A comparison of physicians and medical assistants in interpreting verbal autopsy interviews for allocating cause of neonatal death in Matlab, Bangladesh: can medical assistants be considered an alternative to physicians?

Population Health Metrics

Research

Mohammed Ali¹  Sandra C Thompson²  Hafizur R Chowdhury³  Nurul Alam⁴  Peter K Streatfield⁴  Mohammed Yunus⁵ 

[1] Centre for International Health, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, 6845, Perth, Western Australia, Australia;Centre for International Health, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, 6845, Perth, Western Australia, Australia;Combined Universities Centre for Rural Health, University of Western Australia, 109, Geraldton, Western Australia, USA;Centre for International Health, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, 6845, Perth, Western Australia, Australia;Matlab Health Research Centre, International Centre for Diarrhoeal Disease, Research, Bangladesh (ICDDR,B), 128, Dhaka, Bangladesh;Health and Demographic Surveillance Unit, Public Health Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh, 128, Dhaka, Bangladesh;Public Health Sciences Division, International Centre for Diarrhoeal Disease, Research, Bangladesh (ICDDR,B), 128, Dhaka, Bangladesh;

关键词: Neonatal Death;    Medical Assistant;    Verbal Autopsy;    Individual Physician;    Birth Asphyxia;   

DOI  :  10.1186/1478-7954-8-23

 received in 2010-02-02, accepted in 2010-08-17,  发布年份 2010

来源: Springer

【 摘 要 】

ObjectiveThis study assessed the agreement between medical physicians in their interpretation of verbal autopsy (VA) interview data for identifying causes of neonatal deaths in rural Bangladesh.MethodsThe study was carried out in Matlab, a rural sub-district in eastern Bangladesh. Trained persons conducted the VA interview with the mother or another family member at the home of the deceased. Three physicians and a medical assistant independently reviewed the VA interviews to assign causes of death using the International Classification of Diseases - Tenth Revision (ICD-10) codes. A physician assigned cause was decided when at least two physicians agreed on a cause of death. Cause-specific mortality fraction (CSMF), kappa (k) statistic, sensitivity, specificity, and positive predictive values were applied to compare agreement between the reviewers.ResultsOf the 365 neonatal deaths reviewed, agreement on a direct cause of death was reached by at least two physicians in 339 (93%) of cases. Physician and medical assistant reviews of causes of death demonstrated the following levels of diagnostic agreement for the main causes of deaths: for birth asphyxia the sensitivity was 84%, specificity 93%, and kappa 0.77. For prematurity/low birth weight, the sensitivity, specificity, and kappa statistics were, respectively, 53%, 96%, and 0.55, for sepsis/meningitis they were 48%, 98%, and 0.53, and for pneumonia they were 75%, 94%, and 0.51.ConclusionThis study revealed a moderate to strong agreement between physician- assigned and medical assistant- assigned major causes of neonatal death. A well-trained medical assistant could be considered an alternative for assigning major causes of neonatal deaths in rural Bangladesh and in similar settings where physicians are scarce and their time costs more. A validation study with medically confirmed diagnosis will improve the performance of VA for assigning cause of neonatal death.

【 授权许可】

CC BY   
© Chowdhury et al; licensee BioMed Central Ltd. 2010