Arauz María José, Ridde Valéry, Hernández Libia Milena, Charris Yaneth, Carabali Mabel, Villar Luis Ángel
School of Public Health (ESPUM), University of Montreal / University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada.
Centro de Atención y Diagnóstico de Enfermedades Infecciosas (CDI-APRESIA), Bucaramanga, Colombia.
PLoS One. 2015 Feb 6;10(2):e0117455. doi: 10.1371/journal.pone.0117455. eCollection 2015.
Dengue fever is a public health problem in the tropical and sub-tropical world. Dengue cases have grown dramatically in recent years as well as dengue mortality. Colombia has experienced periodic dengue outbreaks with numerous dengue related-deaths, where the Santander department has been particularly affected. Although social determinants of health (SDH) shape health outcomes, including mortality, it is not yet understood how these affect dengue mortality. The aim of this pilot study was to develop and pre-test a social autopsy (SA) tool for dengue mortality.
The tool was developed and pre-tested in three steps. First, dengue fatal cases and 'near misses' (those who recovered from dengue complications) definitions were elaborated. Second, a conceptual framework on determinants of dengue mortality was developed to guide the construction of the tool. Lastly, the tool was designed and pre-tested among three relatives of fatal cases and six near misses in 2013 in the metropolitan zone of Bucaramanga. The tool turned out to be practical in the context of dengue mortality in Colombia after some modifications. The tool aims to study the social, individual, and health systems determinants of dengue mortality. The tool is focused on studying the socioeconomic position and the intermediary SDH rather than the socioeconomic and political context.
The SA tool is based on the scientific literature, a validated conceptual framework, researchers' and health professionals' expertise, and a pilot study. It is the first time that a SA tool has been created for the dengue mortality context. Our work furthers the study on SDH and how these are applied to neglected tropical diseases, like dengue. This tool could be integrated in surveillance systems to provide complementary information on the modifiable and avoidable death-related factors and therefore, be able to formulate interventions for dengue mortality reduction.
登革热是热带和亚热带地区的一个公共卫生问题。近年来，登革热病例以及登革热死亡率都急剧上升。哥伦比亚曾经历过周期性的登革热疫情，有大量与登革热相关的死亡病例，桑坦德省受到的影响尤为严重。尽管健康的社会决定因素（SDH）塑造了包括死亡率在内的健康结果，但尚不清楚这些因素如何影响登革热死亡率。这项试点研究的目的是开发并预测试一种用于登革热死亡情况的社会尸检（SA）工具。
该工具分三个步骤进行开发和预测试。首先，明确了登革热死亡病例和“险些死亡”（从登革热并发症中康复的患者）的定义。其次，构建了一个关于登革热死亡率决定因素的概念框架，以指导该工具的构建。最后，2013年在布卡拉曼加都会区对3名死亡病例的亲属和6名险些死亡的患者进行了该工具的设计和预测试。经过一些修改后，该工具在哥伦比亚登革热死亡率的背景下被证明是实用的。该工具旨在研究登革热死亡率的社会、个体和卫生系统决定因素。该工具侧重于研究社会经济地位和中间层面的健康社会决定因素，而非社会经济和政治背景。
社会尸检工具基于科学文献、经过验证的概念框架、研究人员和卫生专业人员的专业知识以及一项试点研究。这是首次为登革热死亡情况创建社会尸检工具。我们的工作推动了对健康社会决定因素的研究，以及这些因素如何应用于登革热等被忽视的热带疾病。该工具可纳入监测系统，以提供关于可改变和可避免的死亡相关因素的补充信息，从而能够制定降低登革热死亡率的干预措施。
