Araya Tekebash, Reniers Georges, Schaap Ab, Kebede Derege, Kumie Abera, Nagelkerke Nico, Coutinho Roel, Sanders Eduard
Department of Community Health, Addis Ababa University, Addis Ababa, Ethiopia.
Trop Med Int Health. 2004 Jan;9(1):178-86. doi: 10.1046/j.1365-3156.2003.01172.x.
Lay diagnoses of death collected at burial sites were validated against two 'gold standards': the hospital discharge diagnosis of causes of death obtained by a surveillance of hospital deaths (including autopsy results) and the physician review of verbal autopsies (VAs) that were carried out for a sample of cemetery records. The diagnostic indicators of the lay diagnoses were then used to provide estimates of the share of AIDS-attribuTable mortality. The verbal autopsy results provide an independent estimate of the percentage of AIDS deaths. From a total of 21,274 burial records, 2546 hospital discharge diagnoses, 1480 outcomes of autopsies and 200 adult verbal autopsies were gathered over a period of 1 year starting from February 2001. Independent of the gold standard, lay diagnoses such as lung disease and cold have a specificity of about 90% and a combined sensitivity of about 55% in determining AIDS mortality. Without a significant loss in specificity, the sensitivity increases to 60-65% when diarrhoea, TB, herpes zoster and mental or nerve problem are included. We thus conclude that even in the presence of a reluctance to talk of HIV/AIDS, lay diagnosis of causes of death can be used for monitoring AIDS mortality. Lung disease and cold, in particular, have become well-known euphemisms for AIDS in the community. The share of AIDS deaths in the adult population (20-54) is estimated at 68%, without noticeable differences between men and women. Our results confirm the high impact of HIV/AIDS on mortality as was estimated by epidemiological projections for Addis Ababa.
在墓地收集的死亡情况的外行诊断结果，对照两个“金标准”进行了验证：通过监测医院死亡情况（包括尸检结果）获得的医院出院死亡原因诊断，以及对墓地记录样本进行的口头尸检（VA）的医生审查。然后使用外行诊断的诊断指标来估计艾滋病所致死亡率的比例。口头尸检结果提供了艾滋病死亡百分比的独立估计值。从2001年2月开始的1年时间里，共收集了21274份埋葬记录、2546份医院出院诊断、1480份尸检结果和200份成人口头尸检结果。独立于金标准之外，诸如肺病和感冒等外行诊断在确定艾滋病死亡率方面的特异性约为90%，综合敏感性约为55%。当纳入腹泻、结核病、带状疱疹以及精神或神经问题时，在特异性没有显著损失的情况下，敏感性提高到60% - 65%。因此我们得出结论，即使存在不愿谈论艾滋病毒/艾滋病的情况，死亡原因的外行诊断仍可用于监测艾滋病死亡率。特别是肺病和感冒，在社区中已成为众所周知的艾滋病委婉说法。估计成人（20 - 54岁）中艾滋病死亡的比例为68%，男性和女性之间没有明显差异。我们的结果证实了艾滋病毒/艾滋病对死亡率的高影响，正如亚的斯亚贝巴的流行病学预测所估计的那样。
