic databases. Included studies contained 1) a VA component, 2) a validation component, and 3) original analysis or re-analysis. Characteristics of VA studies were extracted. A total of 527 studies were assessed, and 481 studies screened to give 66 studies selected for data extraction. RESULTS Sixty-six studies were included from multiple countries. Ten studies used an existing database. Sixteen studies used the World Health Organization VA questionnaire and 5 studies used the Population Health Metrics Research Consortium VA questionnaire. Physician certification was used in 36 studies and computer coded methods were used in 14 studies. Thirty-seven studies used high level comparator data with detailed laboratory investigations. CONCLUSION Most studies found VA to be an effective cause of death assignment method and compared VA cause of death to a high-quality established cause of death. Nonetheless, there were inconsistencies in the methodologies of the validation studies, and many used poor quality comparison cause of death data. Future VA validation studies should adhere to consistent methodological criteria so that policymakers can easily interpret the findings to select the most appropriate VA method. PROSPERO REGISTRATION CRD42020186886.
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Affiliation(s)
- Buddhika P. K. Mahesh
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - John D. Hart
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Ajay Acharya
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Hafizur Rahman Chowdhury
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Rohina Joshi
- grid.464831.c0000 0004 8496 8261The George Institute for Global Health, New Delhi, India ,grid.1005.40000 0004 4902 0432School of Population Health, University of New South Wales, Sydney, Australia
| | - Tim Adair
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Riley H. Hazard
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Liu L, Li M, Cummings S, Black RE. Deriving causes of child mortality by re-analyzing national verbal autopsy data applying a standardized computer algorithm in Uganda, Rwanda and Ghana. J Glob Health 2015; 5:010414. [PMID: 26110053 PMCID: PMC4467513 DOI: 10.7189/jogh.05.010414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background To accelerate progress toward the Millennium Development Goal 4, reliable information on causes of child mortality is critical. With more national verbal autopsy (VA) studies becoming available, how to improve consistency of national VA derived child causes of death should be considered for the purpose of global comparison. We aimed to adapt a standardized computer algorithm to re–analyze national child VA studies conducted in Uganda, Rwanda and Ghana recently, and compare our results with those derived from physician review to explore issues surrounding the application of the standardized algorithm in place of physician review. Methods and Findings We adapted the standardized computer algorithm considering the disease profile in Uganda, Rwanda and Ghana. We then derived cause–specific mortality fractions applying the adapted algorithm and compared the results with those ascertained by physician review by examining the individual– and population–level agreement. Our results showed that the leading causes of child mortality in Uganda, Rwanda and Ghana were pneumonia (16.5–21.1%) and malaria (16.8–25.6%) among children below five years and intrapartum–related complications (6.4–10.7%) and preterm birth complications (4.5–6.3%) among neonates. The individual level agreement was poor to substantial across causes (kappa statistics: –0.03 to 0.83), with moderate to substantial agreement observed for injury, congenital malformation, preterm birth complications, malaria and measles. At the population level, despite fairly different cause–specific mortality fractions, the ranking of the leading causes was largely similar. Conclusions The standardized computer algorithm produced internally consistent distribution of causes of child mortality. The results were also qualitatively comparable to those based on physician review from the perspective of public health policy. The standardized computer algorithm has the advantage of requiring minimal resources from the health care system and represents a promising way to re–analyze national or sub-national VA studies in place of physician review for the purpose of global comparison.
