@article {Rakislovae005218, author = {Natalia Rakislova and Dercio Jordao and Mamudo R Ismail and Alfredo Mayor and Pau Cister{\'o} and Lorena Marimon and Melania Ferrando and Juan Carlos Hurtado and Lucilia Lovane and Carla Carrilho and Cesaltina Lorenzoni and Fabiola Fernandes and Tacilta Nhampossa and Anelsio Cossa and Inacio Mandomando and Mireia Navarro and Isaac Casas and Khatia Munguambe and Maria Maixenchs and Lloren{\c c} Quint{\'o} and Eusebio Macete and Mikel Martinez and Robert W Snow and Quique Bassat and Clara Men{\'e}ndez and Jaume Ordi}, title = {Accuracy of verbal autopsy, clinical data and minimally invasive autopsy in the evaluation of malaria-specific mortality: an observational study}, volume = {6}, number = {6}, elocation-id = {e005218}, year = {2021}, doi = {10.1136/bmjgh-2021-005218}, publisher = {BMJ Specialist Journals}, abstract = {Background Global malaria mortality estimates are hindered by the low reliability of the verbal autopsy (VA) and the clinical records, the most common sources of information used to estimate malaria-specific mortality. We aimed to determine the accuracy of these tools, as well as of the minimally invasive autopsy (MIA), a needle-based postmortem sampling method, to identify malaria-specific mortality in a large series of deceased patients from Mozambique, using complete autopsy as the gold standard.Methods Observational study that included 264 deaths, occurring at a tertiary level hospital in Mozambique, from 1 November 2013 to 31 March 2015 (17 months-long period). Clinical data were abstracted, a computer coded VA was completed using the clinical data as source of information, and an MIA followed by a complete autopsy were performed. Screening for malaria infection was conducted postmortem to all participants using molecular and histological techniques (PCR and immunohistochemistry).Findings Malaria infection was considered the cause of death in 6/264 (2.3\%) cases: 2/54 children (3.7\%, both less than 5 years old) and 4/57 (7.0\%) maternal deaths. The sensitivity and specificity of the VA, the clinical data and the MIA to identify malaria-specific deaths were 33.3\% and 96.1\%, 66.7\% and 96.1\%, and 100\% and 100\%, respectively. In addition, malaria was identified as a possible contributor in 14 additional patients who died of other diseases. These cases were also accurately identified by the MIA (sensitivity 82.4\%, specificity 100\%).Interpretation The high sensitivity and specificity of the MIA in identifying malaria may help to improve current estimates of malaria-specific mortality in endemic areas.All data relevant to the study are included in the article.}, URL = {https://gh.bmj.com/content/6/6/e005218}, eprint = {https://gh.bmj.com/content/6/6/e005218.full.pdf}, journal = {BMJ Global Health} }