Potential and limits of verbal autopsies

摘要: The idea of assessing causes death by retrospective interview is as old medical statistics. In 17th century London, so-called searchers visited the houses people who had died to make enquiries about death, especially communicable diseases. 19th century, modern systems registration saw end this practice in Europe; but developing countries, which lack capacity produce certificates for whole population, there still a need lay investigations into cause death. Pioneer projects 1950s and 60s Asia (Khanna Narangwal India, Companiganj Bangladesh) Africa (Keneba Gambia) used systematic interviews well trained physicians assess Workers at project christened new technique "verbal autopsy". However, in-depth research are costly can not be replicated nationwide, sometimes involve biases linked focus research. Systematic investigation on larger scale became possible with use questionnaires. Questionnaire-based verbal autopsies have several advantages over ad hoc investigations. For example, they allow all available information recorded and, although data derived from these do constitute formal proof, objective decisions probable cause. WHO has long recommended recording signs symptoms proposed structured questionnaires countries. (1-3) When list target diseases extensive, questionnaire-based may, principle, ensure high specificity. They administered people, qualified personnel only read forms stories. also statistical analysis algorithms. Many been developed since Reproductive Age Mortality Studies (RAMOS), Matlab, Niakhar questionaires were produced late 1970s early 80s. These tools now many settings, such INDEPTH network, national or large-scale regional surveys (such Morocco, China). (4) Verbal optimum value when applied deaths crucial situations where fraction registered occur hospitals. limits autopsies. First, require skilled field-based record evidence office-based staff code analyse data. Second, that assessed autopsy small sample certificates. Third, quality assessment depends sensitivity specificity each diagnosis. While work some public health importance measles, whooping cough, tetanus, cholera, dysentery) accident violence, more problematic less specific symptoms, equally important HIV/MDS children, malaria adults, cancers). …