Minimally invasive autopsy (MIA) can identify cause of death in pediatric, perinatal and neonatal deaths in Mozambique with significant precision and accuracy compared with complete diagnostic autopsy (CDA), according to two studies published by Clara Menéndez, Quique Bassat and colleagues from ISGlobal, Barcelona, Spain, in PLOS Medicine.
In the first study, the researchers compared cause of death determination from MIA and CDA in 18 stillbirths and 41 neonatal deaths. A cause of death was identified in 16/18 (89%) and 15/18 (83%) of stillborn babies and in all (100%) and 35/41 (85%) neonatal deaths in the CDA and the MIA, respectively. Causes of death identified for stillborn babies included fetal growth restriction (39%), infectious diseases (22%), intrapartum hypoxia (17%), and intrauterine hypoxia (11%), with the MIA showing substantial agreement with the CDA for categorization of disease (Kappa = 0.78, 95% CI [0.56-0.99]). For neonates, the majority of deaths were due to infectious diseases (66%) and the overall agreement of the MIA with the CDA for categorization of disease was moderate (Kappa = 0.40, 95% CI [0.18-0.63]).
In the second study, the researchers compared findings from MIA and CDA for 54 deaths in children <15 years of age. A cause of death was identified in all cases in the CDA and in 52/54 (96%) of the cases in the MIA, with infections (78%) and malignant tumors (13%) accounting for the majority of diagnoses. The MIA categorization of disease showed a substantial agreement with the CDA categorization (Kappa = 0.70, 95% CI 0.49-0.92).
The authors say: "Reliable estimates of the causes of stillbirths and neonatal and child mortality can help policy makers design and implement better and more evidence-based preventive strategies to improve child survival in high-burden low-income settings."
These two studies are part of an ongoing series of articles examining the validity of MIA in different populations. More articles about MIA can be found on the PLOS Minimally Invasive Autopsy collection page.
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Research Article
Funding:
The CaDMIA research project (Validation of the minimally invasive autopsy tool for cause of death investigation in developing countries) was funded by the Bill & Melinda Gates Foundation (Global Health grant numbers OPP1067522; QB) (http://www.gatesfoundation.org/) and by the Spanish Instituto de Salud Carlos III (FIS, PI12/00757; CM) (https://portalfis.isciii.es). Data analysis has been supported by the CaDMIA plus research project, funded by the Bill & Melinda Gates Foundation (Global health grant numbers OPP1128001; JO) (http://www.gatesfoundation.org/) and the Spanish Instituto de Salud Carlos III (Acciones CIBER; CM) (http://www.ciberisciii.es/). ISGlobal is included in the CERCA Programme / Generalitat de Catalunya (http://cerca.cat/en/suma/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests:
CM is a member of the Editorial Board of PLOS Medicine.
Citation:
Bassat Q, Castillo P, Martínez MJ, Jordao D, Lovane L, Hurtado JC, et al. (2017) Validity of a minimally invasive autopsy tool for cause of death determination in pediatric deaths in Mozambique: An observational study. PLoS Med 14(6): e1002317. https://doi.org/10.1371/journal.pmed.1002317
Author Affiliations:
ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
Centro de Investigacão em Saúde de Manhiça, Maputo, Mozambique
Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002317
Research Article
Funding:
The CaDMIA research project (Validation of the minimally invasive autopsy tool for cause of death investigation in developing countries) was funded by the Bill & Melinda Gates Foundation (Global Health grant numbers OPP1067522; QB) (http://www.gatesfoundation.org/) and by the Spanish Instituto de Salud Carlos III (FIS, PI12/00757; CM) (https://portalfis.isciii.es). Data analysis has been supported by the CaDMIA plus research project, funded by the Bill & Melinda Gates Foundation (Global health grant numbers OPP1128001; JO) (http://www.gatesfoundation.org/) and the Spanish Instituto de Salud Carlos III (Acciones CIBER; CM) (http://www.ciberisciii.es/). ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya (http://cerca.cat/en/suma/). No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests:
CM is a member of the Editorial Board of PLOS Medicine.
Citation:
Menéndez C, Castillo P, Martínez MJ, Jordao D, Lovane L, Ismail MR, et al. (2017) Validity of a minimally invasive autopsy for cause-of-death determination in stillborn babies and neonates in Mozambique: An observational study. PLoS Med 14(6): e1002318. https://doi.org/10.1371/journal.pmed.1002318
Author Affiliations:
ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
Centro de Investigacão em Saúde de Manhiça, Maputo, Mozambique
Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Spain
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
Department of Maternal-Fetal Medicine, BCNatal, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
Department of Molecular Microbiology, University Hospital Sant Joan de Déu, Barcelona, Spain
Faculty of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002318
Journal
PLoS Medicine