Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study

BACKGROUND: Despite global health efforts to reduce maternal mortality, rates continue to be unacceptably high in large parts of the world. Feasible, acceptable, and accurate postmortem sampling methods could provide the necessary evidence to improve the understanding of the real causes of maternal...

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Authors: Castillo, Paola, Hurtado, Juan Carlos, Martínez Yoldi, Miguel Julián, Jordão, Dercio, Lovane, Lucilia, Ismail, Mamudo Rafik, Carrilho, Carla, Lorenzoni, Cesaltina, Fernandes, Fabiola, Mocumbi, Sibone, Jaze, Zara, Mabota, Flora, Cossa, Anelsio, Mandomando, Inácio, Cisteró, Pau, Mayor Aparicio, Alfredo Gabriel, Navarro, Mireia, Casas, Isaac, Vila Estapé, Jordi, Maixenchs, Maria, Munguambe, Khátia, Sanz, Ariadna, Quintó, Llorenç, Macete, Eusebio Víctor, Alonso, Pedro, Bassat Orellana, Quique, Ordi i Majà, Jaume, Menéndez, Clara
Format: article
Status:Published version
Publication Date:2017
Country:España
Institution:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repository:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/118788
Online Access:https://hdl.handle.net/2445/118788
Access Level:Open access
Keyword:Mortalitat
Maternitat
Mortality
Motherhood
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spelling Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational studyCastillo, PaolaHurtado, Juan CarlosMartínez Yoldi, Miguel JuliánJordão, DercioLovane, LuciliaIsmail, Mamudo RafikCarrilho, CarlaLorenzoni, CesaltinaFernandes, FabiolaMocumbi, SiboneJaze, ZaraMabota, FloraCossa, AnelsioMandomando, InácioCisteró, PauMayor Aparicio, Alfredo GabrielNavarro, MireiaCasas, IsaacVila Estapé, JordiMaixenchs, MariaMunguambe, KhátiaSanz, AriadnaQuintó, LlorençMacete, Eusebio VíctorAlonso, PedroBassat Orellana, QuiqueOrdi i Majà, JaumeMenéndez, ClaraMortalitatMaternitatMortalityMotherhoodBACKGROUND: Despite global health efforts to reduce maternal mortality, rates continue to be unacceptably high in large parts of the world. Feasible, acceptable, and accurate postmortem sampling methods could provide the necessary evidence to improve the understanding of the real causes of maternal mortality, guiding the design of interventions to reduce this burden. METHODS AND FINDINGS: The validity of a minimally invasive autopsy (MIA) method in determining the cause of death was assessed in an observational study in 57 maternal deaths by comparing the results of the MIA with those of the gold standard (complete diagnostic autopsy [CDA], which includes any available clinical information). Concordance between the MIA and the gold standard diagnostic categories was assessed by the kappa statistic, and the sensitivity, specificity, positive and negative predictive values and their 95% confidence intervals (95% CI) to identify the categories of diagnoses were estimated. The main limitation of the study is that both the MIA and the CDA include some degree of subjective interpretation in the attribution of cause of death. A cause of death was identified in the CDA in 98% (56/57) of cases, with indirect obstetric conditions accounting for 32 (56%) deaths and direct obstetric complications for 24 (42%) deaths. Nonobstetric infectious diseases (22/32, 69%) and obstetric hemorrhage (13/24, 54%) were the most common causes of death among indirect and direct obstetric conditions, respectively. Thirty-six (63%) women were HIV positive, and HIV-related conditions accounted for 16 (28%) of all deaths. Cerebral malaria caused 4 (7%) deaths. The MIA identified a cause of death in 86% of women. The overall concordance of the MIA with the CDA was moderate (kappa = 0.48, 95% CI: 0.31-0.66). Both methods agreed in 68% of the diagnostic categories and the agreement was higher for indirect (91%) than for direct obstetric causes (38%). All HIV infections and cerebral malaria cases were identified in the MIA. The main limitation of the technique is its relatively low performance for identifying obstetric causes of death in the absence of clinical information. CONCLUSIONS: The MIA procedure could be a valuable tool to determine the causes of maternal death, especially for indirect obstetric conditions, most of which are infectious diseases. The information provided by the MIA could help to prioritize interventions to reduce maternal mortality and to monitor progress towards achieving global health targets.Public Library of Science (PLoS)2017201720172017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion15 p.application/pdfhttps://hdl.handle.net/2445/118788Articles publicats en revistes (ISGlobal)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: http://dx.doi.org/10.1371/journal.pmed.1002431PLoS Medicine, 2017, vol. 14, num. 11, p. e1002431http://dx.doi.org/10.1371/journal.pmed.1002431cc by (c) Castillo et al., 2017http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1187882026-05-29T05:05:01Z
dc.title.none.fl_str_mv Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study
title Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study
spellingShingle Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study
Castillo, Paola
Mortalitat
Maternitat
Mortality
Motherhood
title_short Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study
title_full Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study
