Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: An observational study.
<h4>Background</h4>Over 5 million stillbirths and neonatal deaths occur annually. Limited and imprecise information on the cause of these deaths hampers progress in achieving global health targets. Complete diagnostic autopsies (CDAs)-the gold standard for cause of death determination-ar...
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2017-06-01
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| author | Clara Menendez Paola Castillo Miguel J Martínez Dercio Jordao Lucilia Lovane Mamudo R Ismail Carla Carrilho Cesaltina Lorenzoni Fabiola Fernandes Tacilta Nhampossa Juan Carlos Hurtado Mireia Navarro Isaac Casas Paula Santos Ritchie Sonia Bandeira Sibone Mocumbi Zara Jaze Flora Mabota Khátia Munguambe Maria Maixenchs Ariadna Sanz Inacio Mandomando Alfons Nadal Anna Goncé Carmen Muñoz-Almagro Llorenç Quintó Jordi Vila Eusebio Macete Pedro Alonso Jaume Ordi Quique Bassat |
| author_facet | Clara Menendez Paola Castillo Miguel J Martínez Dercio Jordao Lucilia Lovane Mamudo R Ismail Carla Carrilho Cesaltina Lorenzoni Fabiola Fernandes Tacilta Nhampossa Juan Carlos Hurtado Mireia Navarro Isaac Casas Paula Santos Ritchie Sonia Bandeira Sibone Mocumbi Zara Jaze Flora Mabota Khátia Munguambe Maria Maixenchs Ariadna Sanz Inacio Mandomando Alfons Nadal Anna Goncé Carmen Muñoz-Almagro Llorenç Quintó Jordi Vila Eusebio Macete Pedro Alonso Jaume Ordi Quique Bassat |
| author_sort | Clara Menendez |
| collection | DOAJ |
| description | <h4>Background</h4>Over 5 million stillbirths and neonatal deaths occur annually. Limited and imprecise information on the cause of these deaths hampers progress in achieving global health targets. Complete diagnostic autopsies (CDAs)-the gold standard for cause of death determination-are difficult to perform in most high-burden settings. Therefore, validation of simpler and more feasible methods is needed.<h4>Methods and findings</h4>In this observational study, the validity of a minimally invasive autopsy (MIA) method in determining the cause of death was assessed in 18 stillbirths and 41 neonatal deaths by comparing the results of the MIA with those of the CDA. Concordance between the categories of diseases obtained by the 2 methods was assessed by the Kappa statistic, and the sensitivity, specificity, positive, and negative predictive values of the MIA diagnoses were calculated. A cause of death was identified in 16/18 (89%) and 15/18 (83%) stillborn babies in the CDA and the MIA, respectively. Fetal growth restriction accounted for 39%, infectious diseases for 22%, intrapartum hypoxia for 17%, and intrauterine hypoxia for 11% of stillborn babies. Overall, the MIA showed in this group a substantial concordance with the CDA (Kappa = 0.78, 95% CI [0.56-0.99]). A cause of death was identified in all (100%) and 35/41 (85%) neonatal deaths in the CDA and the MIA, respectively. In this group, the majority of deaths were due to infectious diseases (66%). The overall concordance of the MIA with the CDA in neonates was moderate (Kappa = 0.40, 95% CI [0.18-0.63]). A high percentage of accuracy was observed for the MIA in all the diagnostic categories in both stillbirths and neonates (>75%). The main limitation of this study is that some degree of subjective interpretation is inherent to cause-of-death attribution in both the MIA and the CDA; this is especially so in stillbirths and in relation to fetal growth restriction.<h4>Conclusions</h4>The MIA could be a useful tool for cause-of-death determination in stillbirths and neonatal deaths. These findings may help to accelerate progress towards meeting global health targets by obtaining more accurate information on the causes of death in these age groups, which is essential in guiding the design of new interventions and increasing the effectiveness of those already implemented. |
| format | Article |
| id | doaj-art-9f007b9c609d4db7911382eb672dab55 |