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Affiliation(s)
- Li Liu
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; Institute of International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; Joint first authors
| | - Mengying Li
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; Joint first authors
| | - Stirling Cummings
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert E Black
- Institute of International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hamel MJ, Adazu K, Obor D, Sewe M, Vulule J, Williamson JM, Slutsker L, Feikin DR, Laserson KF. A reversal in reductions of child mortality in western Kenya, 2003-2009. Am J Trop Med Hyg 2011; 85:597-605. [PMID: 21976557 DOI: 10.4269/ajtmh.2011.10-0678] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report and explore changes in child mortality in a rural area of Kenya during 2003-2009, when major public health interventions were scaled-up. Mortality ratios and rates were calculated by using the Kenya Medical Research Institute/Centers for Disease Control and Prevention Demographic Surveillance System. Inpatient and outpatient morbidity and mortality, and verbal autopsy data were analyzed. Mortality ratios for children less than five years of age decreased from 241 to 137 deaths/1,000 live-births in 2003 and 2007 respectively. In 2008, they increased to 212 deaths/1,000 live-births. Mortality remained elevated during the first 8 months of 2009 compared with 2006 and 2007. Malaria and/or anemia accounted for the greatest increases in child mortality. Stock-outs of essential antimalarial drugs during a time of increased malaria transmission and disruption of services during civil unrest may have contributed to increased mortality in 2008-2009. To maintain gains in child survival, implementation of good policies and effective interventions must be complemented by reliable supply and access to clinical services and essential drugs.
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Affiliation(s)
- Mary J Hamel
- Malaria Branch, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, International Emerging Infections Program, Global Disease Detection Division, Atlanta, Georgia, USA.
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Girma B, Berhane Y. Children who were vaccinated, breast fed and from low parity mothers live longer: a community based case-control study in Jimma, Ethiopia. BMC Public Health 2011; 11:197. [PMID: 21453455 PMCID: PMC3084172 DOI: 10.1186/1471-2458-11-197] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 03/31/2011] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Improving child survival through various health interventions has been one of the main preoccupations of public health programs in developing nations. However, efforts to understand the child death determinants and determine whether the health interventions are really contributing to the reduction of mortality were not satisfactory. The purpose of this study is to identify determinants and causes of child mortality. METHODS The study was conducted in the town of Jimma, Ethiopia, using a case control study design. Cases were identified through enumeration of all children and deaths prior to interview of the study subjects. Controls were under five children of the same age (+/-2 months) residing in the nearest household. Data was entered into EPI -info 6.4 software and analyzed using SPSS. RESULTS Seventy four cases and 222 controls were included in the study. The study found that children who never breast fed [OR = 13.74, 95%CI (3.34, 56.42]] and children with mothers having more than five children [OR = 3.34, 95%CI (1.27, 8.76)] were more likely to die than their counterparts. Vaccination reduced the risk of death [OR=.26, 95%CI (0.10, 0.67) significantly. Pneumonia was the most common immediate cause of death [29.7% (95% CI (19.66, 41.48)] followed by acute diarrhea and malaria each contributing for 23% [95%CI (13.99, 34.21)] of deaths. CONCLUSION Immunization, breastfeeding and low parity mothers were independently found to be protective from childhood death. Strengthening the child survival initiatives, namely universal child immunization, family planning and breast feeding - is strongly recommended.
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Affiliation(s)
- Belaineh Girma
- Department of Public Health and Social Science, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
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Negin J, Wariero J, Cumming RG, Mutuo P, Pronyk PM. High Rates of AIDS-Related Mortality Among Older Adults in Rural Kenya. J Acquir Immune Defic Syndr 2010; 55:239-44. [DOI: 10.1097/qai.0b013e3181e9b3f2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khademi H, Etemadi A, Kamangar F, Nouraie M, Shakeri R, Abaie B, Pourshams A, Bagheri M, Hooshyar A, Islami F, Abnet CC, Pharoah P, Brennan P, Boffetta P, Dawsey SM, Malekzadeh R. Verbal autopsy: reliability and validity estimates for causes of death in the Golestan Cohort Study in Iran. PLoS One 2010; 5:e11183. [PMID: 20567597 PMCID: PMC2887437 DOI: 10.1371/journal.pone.0011183] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/25/2010] [Indexed: 12/18/2022] Open
Abstract
Background Verbal autopsy (VA) is one method to obtain valid estimates of causes of death in the absence of valid medical records. We tested the reliability and validity of a VA questionnaire developed for a cohort study in Golestan Province in northeastern Iran. Method A modified version of the WHO adult verbal autopsy was used to assess the cause of death in the first 219 Golestan Cohort Study (GCS) subjects who died. The GCS cause of death was determined by two internists who independently reviewed all available medical records. Two other internists (“reviewers”) independently reviewed only the VA answers and classified the cause of death into one of nine general categories; they repeated this evaluation one month later. The reliability of the VA was measured by calculating intra-reviewer and inter-reviewer kappa statistics. The validity of the VA was measured using the GCS cause of death as the gold standard. Results VA showed both good validity (sensitivity, specificity, PPV, and NPV all above 0.81) and reliability (kappa>0.75) in determining the general cause of death independent of sex and place of residence. The overall multi-rater agreement across four reviews was 0.84 (95%CI: 0.78–0.89). The results for identifying specific cancer deaths were also promising, especially for upper GI cancers (kappa = 0.95). The multi-rater agreement in cancer subgroup was 0.93 (95%CI: 0.85–0.99). Conclusions VA seems to have good reliability and validity for determining the cause of death in a large-scale adult follow up study in a predominantly rural area of a middle-income country.