title_fullStr Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study
title_full_unstemmed Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study
title_sort Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study
dc.creator.none.fl_str_mv Castillo, Paola
Hurtado, Juan Carlos
Martínez Yoldi, Miguel Julián
Jordão, Dercio
Lovane, Lucilia
Ismail, Mamudo Rafik
Carrilho, Carla
Lorenzoni, Cesaltina
Fernandes, Fabiola
Mocumbi, Sibone
Jaze, Zara
Mabota, Flora
Cossa, Anelsio
Mandomando, Inácio
Cisteró, Pau
Mayor Aparicio, Alfredo Gabriel
Navarro, Mireia
Casas, Isaac
Vila Estapé, Jordi
Maixenchs, Maria
Munguambe, Khátia
Sanz, Ariadna
Quintó, Llorenç
Macete, Eusebio Víctor
Alonso, Pedro
Bassat Orellana, Quique
Ordi i Majà, Jaume
Menéndez, Clara
author Castillo, Paola
author_facet Castillo, Paola
Hurtado, Juan Carlos
Martínez Yoldi, Miguel Julián
Jordão, Dercio
Lovane, Lucilia
Ismail, Mamudo Rafik
Carrilho, Carla
Lorenzoni, Cesaltina
Fernandes, Fabiola
Mocumbi, Sibone
Jaze, Zara
Mabota, Flora
Cossa, Anelsio
Mandomando, Inácio
Cisteró, Pau
Mayor Aparicio, Alfredo Gabriel
Navarro, Mireia
Casas, Isaac
Vila Estapé, Jordi
Maixenchs, Maria
Munguambe, Khátia
Sanz, Ariadna
Quintó, Llorenç
Macete, Eusebio Víctor
Alonso, Pedro
Bassat Orellana, Quique
Ordi i Majà, Jaume
Menéndez, Clara
author_role author
author2 Hurtado, Juan Carlos
Martínez Yoldi, Miguel Julián
Jordão, Dercio
Lovane, Lucilia
Ismail, Mamudo Rafik
Carrilho, Carla
Lorenzoni, Cesaltina
Fernandes, Fabiola
Mocumbi, Sibone
Jaze, Zara
Mabota, Flora
Cossa, Anelsio
Mandomando, Inácio
Cisteró, Pau
Mayor Aparicio, Alfredo Gabriel
Navarro, Mireia
Casas, Isaac
Vila Estapé, Jordi
Maixenchs, Maria
Munguambe, Khátia
Sanz, Ariadna
Quintó, Llorenç
Macete, Eusebio Víctor
Alonso, Pedro
Bassat Orellana, Quique
Ordi i Majà, Jaume
Menéndez, Clara
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Mortalitat
Maternitat
Mortality
Motherhood
topic Mortalitat
Maternitat
Mortality
Motherhood
description BACKGROUND: Despite global health efforts to reduce maternal mortality, rates continue to be unacceptably high in large parts of the world. Feasible, acceptable, and accurate postmortem sampling methods could provide the necessary evidence to improve the understanding of the real causes of maternal mortality, guiding the design of interventions to reduce this burden. METHODS AND FINDINGS: The validity of a minimally invasive autopsy (MIA) method in determining the cause of death was assessed in an observational study in 57 maternal deaths by comparing the results of the MIA with those of the gold standard (complete diagnostic autopsy [CDA], which includes any available clinical information). Concordance between the MIA and the gold standard diagnostic categories was assessed by the kappa statistic, and the sensitivity, specificity, positive and negative predictive values and their 95% confidence intervals (95% CI) to identify the categories of diagnoses were estimated. The main limitation of the study is that both the MIA and the CDA include some degree of subjective interpretation in the attribution of cause of death. A cause of death was identified in the CDA in 98% (56/57) of cases, with indirect obstetric conditions accounting for 32 (56%) deaths and direct obstetric complications for 24 (42%) deaths. Nonobstetric infectious diseases (22/32, 69%) and obstetric hemorrhage (13/24, 54%) were the most common causes of death among indirect and direct obstetric conditions, respectively. Thirty-six (63%) women were HIV positive, and HIV-related conditions accounted for 16 (28%) of all deaths. Cerebral malaria caused 4 (7%) deaths. The MIA identified a cause of death in 86% of women. The overall concordance of the MIA with the CDA was moderate (kappa = 0.48, 95% CI: 0.31-0.66). Both methods agreed in 68% of the diagnostic categories and the agreement was higher for indirect (91%) than for direct obstetric causes (38%). All HIV infections and cerebral malaria cases were identified in the MIA. The main limitation of the technique is its relatively low performance for identifying obstetric causes of death in the absence of clinical information. CONCLUSIONS: The MIA procedure could be a valuable tool to determine the causes of maternal death, especially for indirect obstetric conditions, most of which are infectious diseases. The information provided by the MIA could help to prioritize interventions to reduce maternal mortality and to monitor progress towards achieving global health targets.
publishDate 2017
dc.date.none.fl_str_mv 2017
2017
2017
2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/118788
url https://hdl.handle.net/2445/118788
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: http://dx.doi.org/10.1371/journal.pmed.1002431
PLoS Medicine, 2017, vol. 14, num. 11, p. e1002431
http://dx.doi.org/10.1371/journal.pmed.1002431
dc.rights.none.fl_str_mv cc by (c) Castillo et al., 2017
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Castillo et al., 2017
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 15 p.
application/pdf
dc.publisher.none.fl_str_mv Public Library of Science (PLoS)
publisher.none.fl_str_mv Public Library of Science (PLoS)
dc.source.none.fl_str_mv Articles publicats en revistes (ISGlobal)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812455

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