# name
Validity of a minimally invasive autopsy for cause of death
                determination in maternal deaths in Mozambique: An observational
                study

# metadata.dc.description.abstract[].value
BACKGROUND: Despite global health efforts to reduce maternal
                mortality, rates continue to be unacceptably high in large parts
                of the world. Feasible, acceptable, and accurate postmortem
                sampling methods could provide the necessary evidence to improve
                the understanding of the real causes of maternal mortality,
                guiding the design of interventions to reduce this burden.
                METHODS AND FINDINGS: The validity of a minimally invasive
                autopsy (MIA) method in determining the cause of death was
                assessed in an observational study in 57 maternal deaths by
                comparing the results of the MIA with those of the gold standard
                (complete diagnostic autopsy [CDA], which includes any available
                clinical information). Concordance between the MIA and the gold
                standard diagnostic categories was assessed by the kappa
                statistic, and the sensitivity, specificity, positive and
                negative predictive values and their 95% confidence intervals
                (95% CI) to identify the categories of diagnoses were estimated.
                The main limitation of the study is that both the MIA and the
                CDA include some degree of subjective interpretation in the
                attribution of cause of death. A cause of death was identified
                in the CDA in 98% (56/57) of cases, with indirect obstetric
                conditions accounting for 32 (56%) deaths and direct obstetric
                complications for 24 (42%) deaths. Nonobstetric infectious
                diseases (22/32, 69%) and obstetric hemorrhage (13/24, 54%) were
                the most common causes of death among indirect and direct
                obstetric conditions, respectively. Thirty-six (63%) women were
                HIV positive, and HIV-related conditions accounted for 16 (28%)
                of all deaths. Cerebral malaria caused 4 (7%) deaths. The MIA
                identified a cause of death in 86% of women. The overall
                concordance of the MIA with the CDA was moderate (kappa = 0.48,
                95% CI: 0.31-0.66). Both methods agreed in 68% of the diagnostic
                categories and the agreement was higher for indirect (91%) than
                for direct obstetric causes (38%). All HIV infections and
                cerebral malaria cases were identified in the MIA. The main
                limitation of the technique is its relatively low performance
                for identifying obstetric causes of death in the absence of
                clinical information. CONCLUSIONS: The MIA procedure could be a
                valuable tool to determine the causes of maternal death,
                especially for indirect obstetric conditions, most of which are
                infectious diseases. The information provided by the MIA could
                help to prioritize interventions to reduce maternal mortality
                and to monitor progress towards achieving global health targets.

# metadata.dc.relation.isformatof[].value
Reproducció del document publicat a:
                http://dx.doi.org/10.1371/journal.pmed.1002431

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Validity of a minimally invasive autopsy for cause of death
                determination in maternal deaths in Mozambique: An observational
                study