RT Journal Article
SR Electronic
T1 Accuracy of verbal autopsy, clinical data and minimally invasive autopsy in the evaluation of malaria-specific mortality: an observational study
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e005218
DO 10.1136/bmjgh-2021-005218
VO 6
IS 6
A1 Rakislova, Natalia
A1 Jordao, Dercio
A1 Ismail, Mamudo R
A1 Mayor, Alfredo
A1 Cisteró, Pau
A1 Marimon, Lorena
A1 Ferrando, Melania
A1 Hurtado, Juan Carlos
A1 Lovane, Lucilia
A1 Carrilho, Carla
A1 Lorenzoni, Cesaltina
A1 Fernandes, Fabiola
A1 Nhampossa, Tacilta
A1 Cossa, Anelsio
A1 Mandomando, Inacio
A1 Navarro, Mireia
A1 Casas, Isaac
A1 Munguambe, Khatia
A1 Maixenchs, Maria
A1 Quintó, Llorenç
A1 Macete, Eusebio
A1 Martinez, Mikel
A1 Snow, Robert W
A1 Bassat, Quique
A1 Menéndez, Clara
A1 Ordi, Jaume
YR 2021
UL http://gh.bmj.com/content/6/6/e005218.abstract
AB 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.