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Affiliation(s)
- Hooman Khademi
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
| | - Arash Etemadi
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, United States of America
| | - Mehdi Nouraie
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
- Department of Internal Medicine and Center for Sickle Cell Disease, Howard University, Washington, District of Columbia, United States of America
| | - Ramin Shakeri
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
| | - Behrooz Abaie
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
| | - Akram Pourshams
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
| | - Mohammad Bagheri
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
| | - Afshin Hooshyar
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
| | - Farhad Islami
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
- International Agency for Research on Cancer, Lyon, France
| | - Christian C. Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Paul Pharoah
- Department of Oncology and Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Paolo Boffetta
- The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York, United States of America
- International Prevention Research Institute, Lyon, France
| | - Sanford M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Reza Malekzadeh
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
- * E-mail:
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Ombok M, Adazu K, Odhiambo F, Bayoh N, Kiriinya R, Slutsker L, Hamel MJ, Williamson J, Hightower A, Laserson KF, Feikin DR. Geospatial distribution and determinants of child mortality in rural western Kenya 2002-2005. Trop Med Int Health 2010; 15:423-33. [PMID: 20409294 DOI: 10.1111/j.1365-3156.2010.02467.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe local geospatial variation and geospatial risk factors for child mortality in rural western Kenya. METHODS We calculated under-5 mortality rates (U5MR) in 217 villages in a Health and Demographic Surveillance System (HDSS) area in western Kenya from 1 May 2002 through 31 December 2005. U5MRs by village were mapped. Geographical positioning system coordinates of residences at the time of death and distances to nearby locations were calculated. Multivariable Poisson regression accounting for clustering at the compound level was used to evaluate the association of geospatial factors and mortality for infants and children aged 1-4 years. RESULTS Among 54 057 children, the overall U5MR was 56.5 per 1000 person-years and varied by village from 21 to 177 per 1000 person-years. High mortality villages occurred in clusters by location and remained in the highest mortality quintile over several years. In multivariable analysis, controlling for maternal age and education as well as household crowding, higher infant mortality was associated with living closer to streams and further from public transport roads. For children 1-4 years, living at middle elevations (1280-1332 metres), living within lower population densities areas, and living in the northern section of the HDSS were associated with higher mortality. CONCLUSIONS Childhood mortality was significantly higher in some villages. Several geospatial factors were associated with mortality, which might indicate variability in access to health care or exposure and transmission of infectious diseases. These results are useful in prioritising areas for further study and implementing directed public health interventions.
