Sarimawar, Lamria, Yuana, Suhardi, S.Kosen, C.Rao, T.Adair
NIHRD and Univ. of Queensland
IMRSSP IS AIMED TO DEVELOP THE COD REGISTRATION SYSTEM
USING VA QUESTIONNAIRE FOR DEATH CASES AT HOME
VALIDITY TEST OF SOME PREVALENT DISEASES AS UCOD FROM THE VA QUESTIONNAIRE
THREE GROUPS OF VA: 0-28DAYS, 29DAYS-BELOW 5 YRS, 5 YEARS AND OVER
VA QUESTIONNAIRE USED BY PARAMEDICS AND WELL TRAINED DOCTORS FROM PHC
THE EXPECTED RESULT IS TO FIND OUT WHETHER THE VA QUESTIONNAIRE IS ACCURATE AS AN INSTRUMENT TO DIAGNOSE THE UCOD BASED ON THE RELATED SIGNS AND SYMPTOMS
THE DISEASES TRIALED ARE (18 DISEASES): PERINATAL CONDITIONS, BRONCHOPNEUMONIA, MATERNAL CONDITION, TBC, DIARRHOEA, DENGUE, MALIGNANT NEOPLASM OF GI TRACT, LUNG, BREAST, CERVIX, DM, IHD, HHD/CHF/DC, STROKE, PNEUMONIA, COPD, HEPATIC CIRRHOSIS, INJURY.
N SAMPLE 924 DEATH CASES: 13 HOSPITALS IN JAKARTA AND SOLO
18 PREVALENT DISEASES SELECTED FROM MED RECORD, AND ARE REGARDED OF GOLD STANDARD
THE IMRSSP INTERVIEWERS ASKING THE FAMILY OF THE DECEASED FOR SIGNS & SYMPTOMS USING VA QUESTIONNAIRE
REVIEWERS DETERMINE THE UCOD BASED ON ICD-10
TO DESCRIBE A DIAGNOSTIC TEST IS USED SENSITIVITY & POSITIF PREDICTIVE VALUE (PPV)
SENSITIVITY: PROBABILITY OF X-DISEASE DIAGNOSED BY VA TOOL AMONG X-DISEASE DEATH CASES DIAGNOSED IN THE HOSPITAL (GS); FORMULA a/(a+c)
PPV: THE PROBABILITY OF X-DISEASE DIAGNOSED BY HOSPITAL AS A GOLD STANDARD AMONG X-DISEASE DEATH CASES DIAGNOSE BY VA; FORMULA: a/(a+b)
Gold standard (hospital diagnoses)
X disease Non-X disease Total
Verbal Autopsy based diagnoses
X disease a b a+b
Non-X diseases c d c+d
Total a+c b+d a+b+c+d
OUT OF 924 DEATH CASES FROM MED.RECORD, 464 CASES VISITED & INTERVIEWED COMPLETELY (50.8%)DISTRIBUTION OF
DEATH CASES N (464) PERCENTAGE
< 28 DAYS 35 7.5
29 DAYS-<5 YEARS 24 5.2
5-14 YEARS 14 3.0
15-44 YEARS 73 15.7
45-54 YEARS 74 15.9
55 YEARS AND UP 244 52.6
THE DISEASES W/ HIGH SENSITIVITY (80%+): BRONCHOPNEUMONIA (NEONATAL), CA CERVIX
MEDIUM SENSITIVITY (70-80%): DIARRHOEA, DENGUE, CA OF LUNG, MATERNAL COMPLICATION, INJURY
LOW SENSITIVITY (60-70%): TB, CA OF GI TRACT, CA OF BREAST, STROKE
VERY LOW SENSITIVITY (<60%): DM, IHD, CHF, PNEUMONIA, COPD, CIRRHOSIS HEPATIS.
THE DISEASES W/ HIGH SENSITIVITY AND HIGH PPV ARE:
CONDITIONS IN PERINATAL PERIOD BRONCHOPNEUMONIA IN NEONATAL DENGUE MATERNAL COMPLICATION
HOSPITAL DIAGNOSES NOT FULLY GOLD STANDARD (DIFFICULT TO DETERMINE THE UCOD) E.C. UN CHRONOLOGICAL NARRATIONS, LACK OF DISTINCT INFORMATION ON PREVIOUS SYMPTOMS
THE N OF SAMPLE OF SEVERAL DISEASES ARE TO SMALL
EXTRA CARE SHOULD BE TAKEN WHEN INTERPRETING THE SENSITIVITY AND PPV TEST FOR CERTAIN COD DISEASES WITH ONLY TOO FEW SAMPLES OF CASES (<20)
THE MOH SHOULD DETERMINE THE RULES TO IMPLEMENTATE THE STANDARDIZED MORTALITY RR IN HOSPTAL