Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: An observational study
PloS med
; 16(6): 1-17, Jun 20, 2017. tab
Article
in English
| AIM (Africa), RSDM
| ID: biblio-1527321
Responsible library:
MZ1.1
ABSTRACT
Over 5 million stillbirths and neonatal deaths occur annually. Limited and imprecise information on the cause of these deaths hampers progress in achieving global health targets. Complete diagnostic autopsies (CDAs)-the gold standard for cause of death determination-are difficult to perform in most high-burden settings. Therefore, validation of simpler and more feasible methods is needed. Methods and findings:
In this observational study, the validity of a minimally invasive autopsy (MIA) method in determining the cause of death was assessed in 18 stillbirths and 41 neonatal deaths by comparing the results of the MIA with those of the CDA. Concordance between the categories of diseases obtained by the 2 methods was assessed by the Kappa statistic, and the sensitivity, specificity, positive, and negative predictive values of the MIA diagnoses were calculated. A cause of death was identified in 16/18 (89%) and 15/18 (83%) stillborn babies in the CDA and the MIA, respectively. Fetal growth restriction accounted for 39%, infectious diseases for 22%, intrapartum hypoxia for 17%, and intrauterine hypoxia for 11% of stillborn babies. Overall, the MIA showed in this group a substantial concordance with the CDA (Kappa = 0.78, 95% CI [0.56-0.99]). A cause of death was identified in all (100%) and 35/41 (85%) neonatal deaths in the CDA and the MIA, respectively. In this group, the majority of deaths were due to infectious diseases (66%). The overall concordance of the MIA with the CDA in neonates was moderate (Kappa = 0.40, 95% CI [0.18-0.63]). A high percentage of accuracy was observed for the MIA in all the diagnostic categories in both stillbirths and neonates (>75%). The main limitation of this study is that some degree of subjective interpretation is inherent to cause-of-death attribution in both the MIA and the CDA; this is especially so in stillbirths and in relation to fetal growth restriction.Conclusions:
The MIA could be a useful tool for cause-of-death determination in stillbirths and neonatal deaths. These findings may help to accelerate progress towards meeting global health targets by obtaining more accurate information on the causes of death in these age groups, which is essential in guiding the design of new interventions and increasing the effectiveness of those already implemented.
Full text:
Available
Collection:
National databases
/
MZ
Database:
AIM (Africa)
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RSDM
Main subject:
Autopsy
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Infant, Newborn
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Sensitivity and Specificity
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Mozambique
Limits:
Humans
Country/Region as subject:
Africa
Language:
English
Journal:
PloS med
Year:
2017
Document type:
Article
Institution/Affiliation country:
1ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona/ES
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Centro de Investigação em Saúde de Manhiça/MZ
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Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)/ES
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Department of Gynecology and Obstetrics, Maputo Central Hospital/MA
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Department of Gynecology and Obstetrics, Maputo Central Hospital/MZ
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Department of Maternal-Fetal Medicine, BCNatal, Hospital Clinic of Barcelona, Universitat de Barcelona/ES
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Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona/ES
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Department of Pathology, Maputo Central Hospital/MZ
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Department of Pathology, Maputo Central Hospital, Maputo, Mozambique/MZ
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Department of Pediatrics, Maputo Central Hospital/MZ