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Jahn A, Floyd S, Crampin AC, Mvula H, Mwinuka V, Mwaiyeghele E, McGrath N, Zaba B, Fine PEM, Glynn JR. Declining child mortality in northern Malawi despite high rates of infection with HIV. Bull World Health Organ 2010; 88:746-53. [PMID: 20931059 DOI: 10.2471/blt.09.075085] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 03/01/2010] [Accepted: 03/01/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To determine whether routine surveys, such as the Demographic and Health Surveys (DHS), have underestimated child mortality in Malawi. METHODS Rates and causes of child mortality were obtained from a continuous-registration demographic surveillance system (DSS) in Malawi for a population of 32 000. After initial census, births and deaths were reported by village informants and updated monthly by project enumerators. Cause of death was established by verbal autopsy whenever possible. The likely impact of human immunodeficiency virus (HIV) infection on child mortality was also estimated from antenatal clinic surveillance data. Overall and age-specific mortality rates were compared with those from the 2004 Malawi DHS. FINDINGS Between August 2002 and February 2006, 38 617 person-years of observation were recorded for 20 388 children aged < 15 years. There were 342 deaths. Re-census data, follow-up visits at 12 months of age and the ratio of stillbirths to neonatal deaths suggested that death registration by the DSS was nearly complete. Infant mortality was 52.7 per 1000 live births, under-5 mortality was 84.8 per 1000 and under-15 mortality was 99.1 per 1000. One-fifth of deaths by age 15 were attributable to HIV infection. Child mortality rates estimated with the DSS were approximately 30% lower than those from national estimates as determined by routine surveys. CONCLUSION The fact that child mortality rates based on the DSS were relatively low in the study population is encouraging and suggests that the low mortality rates estimated nationally are an accurate reflection of decreasing rates.
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Affiliation(s)
- A Jahn
- Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, England
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Abstract
Understanding of global health and changing morbidity and mortality is limited by inadequate measurement of population health. With fewer than one-third of deaths worldwide being assigned a cause, this long-standing dearth of information, almost exclusively in the world's poorest countries, hinders understanding of population health and limits opportunities for planning, monitoring, and evaluating interventions. In the absence of routine death registration, verbal autopsy (VA) methods are used to derive probable causes of death. Much effort has been put into refining the approach for specific purposes; however, there has been a lack of harmony regarding such efforts. Subsequently, a variety of methods and principles have been developed, often focusing on a single aspect of VA, and the resulting literature provides an inconsistent picture. By reviewing methodological and conceptual issues in VA, it is evident that VA cannot be reduced to a single one-size-fits-all tool. VA must be contextualized; given the lack of "gold standards," methodological developments should not be considered in terms of absolute validity but rather in terms of consistency, comparability, and adequacy for the intended purpose. There is an urgent need for clarified thinking about the overall objectives of population-level cause-of-death measurement and harmonized efforts in empirical methodological research.
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Affiliation(s)
- Edward Fottrell
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901-85 Umeå, Sweden.
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Kahn K, Tollman SM, Collinson MA, Clark SJ, Twine R, Clark BD, Shabangu M, Gómez-Olivé FX, Mokoena O, Garenne ML. Research into health, population and social transitions in rural South Africa: data and methods of the Agincourt Health and Demographic Surveillance System. Scand J Public Health 2007; 69:8-20. [PMID: 17676498 PMCID: PMC2826136 DOI: 10.1080/14034950701505031] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
RATIONALE FOR STUDY Vital registration is generally lacking in infrastructurally weak areas where health and development problems are most pressing. Health and demographic surveillance is a response to the lack of a valid information base that can provide high-quality longitudinal data on population dynamics, health, and social change to inform policy and practice. DESIGN AND MEASUREMENT PROCEDURES Continuous demographic monitoring of an entire geographically defined population involves a multi-round, prospective community study, with annual recording of all vital events (births, deaths, migrations). Status observations and special modules add value to particular research areas. A verbal autopsy is conducted on every death to determine its probable cause. A geographic surveillance system supports spatial analyses, and strengthens field management. POPULATION AND SAMPLE SIZE CONSIDERATIONS Health and demographic surveillance covers the Agincourt sub-district population, sited in rural north-eastern South Africa, of some 70,000 people (nearly a third are Mozambican immigrants) in 21 villages and 11,700 households. Data enumerated are consistent or more detailed when compared with national sources; strategies to improve incomplete data, such as counts of perinatal deaths, have been introduced with positive effect. Basic characteristics: A major health and demographic transition was documented over a 12-year period with marked changes in population structure, escalating mortality, declining fertility, and high levels of temporary migration increasing particularly amongst women. A dual burden of infectious and non-communicable disease exists against a background of dramatically progressing HIV/AIDS. POTENTIAL AND RESEARCH QUESTIONS Health and demographic surveillance sites - fundamental to the INDEPTH Network - generate research questions and hypotheses from empirical data, highlight health, social and population priorities, provide cost-effective support for diverse study designs, and track population change and the impact of interventions over time.[image omitted].
