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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
David R. Marsh, MD, MPH1, Salim Sadruddin, PhD Student2, Fariyal Fikree, MBBSDrPH3, Chitra Krishnan, MHS4, and Gary Darmstadt, MD1. (1) Save the Children, 54 Wilton Rd, Westport, CT 06880, 203-221-4145, dmarsh@savechildren.org, (2) University of South Bank, UK, 30 Charles St. West, Apt. 518, Toronto, ON M4Y 1R5, Canada, (3) Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, (4) Department of Neurology, Johns Hopkins Transverse Myelopathy Center, 600 N. Wolfe St., Pathology 627 C, Baltimore, MD 21287-6965
Background: Verbal autopsy (VA) aims to approximate a community’s mortality experience in the absence of contact with formal registration or health care systems. Application of VA to neonatal deaths is problematic as the agonal phase of a neonatal death tends to be indistinct. This is the first attempt to validate the technique exclusively on newborns who died. Methods: Seriously ill neonates (n=137) were enrolled from the Civil Hospital, Karachi between October 31, 1993 and July 31, 1994. All died as newborns, and caregivers were interviewed at home 3-230 days later. Surveillance physicians completed case questionnaires in the hospital, and investigator physicians assigned the main and associated causes of death using clinical criteria. One interviewer completed field questionnaires including a verbatim open-ended history and syndrome modules, and investigator physicians again assigned the main and associated causes of death based on 3 diagnostic methods: verbatim alone, modules alone, and verbatim and modules combined. We assessed the validity of VA by comparing field against hospital diagnoses by diagnostic (verbatim vs. modules vs. both) and analytic method (main vs. any diagnosis). Results: VA identified at least one diagnosis accurately in 71% of the newborns. VA under-diagnosed LBW and prematurity. Verbatim and modules diagnostic method comparing any field against main hospital diagnoses revealed high sensitivities for Too Early/Too Small syndrome (90%) and NNT (84%). Conclusions: VA correctly identifies some important causes of newborn death in the field. Assigning multiple diagnoses using both open and closed-ended questions increases the likelihood of correct ascertainment.
Learning Objectives:
Keywords: Community Research, Child Health
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.