School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
PLoS One. 2018 May 31;13(5):e0198172. doi: 10.1371/journal.pone.0198172. eCollection 2018.
Verbal autopsy methods have been developed to determine medical causes of deathforprioritizing disease control programs. Additional information on social causesmay facilitate designing of more appropriate prevention strategies. Use of social autopsy in investigations of causes of adult deaths has been limited. Therefore, acommunity-based study was conducted in NandpurKalour Block of Fatehgarh Sahib District in Punjab (India)for finding social causes of adult deaths. An integrated verbal and social autopsy toolwas developed and verbal autopsies of 600 adult deaths, occurring over a reference period of one year, were conducted in 2014. Quantitative analysis described the socio-demographic characteristics of the deceased, number and type of consultations from health care providers, and type of care received during illness. Qualitative data was analyzed to find out social causes of death by thematic analysis. The median duration of illness from symptom onset till death was 9 days (IQR = 1-45 days). At the onset of illness, 72 (12%) deceased utilized home remedies and 424 (70.7%)received care from a clinic/hospital, and 104 (17.3%) died withoutreceiving any care. The number of medical consultations varied from one to six (median = 2). The utilization of government health facilities and qualified allopathic doctor increased with each consultation (p value<0.05). The top five social causes of adult deaths in a rural area of Punjab in India. (1) Non availability of medical practitioner in the vicinity, (2) communication gaps between doctor and patient on regular intake of medication, (3) delayed referral by service provider, (4) poor communication with family on illness, and (5) perception of illness to be 'mild' by the family or care taker. To conclude, social autopsy tool should be integrated with verbal autopsy tool for identification of individual, community, and health system level factors associated with adult mortality.
死因推断方法已被开发出来，以确定医学死因，从而为疾病控制项目提供优先排序。更多关于社会原因的信息可能有助于制定更合适的预防策略。社会死因推断在成人死因调查中的应用有限。因此，在旁遮普邦法塔赫加尔沙布区南德布尔卡尔洛尔街区（印度）进行了一项基于社区的研究，以寻找成人死亡的社会原因。开发了一种综合的口头和社会死因推断工具，并于 2014 年对一年参考期内发生的 600 例成人死亡进行了口头死因推断。定量分析描述了死者的社会人口统计学特征、从医疗保健提供者处进行的咨询次数和类型，以及患病期间接受的护理类型。定性数据分析用于通过主题分析找出死亡的社会原因。从症状出现到死亡的中位病程为 9 天（IQR=1-45 天）。发病时，有 72 人（12%）使用了家庭疗法，有 424 人（70.7%）到诊所/医院就诊，有 104 人（17.3%）未接受任何治疗就死亡。医疗咨询次数从一次到六次不等（中位数=2）。每咨询一次，使用政府卫生设施和合格的全西医的人数就会增加（p 值<0.05）。印度旁遮普邦农村地区成人死亡的前五个社会原因。（1）附近没有医疗从业者，（2）医生和患者在定期服药方面存在沟通障碍，（3）服务提供者延迟转诊，（4）与家人沟通不良有关疾病，以及（5）家人或照顾者认为疾病“轻微”。总之，应将社会死因推断工具与口头死因推断工具相结合，以确定与成人死亡率相关的个体、社区和卫生系统层面的因素。