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Affiliation(s)
- Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, South Africa.
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Abstract
OBJECTIVE To determine child mortality rates in a rural area of South Africa with high HIV prevalence. METHODS A community-based survey was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through four monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson regression. RESULTS Mortality ratios were 59.6 deaths per 1000 live births for infants and 97.1 for children under 5 years of age. Infant and under-5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 person-years. HIV/AIDS was attributed to 41% of deaths in the under-5 age group, with a mortality rate of 8.6 per 1000 person-years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person-years in children under 1 year of age. CONCLUSIONS In rural South Africa, infant and child mortality levels are high, with HIV/AIDS estimated as the single largest cause of death. Interventions to reduce child mortality are required urgently.
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Affiliation(s)
- Anupam Garrib
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
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Setel PW, Whiting DR, Hemed Y, Chandramohan D, Wolfson LJ, Alberti KGMM, Lopez AD. Validity of verbal autopsy procedures for determining cause of death in Tanzania. Trop Med Int Health 2006; 11:681-96. [PMID: 16640621 DOI: 10.1111/j.1365-3156.2006.01603.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To validate verbal autopsy (VA) procedures for use in sample vital registration. Verbal autopsy is an important method for deriving cause-specific mortality estimates where disease burdens are greatest and routine cause-specific mortality data do not exist. METHODS Verbal autopsies and medical records (MR) were collected for 3123 deaths in the perinatal/neonatal period, post-neonatal <5 age group, and for ages of 5 years and over in Tanzania. Causes of death were assigned by physician panels using the International Classification of Disease, revision 10. Validity was measured by: cause-specific mortality fractions (CSMF); sensitivity; specificity and positive predictive value. Medical record diagnoses were scored for degree of uncertainty, and sensitivity and specificity adjusted. Criteria for evaluating VA performance in generating true proportional mortality were applied. RESULTS Verbal autopsy produced accurate CSMFs for nine causes in different age groups: birth asphyxia; intrauterine complications; pneumonia; HIV/AIDS; malaria (adults); tuberculosis; cerebrovascular diseases; injuries and direct maternal causes. Results for 20 other causes approached the threshold for good performance. CONCLUSIONS Verbal autopsy reliably estimated CSMFs for diseases of public health importance in all age groups. Further validation is needed to assess reasons for lack of positive results for some conditions.
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Affiliation(s)
- Philip W Setel
- Department of Epidemiology and MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.
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Lopez AD. The evolution of the Global Burden of Disease framework for disease, injury and risk factor quantification: developing the evidence base for national, regional and global public health action. Global Health 2005; 1:5. [PMID: 15847690 PMCID: PMC1143783 DOI: 10.1186/1744-8603-1-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Accepted: 04/22/2005] [Indexed: 11/30/2022] Open
Abstract
Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries and risk factors are generally incomplete, fragmented and of uncertain reliability and comparability. Lack of a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and failure to systematically evaluate data quality have impeded comparative analyses of the true public health importance of various conditions and risk factors. As a consequence the impact of major conditions and hazards on population health has been poorly appreciated, often leading to a lack of public health investment. Global disease and risk factor quantification improved dramatically in the early 1990s with the completion of the first Global Burden of Disease Study. For the first time, the comparative importance of over 100 diseases and injuries, and ten major risk factors, for global and regional health status could be assessed using a common metric (Disability-Adjusted Life Years) which simultaneously accounted for both premature mortality and the prevalence, duration and severity of the non-fatal consequences of disease and injury. As a consequence, mental health conditions and injuries, for which non-fatal outcomes are of particular significance, were identified as being among the leading causes of disease/injury burden worldwide, with clear implications for policy, particularly prevention. A major achievement of the Study was the complete global descriptive epidemiology, including incidence, prevalence and mortality, by age, sex and Region, of over 100 diseases and injuries. National applications, further methodological research and an increase in data availability have led to improved national, regional and global estimates for 2000, but substantial uncertainty around the disease burden caused by major conditions, including, HIV, remains. The rapid implementation of cost-effective data collection systems in developing countries is a key priority if global public policy to promote health is to be more effectively informed.
