Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, North Carolina 27599-7596, USA.
Trop Med Int Health. 2009 Dec;14(12):1496-504. doi: 10.1111/j.1365-3156.2009.02395.x. Epub 2009 Oct 1.
To develop a standardized verbal autopsy (VA) training program and evaluate whether its implementation resulted in comparable knowledge required to classify perinatal cause of death (COD) by physicians and non-physicians.
Training materials, case studies, and written and mock scenarios for this VA program were developed using conventional VA and ICD-10 guidelines. This program was used to instruct physicians and non-physicians in VA methodology using a train-the-trainer model. Written tests of cognitive and applied knowledge required to classify perinatal COD were administered before and after training to evaluate the effect of the VA training program.
Fifty-three physicians and non-physicians (nurse-midwives/nurses and Community Health Workers [CHW]) from Pakistan, Zambia, the Democratic Republic of Congo, and Guatemala were trained. Cognitive and applied knowledge mean scores among all trainees improved significantly (12.8 and 28.8% respectively, P < 0.001). Cognitive and applied knowledge post-training test scores of nurse-midwives/nurses were comparable to those of physicians. CHW (high-school graduates with 15 months or less formal health/nursing training) had the largest improvements in post-training applied knowledge with scores comparable to those of physicians and nurse-midwives/nurses. However, CHW cognitive knowledge post-training scores were significantly lower than those of physicians and nurses.
With appropriate training in VA, cognitive and applied knowledge required to determine perinatal COD is similar for physicians and nurses-midwives/nurses. This suggests that midwives and nurses may play a useful role in determining COD at the community level, which may be a practical way to improve the accuracy of COD data in rural, remote, geographic areas.
制定标准化的死因推断（VA）培训方案，并评估其实施是否使医生和非医生具备了相当的知识，以对围产期死亡原因（COD）进行分类。
使用传统的 VA 和 ICD-10 指南，为该 VA 方案开发培训材料、病例研究以及书面和模拟场景。使用培训员培训模式，用该方案向医生和非医生传授 VA 方法学。在培训前后，采用书面考试的方式评估 VA 培训方案对认知和应用知识的影响，这些知识是对围产期 COD 进行分类所必需的。
来自巴基斯坦、赞比亚、刚果民主共和国和危地马拉的 53 名医生和非医生（助产士/护士和社区卫生工作者[CHW]）接受了培训。所有受训者的认知和应用知识平均分数均显著提高（分别为 12.8%和 28.8%，P<0.001）。助产士/护士的认知和应用知识的培训后考试分数与医生的分数相当。CHW（具有 15 个月或更短正规卫生/护理培训的高中毕业生）在培训后的应用知识方面的提高最大，其分数与医生和助产士/护士的分数相当。但是，CHW 的认知知识的培训后分数明显低于医生和护士的分数。
经过 VA 适当培训，确定围产期 COD 所需的认知和应用知识在医生和助产士/护士之间是相似的。这表明，在社区一级，助产士和护士可能在确定 COD 方面发挥有用的作用，这可能是提高农村、偏远、地理区域 COD 数据准确性的一种实用方法。
