Academic journal article Bulletin of the World Health Organization

Validity of Verbal Autopsy for Ascertaining the Causes of stillbirth/Validite De L'autopsie Verbale Dans la Determination Des Causes De Mortinaissance /Validez De Las Investioaciones Verbales Nara Determinar Las Causas De la Mortinatalidad

Academic journal article Bulletin of the World Health Organization

Validity of Verbal Autopsy for Ascertaining the Causes of stillbirth/Validite De L'autopsie Verbale Dans la Determination Des Causes De Mortinaissance /Validez De Las Investioaciones Verbales Nara Determinar Las Causas De la Mortinatalidad

Article excerpt

Objective To validate the verbal autopsy tool for stillbirths of the World Health Organization (WHO) by using hospital diagnosis of the underlying cause of stillbirth (the gold standard) and to compare the fraction of stillbirths attributed to various specific causes through hospital assessment versus verbal autopsy.

Methods In a hospital in Chandigarh, we prospectively studied all stillbirths occurring from 15 April 2006 to 31 March 2008 whose cause was diagnosed within 2 days. AII mothers had to be at least 24 weeks pregnant and live within 1 00 km of the hospital. For verbal autopsy, field workers visited mothers 4 to 6 weeks after the stillbirth. Autopsy results were reviewed by two independent obstetricians and disagreements were resolved by engaging a third expert. Causes of stillbirths as determined by hospital assessment and verbal autopsy were compared in frequency.

Findings Hospital assessment and verbal autopsy yielded the same top five underlying causes of stillbirth: pregnancy-induced hypertension (30%), antepartum haemorrhage (16%), underlying maternal illness (12%), congenital malformations (12%) and obstetric complications (10%). Overall diagnostic accuracy of verbal autopsy diagnosis versus hospital-based diagnosis for all five top causes of stillbirth was 64%. The areas under the receiver operator characteristic curve (ROC) were, for congenital malformations, 0.91 (95% confidence interval, CI: 0.83-0.97); pre-gestational maternal illness, 0.75 (95% Cl: 0.65-0.84); pregnancy-induced hypertension, 0.76 (95% Cl: 0.69-0.81); antepartum haemorrhage, 0.76 (95% Cl: 0.67-0.84) and obstetric complication, 0.82 (95% CI: 0.71-0.93).

Conclusion The WHO verbal autopsy tool for stillbirth can provide reasonably good estimates of common underlying causes of stillbirth in resource-limited settings where a medically certified cause of stillbirth may not be available.

[TEXT REPRODUCIBLE IN ASCII.]

[TEXT REPRODUCIBLE IN ASCII.]

Resume

Objectif Valider l'outil de l'autopsie verbale de l'Organisation mondiale de la Sante dans le cadre des mortinaissances en recourant au diagnostic hospitalier de la cause sous-jacente de la mortinaissance (module ideal) et comparer la part des mortinaissances attribuee a differentes causes specifiques selon l'evaluation de l'hopital d'une part, et l'autopsie verbale, d'autre part.

Methodes Dans un hopital de Chandigarh, nous avons etudie de maniure prospective toutes les mortinaissances survenues du 15 avril 2006 au 31 mars 2008 et dont les causes avaient ete diagnostiquees dans les 2 jours suivant l'evunement. Toutes les mures devaient avoir eu une grossesse d'une duree minimale de 24 semaines et resider dans un perimitre maximum de 1 O0 km autour de l'hopital. Pour realiser l'autopsie verbale, les agents de terrain ont rendu visite aux mires 4 a 6 semaines apris la mortinaissance. Les resultats de l'autopsie ont ensuite ete examines par deux obstetriciens independants et leurs divergences ont ete resolues par l'engagement d'un troisiime expert. Les causes des mortinaissances, telles que determinees par l'evaluation hospitaliire et par l'autopsie verbale, ont ete comparees en fonction de leur frequence. Resultats L'evaluation hospitaliire et l'autopsie verbale ont rapporte cinq causes sous-jacentes principales identiques de la mortinaissance: hypertension liee a la grossesse (30%), hemorragie ante partum (16%), pathologie maternelle sous-jacente (12%), malformations congenitales (12%) et complications obstetriques (10%). L'exactitude generale de l'autopsie verbale au regard du diagnostic hospitalier, pour les cinq causes principales de mortinaissance, etait de 64%. Les aires sous la courbe de caracteristique de fonctionnement du recepteur etaient, pour les malformations congenitales, 0,91 (95% intervalle de confiance, IC: 0,83-0,97); les pathologies maternelles pregestationnelles, 0,75 (95% IC: 0,65-0,84); l'hypertension due a la grossesse, 0,76 (95% IC: 0,69-0,81); l'hemorragie ante partum, 0,76 (95% IC: 0,67-0,84) et les complications obstetriques, 0,82 (95% IC: 0,71-0,93). …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.