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Affiliation(s)
- Alan D Lopez
- School of Population Health, The University of Queensland, Brisbane, Australia.
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Ng'weshemi J, Urassa M, Isingo R, Mwaluko G, Ngalula J, Boerma T, Marston M, Zaba B. HIV impact on mother and child mortality in rural Tanzania. J Acquir Immune Defic Syndr 2003; 33:393-404. [PMID: 12843752 DOI: 10.1097/00126334-200307010-00015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Child mortality in Tanzania rose from 137 per 1000 in 1992-1996 to 147 per 1000 in 1995-1999. Impact of HIV on child mortality is analyzed in a longitudinal community-based study in Kisesa ward, Mwanza region. HIV data on 4273 mothers from 3 rounds of serologic testing are linked to survival information for 6049 children born between 1994 and 2001, contributing 10,002 person-years of observation and 584 child deaths. Impacts of maternal survival and HIV status on child mortality are assessed using hazard analysis. Infant mortality for children of HIV-positive mothers was 158 per 1000 live births compared with 79 per 1000 for children of uninfected mothers; by age 5, child mortality risks were 270 per 1000 live births and 135 per 1000, respectively. Fifty-one deaths were observed among child-bearing women, 14 to HIV-positive mothers. Infant mortality among children whose mothers died was 489 per 1000 live births compared with 84 per 1000 for children of surviving mothers. Maternal death effects were statistically independent of HIV status. Allowing for age, sex, twinning, birth interval, maternal education, and residence, the child death hazard ratio for maternal HIV infection was 2.3 (1.7-3.3); hazard ratio associated with maternal death was 4.8 (2.7-8.4). The HIV-attributable fraction of infant mortality is 8.3% in a population in which prevalence among women giving birth is around 6.2%.
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Langston C, Cooper ER, Goldfarb J, Easley KA, Husak S, Sunkle S, Starc TJ, Colin AA. Human immunodeficiency virus-related mortality in infants and children: data from the pediatric pulmonary and cardiovascular complications of vertically transmitted HIV (P(2)C(2)) Study. Pediatrics 2001; 107:328-38. [PMID: 11158466 PMCID: PMC4311730 DOI: 10.1542/peds.107.2.328] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify the causes of mortality in children with vertically transmitted human immunodeficiency virus (HIV) infection and to study age-related mortality trends. METHODS In the multicenter P(2)C(2) HIV Study, 816 children born to HIV-infected mothers were followed for a median of 3.6 years. Two hundred five study participants with HIV infection were enrolled at a median age of 23 months; 611 were enrolled either prenatally or in the neonatal period before their HIV infection status was known. There were 121 deaths in study patients. The cause of death for all patients, its relationship to HIV infection, and pulmonary or cardiac involvement were determined. Age trends in disease-specific mortality were summarized for the HIV-related deaths. RESULTS Ninety-three children died of HIV-related conditions. Infection was the most prevalent cause of death for children under 6 years of age with 32.3% caused by pulmonary infection and another 16.9% caused by nonpulmonary infection. The frequency of pulmonary disease as the underlying cause of death decreased significantly with increasing age: 5/9 (55.6%) by age 1, 1/12 (8.3%) after age 10 years. The frequency of chronic cardiac disease as the underlying cause increased with age-0% by age 1 year, 3/12 (25.0%) after age 10 years, as did the frequency of wasting syndrome with disseminated Mycobacterium avium complex-0% by age 1 year, 6/12 (50.0%) after age 10 years. CONCLUSIONS Children with HIV who survive longer are less likely to die of pulmonary disease or infection and more likely to die of cardiac causes or with wasting syndrome.pediatric acquired immunodeficiency syndrome, mortality, human immunodeficiency virus.
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Affiliation(s)
- C Langston
- Department of Pathology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas 77030, USA.
