Fobil Julius N, Kumoji Robert, Armah Henry B, Aryee Eunice, Bilson Francis, Carboo Derick, Rodrigues Frederick K, Meyer Christian G, May Juergen, Kraemer Alexander
School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana;; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany;; Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany.
Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana.
J Public Health Afr. 2011 Mar 4;2(1):e7. doi: 10.4081/jphia.2011.e7. eCollection 2011 Mar 1.
The study of cause of death certification remains a largely neglected field in many developing countries, including Ghana. Yet, mortality information is crucial for establishing mortality patterns over time and for estimating mortality attributed to specific causes. In Ghana, autopsies remain the appropriate option for determining the cause of deaths occurring in homes and those occurring within 48 hours after admission into health facilities. Although these organ-based autopsies may generate convincing results and are considered the gold standard tools for ascertainments of causes of death, procedural and practical constraints could limit the extent to which autopsy results can be accepted and/or trusted. The objective of our study was to identify and characterise the procedural and practical constraints as well as to assess their potential effects on autopsy outcomes in Ghana. We interviewed 10 Ghanaian pathologists and collected and evaluated procedural manuals and operational procedures for the conduct of autopsies. A characterisation of the operational constraints and the Delphi analysis of their potential influence on the quality of mortality data led to a quantification of the validity threats as moderate (average expert panel score = 1) in the generality of the autopsy operations in Ghana. On the basis of the impressions of the expert panel, it was concluded that mortality data generated from autopsies in urban settings in Ghana were of sufficiently high quality to guarantee valid use in health analysis.
在包括加纳在内的许多发展中国家，死因证明的研究在很大程度上仍是一个被忽视的领域。然而，死亡率信息对于确定长期的死亡模式以及估算特定原因导致的死亡率至关重要。在加纳，尸检仍然是确定在家中死亡以及在进入医疗机构后48小时内死亡原因的合适选择。尽管这些基于器官的尸检可能会得出令人信服的结果，并且被视为确定死因的金标准工具，但程序和实际限制可能会限制尸检结果被接受和/或信任的程度。我们研究的目的是识别和描述程序和实际限制，并评估它们对加纳尸检结果的潜在影响。我们采访了10位加纳病理学家，并收集和评估了尸检操作的程序手册和操作流程。对操作限制的描述以及对其对死亡率数据质量潜在影响的德尔菲分析，得出在加纳尸检操作的一般情况下，有效性威胁的量化为中等（专家小组平均得分 = 1）。根据专家小组的意见，得出结论认为，加纳城市地区尸检产生的死亡率数据质量足够高，能够保证在健康分析中有效使用。
