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Diagnostic accuracy of WHO verbal autopsy tool for ascertaining causes of neonatal deaths in the urban setting of Pakistan: a hospital-based prospective study.

Soofi SB, Ariff S, Khan U, Turab A, Khan GN, Habib A, Sadiq K, Suhag Z, Bhatti Z, Ahmed I, Bhal R, Bhutta ZA - BMC Pediatr (2015)

Bottom Line: The reference standard cause of death was established by two senior pediatricians within 2 days of occurrence of death using the International Cause of Death coding system.Cause of death was assigned by 2 trained pediatricians.The tool can be used in resource limited community-based settings where neonatal mortality rate is high and death certificates from hospitals are not available.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics & Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan. sajid.soofi@aku.edu.

ABSTRACT

Background: Globally, clinical certification of the cause of neonatal death is not commonly available in developing countries. Under such circumstances it is imperative to use available WHO verbal autopsy tool to ascertain causes of death for strategic health planning in countries where resources are limited and the burden of neonatal death is high. The study explores the diagnostic accuracy of WHO revised verbal autopsy tool for ascertaining the causes of neonatal deaths against reference standard diagnosis obtained from standardized clinical and supportive hospital data.

Methods: All neonatal deaths were recruited between August 2006 -February 2008 from two tertiary teaching hospitals in Province Sindh, Pakistan. The reference standard cause of death was established by two senior pediatricians within 2 days of occurrence of death using the International Cause of Death coding system. For verbal autopsy, trained female community health worker interviewed mother or care taker of the deceased within 2-6 weeks of death using a modified WHO verbal autopsy tool. Cause of death was assigned by 2 trained pediatricians. The performance was assessed in terms of sensitivity and specificity.

Results: Out of 626 neonatal deaths, cause-specific mortality fractions for neonatal deaths were almost similar in both verbal autopsy and reference standard diagnosis. Sensitivity of verbal autopsy was more than 93% for diagnosing prematurity and 83.5% for birth asphyxia. However the verbal autopsy didn't have acceptable accuracy for diagnosing the congenital malformation 57%. The specificity for all five major causes of neonatal deaths was greater than 90%.

Conclusion: The WHO revised verbal autopsy tool had reasonable validity in determining causes of neonatal deaths. The tool can be used in resource limited community-based settings where neonatal mortality rate is high and death certificates from hospitals are not available.

No MeSH data available.


Related in: MedlinePlus

Cause of death; case definitions [12]
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Fig2: Cause of death; case definitions [12]

Mentions: Similarly another three days training was arranged for the 4 study physicians. The physicians were Senior Pediatrician with significant experience in neonatal care working as faculty members in the department of Pediatrics and Child health at the Aga Khan University. They were trained on use of International classification of diseases, 10th version (ICD-10) [15] and assigning primary single cause (Fig. 2) as per hierarchy by NICE (Table 1) given in the study manual. The training was conducted by a WHO official. In order to standardize the assignment of primary cause of death, a standardized instruction manual for was developed and used across the study sites.Fig. 2


Diagnostic accuracy of WHO verbal autopsy tool for ascertaining causes of neonatal deaths in the urban setting of Pakistan: a hospital-based prospective study.

Soofi SB, Ariff S, Khan U, Turab A, Khan GN, Habib A, Sadiq K, Suhag Z, Bhatti Z, Ahmed I, Bhal R, Bhutta ZA - BMC Pediatr (2015)

Cause of death; case definitions [12]
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4595242&req=5

Fig2: Cause of death; case definitions [12]
Mentions: Similarly another three days training was arranged for the 4 study physicians. The physicians were Senior Pediatrician with significant experience in neonatal care working as faculty members in the department of Pediatrics and Child health at the Aga Khan University. They were trained on use of International classification of diseases, 10th version (ICD-10) [15] and assigning primary single cause (Fig. 2) as per hierarchy by NICE (Table 1) given in the study manual. The training was conducted by a WHO official. In order to standardize the assignment of primary cause of death, a standardized instruction manual for was developed and used across the study sites.Fig. 2

Bottom Line: The reference standard cause of death was established by two senior pediatricians within 2 days of occurrence of death using the International Cause of Death coding system.Cause of death was assigned by 2 trained pediatricians.The tool can be used in resource limited community-based settings where neonatal mortality rate is high and death certificates from hospitals are not available.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics & Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan. sajid.soofi@aku.edu.

ABSTRACT

Background: Globally, clinical certification of the cause of neonatal death is not commonly available in developing countries. Under such circumstances it is imperative to use available WHO verbal autopsy tool to ascertain causes of death for strategic health planning in countries where resources are limited and the burden of neonatal death is high. The study explores the diagnostic accuracy of WHO revised verbal autopsy tool for ascertaining the causes of neonatal deaths against reference standard diagnosis obtained from standardized clinical and supportive hospital data.

Methods: All neonatal deaths were recruited between August 2006 -February 2008 from two tertiary teaching hospitals in Province Sindh, Pakistan. The reference standard cause of death was established by two senior pediatricians within 2 days of occurrence of death using the International Cause of Death coding system. For verbal autopsy, trained female community health worker interviewed mother or care taker of the deceased within 2-6 weeks of death using a modified WHO verbal autopsy tool. Cause of death was assigned by 2 trained pediatricians. The performance was assessed in terms of sensitivity and specificity.

Results: Out of 626 neonatal deaths, cause-specific mortality fractions for neonatal deaths were almost similar in both verbal autopsy and reference standard diagnosis. Sensitivity of verbal autopsy was more than 93% for diagnosing prematurity and 83.5% for birth asphyxia. However the verbal autopsy didn't have acceptable accuracy for diagnosing the congenital malformation 57%. The specificity for all five major causes of neonatal deaths was greater than 90%.

Conclusion: The WHO revised verbal autopsy tool had reasonable validity in determining causes of neonatal deaths. The tool can be used in resource limited community-based settings where neonatal mortality rate is high and death certificates from hospitals are not available.

No MeSH data available.


Related in: MedlinePlus