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Classifying perinatal mortality using verbal autopsy: is there a role for nonphysicians?
Cyril Engmann1, John Ditekemena, Imtiaz Jehan
1Departments of Pediatrics and Maternal Child Health, University of North Carolina at Chapel Hill, North Carolina, USA. cengmann@med.unc.edu.
Population Health Metrics
|August 9, 2011
Summary
Nonphysicians trained in verbal autopsy showed limited concordance with physician diagnoses for perinatal mortality. Current findings suggest nonphysicians are not yet reliable for assigning causes of perinatal death.
Area of Science:
- Global Health
- Medical Diagnostics
- Public Health
Background:
- Physician shortages in low-income countries necessitate exploring nonphysician roles in classifying perinatal mortality.
- Verbal autopsy (VA) is a potential tool for nonphysicians to determine stillbirth and early neonatal death causes.
Purpose of the Study:
- To assess the concordance between nonphysician-assigned and physician-assigned causes of perinatal death using verbal autopsy.
- To evaluate the reliability of nonphysicians in determining underlying perinatal mortality causes in diverse settings.
Main Methods:
- A train-the-trainer model educated physicians and nonphysicians on a standardized verbal autopsy program.
- Physician panels and individual nonphysicians independently reviewed VA data for stillbirths and early neonatal deaths.
- Statistical measures including sensitivity, specificity, and predictive values were used to evaluate nonphysician performance against physician standards.
Main Results:
- Nonphysicians achieved 47% concordance for early neonatal death causes and 57% for stillbirth causes compared to physician panels.
- Tetanus met robustness criteria for early neonatal death, while cord prolapse met criteria for stillbirth.
- Significant discrepancies were observed between nonphysician and physician cause-of-death assignments.
Conclusions:
- Despite training, significant differences persist in cause-of-death determination between physicians and nonphysicians.
- Current evidence indicates nonphysicians cannot reliably assign underlying causes of perinatal death via verbal autopsy.
- Further research and refined training methods may be needed to improve nonphysician performance in perinatal mortality classification.
