ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain.
BMJ Glob Health. 2021 Jun;6(6). doi: 10.1136/bmjgh-2021-005218.
Global malaria mortality estimates are hindered by the low reliability of the verbal autopsy (VA) and the clinical records, the most common sources of information used to estimate malaria-specific mortality. We aimed to determine the accuracy of these tools, as well as of the minimally invasive autopsy (MIA), a needle-based postmortem sampling method, to identify malaria-specific mortality in a large series of deceased patients from Mozambique, using complete autopsy as the gold standard.
Observational study that included 264 deaths, occurring at a tertiary level hospital in Mozambique, from 1 November 2013 to 31 March 2015 (17 months-long period). Clinical data were abstracted, a computer coded VA was completed using the clinical data as source of information, and an MIA followed by a complete autopsy were performed. Screening for malaria infection was conducted postmortem to all participants using molecular and histological techniques (PCR and immunohistochemistry).
Malaria infection was considered the cause of death in 6/264 (2.3%) cases: 2/54 children (3.7%, both less than 5 years old) and 4/57 (7.0%) maternal deaths. The sensitivity and specificity of the VA, the clinical data and the MIA to identify malaria-specific deaths were 33.3% and 96.1%, 66.7% and 96.1%, and 100% and 100%, respectively. In addition, malaria was identified as a possible contributor in 14 additional patients who died of other diseases. These cases were also accurately identified by the MIA (sensitivity 82.4%, specificity 100%).
The high sensitivity and specificity of the MIA in identifying malaria may help to improve current estimates of malaria-specific mortality in endemic areas.
全球疟疾死亡率的估计受到口头尸检（VA）和临床记录可靠性低的影响，这是最常用的估计疟疾特异性死亡率的信息来源。我们旨在确定这些工具的准确性，以及微创尸体解剖（MIA）的准确性，这是一种基于针的死后采样方法，以确定莫桑比克大量死亡患者的疟疾特异性死亡率，使用完整的尸检作为金标准。
这是一项观察性研究，包括 264 例死亡病例，发生在莫桑比克的一家三级医院，时间为 2013 年 11 月 1 日至 2015 年 3 月 31 日（17 个月）。从临床数据中提取信息，使用临床数据作为信息来源编写计算机编码的 VA，并进行 MIA 后进行完整的尸检。对所有参与者进行死后疟疾感染筛查，使用分子和组织学技术（PCR 和免疫组织化学）。
疟疾感染被认为是 264 例死亡中的 6 例（2.3%）的死亡原因：2 例（3.7%，均小于 5 岁）儿童和 4 例（7.0%）孕产妇死亡。VA、临床数据和 MIA 识别疟疾特异性死亡的敏感性和特异性分别为 33.3%和 96.1%、66.7%和 96.1%以及 100%和 100%。此外，14 例死于其他疾病的患者也被确定为疟疾的可能原因。这些病例也被 MIA 准确识别（敏感性 82.4%，特异性 100%）。
MIA 识别疟疾的高敏感性和特异性可能有助于提高疟疾流行地区疟疾特异性死亡率的当前估计。