| institution | DOAJ |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2017-06-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj-art-9f007b9c609d4db7911382eb672dab552025-08-20T02:45:28ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762017-06-01146e100231810.1371/journal.pmed.1002318Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: An observational study.Clara MenendezPaola CastilloMiguel J MartínezDercio JordaoLucilia LovaneMamudo R IsmailCarla CarrilhoCesaltina LorenzoniFabiola FernandesTacilta NhampossaJuan Carlos HurtadoMireia NavarroIsaac CasasPaula Santos RitchieSonia BandeiraSibone MocumbiZara JazeFlora MabotaKhátia MunguambeMaria MaixenchsAriadna SanzInacio MandomandoAlfons NadalAnna GoncéCarmen Muñoz-AlmagroLlorenç QuintóJordi VilaEusebio MacetePedro AlonsoJaume OrdiQuique Bassat<h4>Background</h4>Over 5 million stillbirths and neonatal deaths occur annually. Limited and imprecise information on the cause of these deaths hampers progress in achieving global health targets. Complete diagnostic autopsies (CDAs)-the gold standard for cause of death determination-are difficult to perform in most high-burden settings. Therefore, validation of simpler and more feasible methods is needed.<h4>Methods and findings</h4>In this observational study, the validity of a minimally invasive autopsy (MIA) method in determining the cause of death was assessed in 18 stillbirths and 41 neonatal deaths by comparing the results of the MIA with those of the CDA. Concordance between the categories of diseases obtained by the 2 methods was assessed by the Kappa statistic, and the sensitivity, specificity, positive, and negative predictive values of the MIA diagnoses were calculated. A cause of death was identified in 16/18 (89%) and 15/18 (83%) stillborn babies in the CDA and the MIA, respectively. Fetal growth restriction accounted for 39%, infectious diseases for 22%, intrapartum hypoxia for 17%, and intrauterine hypoxia for 11% of stillborn babies. Overall, the MIA showed in this group a substantial concordance with the CDA (Kappa = 0.78, 95% CI [0.56-0.99]). A cause of death was identified in all (100%) and 35/41 (85%) neonatal deaths in the CDA and the MIA, respectively. In this group, the majority of deaths were due to infectious diseases (66%). The overall concordance of the MIA with the CDA in neonates was moderate (Kappa = 0.40, 95% CI [0.18-0.63]). A high percentage of accuracy was observed for the MIA in all the diagnostic categories in both stillbirths and neonates (>75%). The main limitation of this study is that some degree of subjective interpretation is inherent to cause-of-death attribution in both the MIA and the CDA; this is especially so in stillbirths and in relation to fetal growth restriction.<h4>Conclusions</h4>The MIA could be a useful tool for cause-of-death determination in stillbirths and neonatal deaths. These findings may help to accelerate progress towards meeting global health targets by obtaining more accurate information on the causes of death in these age groups, which is essential in guiding the design of new interventions and increasing the effectiveness of those already implemented.https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002318&type=printable |
| spellingShingle | Clara Menendez Paola Castillo Miguel J Martínez Dercio Jordao Lucilia Lovane Mamudo R Ismail Carla Carrilho Cesaltina Lorenzoni Fabiola Fernandes Tacilta Nhampossa Juan Carlos Hurtado Mireia Navarro Isaac Casas Paula Santos Ritchie Sonia Bandeira Sibone Mocumbi Zara Jaze Flora Mabota Khátia Munguambe Maria Maixenchs Ariadna Sanz Inacio Mandomando Alfons Nadal Anna Goncé Carmen Muñoz-Almagro Llorenç Quintó Jordi Vila Eusebio Macete Pedro Alonso Jaume Ordi Quique Bassat Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: An observational study. PLoS Medicine |
| title | Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: An observational study. |
| title_full | Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: An observational study. |
| title_fullStr | Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: An observational study. |
| title_full_unstemmed | Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: An observational study. |
| title_short | Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: An observational study. |
| title_sort | validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in mozambique an observational study |
| url | https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002318&type=printable |
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