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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Classifying perinatal mortality using verbal autopsy: Is there a role for nonphysicians?
Population Health Metrics, Volume 9, Article 42, Year 2011
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Description
Background: Because of a physician shortage in many low-income countries, the use of nonphysicians to classify perinatal mortality (stillbirth and early neonatal death) using verbal autopsy could be useful.Objective: To determine the extent to which underlying perinatal causes of deaths assigned by nonphysicians in Guatemala, Pakistan, Zambia, and the Democratic Republic of the Congo using a verbal autopsy method are concordant with underlying perinatal cause of death assigned by physician panels.Methods: Using a train-the-trainer model, 13 physicians and 40 nonphysicians were trained to determine cause of death using a standardized verbal autopsy training program. Subsequently, panels of two physicians and individual nonphysicians from this trained cohort independently reviewed verbal autopsy data from a sample of 118 early neonatal deaths and 134 stillbirths. With the cause of death assigned by the physician panel as the reference standard, sensitivity, specificity, positive and negative predictive values, and cause-specific mortality fractions were calculated to assess nonphysicians' coding responses. Robustness criteria to assess how well nonphysicians performed were used.Results: Causes of early neonatal death and stillbirth assigned by nonphysicians were concordant with physician-assigned causes 47% and 57% of the time, respectively. Tetanus filled robustness criteria for early neonatal death, and cord prolapse filled robustness criteria for stillbirth.Conclusions: There are significant differences in underlying cause of death as determined by physicians and nonphysicians even when they receive similar training in cause of death determination. Currently, it does not appear that nonphysicians can be used reliably to assign underlying cause of perinatal death using verbal autopsy. © 2011 Engmann et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Engmann, Cyril Mark
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Ditekemena, John Dinanga
Congo, Kinshasa
Kinshasa School of Public Health
Jehan, Imtiaz
Pakistan, Karachi
The Aga Khan University
Garcés, Ana Lucía
Guatemala, Guatemala City
San Carlos University
Phiri, M.
Zambia, Lusaka
University Teaching Hospital Lusaka
Thorsten, Vanessa R.
United States, Research Triangle Park
Rti International
Mazariegos, Manolo
Guatemala, Guatemala City
Institute of Nutrition of Central America and Panama Guatemala
Chomba, Elwyn Nachanya
Zambia, Lusaka
University Teaching Hospital Lusaka
Pasha, Omrana
Pakistan, Karachi
The Aga Khan University
Tshefu, Antoinette Kitoto
Congo, Kinshasa
Kinshasa School of Public Health
McClure, Elizabeth M.
United States, Research Triangle Park
Rti International
Wallace, Dennis D.
United States, Research Triangle Park
Rti International
Goldenberg, Robert L.
United States, Philadelphia
Drexel University College of Medicine
Carlo, Waldemar A.
United States, Birmingham
The University of Alabama at Birmingham
Wright, Linda L.
United States, Bethesda
National Institute of Child Health and Human Development Nichd
Bose, Carl Lewis
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 16
Authors: 16
Affiliations: 10
Identifiers
Doi:
10.1186/1478-7954-9-42
e-ISSN:
14787954
Research Areas
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Congo
Zambia