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Abstract
OBJECTIVE To validate the causes of death determined with a single verbal autopsy instrument covering all age groups in the Agincourt subdistrict of rural South Africa. METHODS Verbal autopsies (VAs) were conducted on all deaths recorded during annual demographic and health surveillance over a 3-year period (1992-95) in a population of about 63 000 people. Trained fieldworkers elicited signs and symptoms of the terminal illness from a close caregiver, using a comprehensive questionnaire written in the local language. Questionnaires were assessed blind by three clinicians who assigned a probable cause of death using a stepwise consensus process. Validation involved comparison of VA diagnoses with hospital reference diagnoses obtained for those who died in a district hospital; and calculation of sensitivity, specificity and positive predictive value (PPV) for children under 5 years, and adults 15 years and older. RESULTS A total of 127 hospital diagnoses satisfied the criteria for inclusion as reference diagnoses. For communicable diseases, sensitivity of VA diagnoses among children was 69%, specificity 96%, and PPV 90%; among adults the values were 89, 93 and 76%. Lower values were found for non-communicable diseases: 75, 91 and 86% among children; and 64, 50 and 80% among adults. Most misclassification occurred within the category itself. For deaths due to accidents or violence, sensitivity was 100%, specificity 97%, and PPV 80% among children; and 75, 98 and 60% among adults. Since causes of death were largely age-specific, few differences in sensitivity, specificity and PPV were found for adults and children. The frequency distribution of causes of death based on VAs closely approximated that of the hospital records used for validation. CONCLUSION VA findings need to be validated before they can be applied to district health planning. In Agincourt, a single verbal autopsy instrument provided a reasonable estimate of the frequency of causes of death among adults and children. Findings can be reliably used to inform local health planning and evaluation.
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Affiliation(s)
- K Kahn
- Health Systems Development Unit, Department of Community Health, University of the Witwatersrand, Johannesburg, South Africa.
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Abstract
Information on cause of death is essential for rational public health planning, yet mortality data in South Africa is limited. In the Agincourt subdistrict, verbal autopsies (VA) have been used to determine cause of death. A VA is conducted on all deaths recorded during annual demographic and health surveillance. Trained lay fieldworkers interview a close caregiver to elicit signs and symptoms of the terminal illness. Each questionnaire is reviewed by three medical practitioners blind to each other's assessment, who assign a 'probable cause of death' where possible. Of 1001 deaths of adults and children identified between 1992 and 1995, 932 VAs were completed. The profile of deaths reflects a mixed picture: the 'unfinished agenda' of communicable disease and malnutrition (diarrhoea and kwashiorkor predominantly) are responsible for over half of deaths in under-fives, accidents are prominent in the 5-14 age-group, while the 'emerging agenda' of violence and chronic degenerative disease (particularly circulatory disease) is pronounced among the middle-aged and elderly. This profile shows the social and demographic transition to be well underway within a rural, underdeveloped population. Validation of VA findings demonstrate that the cause of death profile derived from VA can be used with confidence for planning purposes. Findings of note include the high death rates from kwashiorkor and violence, emerging AIDS and pulmonary tuberculosis, and circulatory deaths in the middle-aged and young elderly. A deeper understanding of the causal factors underlying these critical health problems is needed to strengthen policy and better target interventions.
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Affiliation(s)
- K Kahn
- Health Systems Development Unit, University of the Witwatersrand, Johannesburg, South Africa.
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Abstract
OBJECTIVES The current study followed HIV-infected women through pregnancy and their infants through the first 2 years of life to determine the rate of vertical transmission of HIV infection from Haitian women, factors in maternal health and obstetrical history that might influence such transmission and the natural history of HIV infection in their affected offspring. STUDY DESIGN The medical histories of 81 infants born of HIV-infected women and of a control group of 88 infants born to uninfected women were documented with close clinical and serologic follow-up. In addition to standard tests for persistence of HIV antibodies, the use of acid-dissociated p24 assays enabled us to assign some additional infants to the HIV-infected cohort. RESULTS Transmission could be documented in 27% of infants born to HIV-infected women. Excess early deaths occurred in infants of HIV-infected women in Port-au-Prince with 60% of infected infants dead by 6 months of age. This is a more accelerated mortality than that in a group of 42 HIV-infected infants born of Haitian mothers living in Miami where 10% were dead at 6 months. Clinically, in 6 of 19 deaths in HIV-infected children in Haiti, failure to thrive and gastroenteritis lead to a systemic infection manifested as meningitis, sepsis or pneumonia as the immediate cause of death. CONCLUSIONS Early mortality attributable to perinatally acquired AIDS was identified in Haiti. The comparison of data from Miami and Port-au-Prince suggests that environmental exposures in developing countries may be more operative in this early mortality than viral strain or maternal host factors, both of which might be expected to be similar between the two groups of Haitian ethnicity.
