Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review

Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and Inter VA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making

Postmortem forensic imaging: An essential tool in contentious cases

Background: Traditional autopsy (TA) is employed towards determining the cause and manner of death. Over the last decade, virtual autopsy (VA), involving the application of forensic imaging techniques have gained prominence and, with great precision in developed countries. Aim: This is to compare the findings at post-mortem using forensic imaging techniques and, those of TA. Materials and Methods: Post-mortem CT-Scan and MRI techniques were employed in the present case and for the first time in Nigeria, to identify the fatal injuries and determine their causation. The examination was done prior to the TA; the latter was done by a team of pathologists without the prior knowledge of the imaging findings. The results, using both methods, were subsequently compared. Results: Most of the VA and TA findings were the same except for the areas that were not readily accessible to the pathology team because of prior embalmment of the body. The inexperience of the radiologist in the area of post-mortem forensic imaging also contributed to the few discrepancies. Conclusion: This is the first virtopsy to be conducted in Nigeria and, with impressive results. The findings compare favourably with those of TA and, have the added advantage of identifying minor injuries that might easily be missed using TA method. Success is however hinged on the expertise of the forensic radiologist and forensic pathologist. While VA can be employed to solve the problems of religious opposition to TA, the cost of the former is astronomical

Revue de 10 annees d'autopsies medico-legales en Cote d'Ivoire (2002 A 2011)

Introduction : Le but de cette etude etait de faire une analyse synoptique des resultats de 10 annees d'autopsies judiciaires afin de disposer de donnees statistiques nationales au plan epidemiologique et medico legal. Patients et Methode : Il s'agissait d'une etude retrospective descriptive sur les autopsies judiciaires pratiquees de 2002 a 20011 (10 ans) dans le service d'anatomo-pathologie et de medecine legale du CHU d'Abidjan Treichville. Resultats : 834 autopsies judiciaires sur 24227 deces enregistres ont ete realisees sur la periode d'etude; ce qui representait 3;4 des actes medico legaux. La majorite des sujets autopsies etait des adultes jeunes (moyenne d'age = 37;6 ans); de sexe masculin (87) et les deces survenaient le plus souvent sur la voie publique (36;2) des suites d'une agression physique (26). Ainsi les morts violentes predominaient (71;7) et etaient volontiers d'origine criminelle (55). Ces agressions criminelles etaient dans la majorite des cas perpetrees avec les armes a feu (60;8) qui representaient en outre la premiere origine des morts violentes. Les deces accidentels representaient 30;8 et etaient en rapport avec les accidents du trafic (31) tandis que les morts naturelles (23;6) etaient liees essentiellement a des pathologies cardio vasculaires (41;6). Conclusion : L'autopsie medico legale joue un role important dans la manifestation de la verite au plan judiciaire mais permet egalement de participer a la collecte de donnees en matiere de sante publique; d'ou l'interet d'encourager la pratique de cet acte medico legal qui merite egalement d'etre valoriser au plan des frais de justice criminelle

The Role of Necropsy in Diagnostic Dilemmas as Seen in a Tertiary Hospital in North Central Nigeria

Background. Necropsy (autopsy) has helped medical science and law. It has given rise to numerous diagnostic surprises as it explains cause of death; pathogenesis of diseases; and circumstances of death. It also explains reasons for most therapeutic failures. In spite of its usefulness; the rate has dropped worldwide and Africa is worse hit. This work aims to highlight the role autopsy (Necropsy) plays in demystifying diagnostic dilemmas and to encourage its patronage by medical practitioners; law enforcement agents and society. Methods. This is a retrospective review of autopsy and clinical reports of cases seen by pathologists and physicians in the Jos University Teaching Hospital (JUTH); Jos; North central Nigeria. Results. A total 166 cases were studied out of which 52 had same diagnosis for both attending physician and pathologist; 106 had different diagnoses and in eight cases diagnoses remained unknown even after autopsy was performed. Conclusions. Autopsy remains an important tool for obtaining definitive diagnosis; determining cause of death to explain pathogenesis of diseases; medical auditing and a vital source of data for health statistics and planning

A Study of Autopsy Procedures in Ghana: Implications for the Use of Autopsy Data in Epidemiological Analyses

The study of cause of death certification remains a largely neglected field in many developing countries; including Ghana. Yet; mortality information is crucial for establishing mortality patterns over time and for estimating mortality attributed to specific causes. In Ghana; in deaths occurring in homes and those occurring within 48 hours after admission into health facilities; autopsies remain the appropriate option for determining the cause of death. Although these organ-based autopsies may generate convincing results and are considered the `gold standard' tools for ascertainments of causes of death; procedural and practical constraints could limit the extent to which autopsy results can be accepted and/or trusted. The objective of our study was to identify and characterise the procedural and practical constraints as well as to assess their potential effects on autopsy outcomes in Ghana. We interviewed 10 Ghanaian pathologists and collected and evaluated procedural manuals and operational procedures for the conduct of autopsies. A characterisation of the operational constraints and the Delphi analysis of their potential influence on the quality of mortality data led to a quantification of the validity threats as moderate (average expert panel score = 1) in the generality of the autopsy operations in Ghana. On the basis of the impressions of the expert panel; it was concluded that mortality data generated from autopsies in urban settings in Ghana were of sufficiently high quality to guarantee valid use in health analysis