THE UTILITY OF VERBAL AUTOPSIES FOR IDENTIFYING HIV-1-RELATED DEATHS IN HAITIAN CHILDREN

被引:22
作者
DOWELL, SF
DAVIS, HL
HOLT, EA
RUFF, AJ
KISSINGER, PJ
BIJOUX, J
BOULOS, R
BOULOS, C
HALSEY, NA
机构
[1] JOHNS HOPKINS UNIV,SCH HYG & PUBL HLTH,DEPT INT HLTH,615 N WOLFE ST,BALTIMORE,MD 21205
[2] CTR DEV & HLTH,PORT AU PRINCE,HAITI
关键词
PEDIATRIC HIV-1; MORTALITY; VERBAL AUTOPSIES; CAUSE OF DEATH; DEVELOPING COUNTRY;
D O I
10.1097/00002030-199309000-00016
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: To determine whether deaths among Haitian infants born to HIV-1-sero-negative women could be distinguished from deaths among children born to HIV-1-seropositive women using the verbal autopsy technique. Methods: Mothers of 315 Haitian children who died were interviewed about events leading to the child's death. Three physicians independently reviewed interview data and determined the probable cause of death without knowledge of maternal HIV-1 status or hospital records. The underlying causes of death assigned to the infants were analyzed to determine whether maternal HIV status could be predicted. Results: There was good agreement among the physicians (kappa = 0.62) and 90% agreement between hospital records and the verbal autopsy diagnosis. Compared with children born to HIV-1-seronegative women, deaths in children born to HIV-1-seropositive mothers were more likely to be ascribed to a presumptive diagnosis of AIDS (37 versus 21%; P = 0.01). The sensitivity and specificity of verbal autopsies for identifying deaths associated with maternal HIV-1 infection ranged from 37 to 59% and from 69 to 79%, respectively, depending on the classification system used. The predictive positive value of a death believed to be consistent with pediatric HIV-1 infection was 26-30% and the predictive negative value was 85-90%. Conclusion: Verbal autopsies may be useful for distinguishing certain causes of death, but have limited utility for distinguishing deaths associated with maternal HIV-1 infection from deaths among children born to HIV-1-seronegative women.
引用
收藏
页码:1255 / 1259
页数:5
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