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Affiliation(s)
- S S Jean
- Cornell University Infectious Diseases Research Unit, Institut National de Laboratoire et de Recherches and Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, Port-au-Prince
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Abstract
Although reports suggest that infant mortality is increased during iodine deficiency, the effect of iodine supplementation on infant mortality is unknown. A double-masked, randomized, placebo-controlled, clinical trial of oral iodized oil was conducted in Subang, West Java, Indonesia to evaluate the effect of iodine supplementation on infant mortality. Infants were allocated to receive placebo or oral iodized oil (100 mg) at about 6 wk of age and were followed to 6 mo of age. Six hundred seventeen infants were enrolled in the study. Infant survival was apparently improved, as indicated by a 72% reduction in the risk of death during the first 2 mo of follow-up (P < 0.05) and a delay in the mean time to death among infants who died in the iodized oil group compared with infants who died in the placebo group (48 days vs. 17.5 d, P = 0.06). Other infant characteristics associated with reduced risk of death included weight-for-age at base line, consumption of solid foods, female gender and recent history of maternal iodine supplementation. Oral iodized oil supplementation had a stronger effect on the mortality of males compared with females. This study suggests that oral iodized oil supplementation of infants may reduce infant mortality in populations at risk for iodine deficiency.
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Affiliation(s)
- C Cobra
- Department of International Health, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA
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Lucas SB, Peacock CS, Hounnou A, Brattegaard K, Koffi K, Hondé M, Andoh J, Bell J, De Cock KM. Disease in children infected with HIV in Abidjan, Côte d'Ivoire. BMJ 1996; 312:335-8. [PMID: 8611829 PMCID: PMC2350283 DOI: 10.1136/bmj.312.7027.335] [Citation(s) in RCA: 134] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To document the range of disease in African children infected with HIV. DESIGN Necropsy results in consecutive children aged 1 month or more who were HIV positive and in children who were HIV negative for comparison; IgA western blots on serum samples from children under 2 years of age who were positive for HIV-1 to test the validity of routine HIV serology. SETTING Largest hospital in Abidjan, Côte d'Ivoire. SUBJECTS 78 children who were HIV positive and 77 children who were HIV negative on whom a necropsy was performed; their median ages at death were 18 and 21 months respectively. 36 HIV positive children and 29 HIV negative children were 1-14 months old; 42 HIV positive and 48 HIV negative children were > or = 15 months old. MAIN OUTCOME MEASURES Cause of death and prevalence of diseases confirmed pathologically. RESULTS Respiratory tract infections were more common in HIV positive than in HIV negative children (73 (94%) v 52 (68%); P < 0.05), and were aetiologically heterogeneous. Pneumocystis carinii pneumonia was found in 11 out of 36 (31%) HIV positive children aged < 15 months, but in no HIV negative children. Among older children measles was more common in HIV positive children (8/42 (19%) v 2/48 (4%); P < 0.06). Pyogenic meningitis was present in similar proportions of HIV positive and HIV negative children aged < 15 months (7/36 (19%) and 7/29 (24%)). In HIV positive children tuberculosis (1/78), lymphocytic interstitial pneumonitis (1/78), and HIV encephalitis (2/78) were rare. CONCLUSIONS There is greater overlap between diseases associated with HIV infection and other common health problems in African children than there is in adults. Compared with adults, HIV positive children had a high prevalence of P carinii pneumonia and a low prevalence of tuberculosis. Measles, but not malaria, was associated with HIV infection.
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Affiliation(s)
- S B Lucas
- Department of Histopathology, University College London Medical School
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