The utility of verbal autopsies for identifying HIV-1-related deaths in Haitian children.

Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.

The utility of verbal autopsies for identifying HIV-1-related deaths in Haitian children.

AIDS. 1993 Sep;7(9):1255-9. Unique Identifier : AIDSLINE MED/94030758
Dowell SF; Davis HL; Holt EA; Ruff AJ; Kissinger PJ; Bijoux J; Boulos R; Boulos C; Halsey NA; Department of International Health, Johns Hopkins School of; Hygiene and Public Health, Baltimore, Maryland 21205.

Abstract: OBJECTIVE: To determine whether deaths among Haitian infants born to HIV-1-seronegative women could be distinguished from deaths among children born to HIV-1-seropositive women using the verbal autopsy technique. METHODS: Mothers of 315 Haitian children who died were interviewed about events leading to the child's death. Three physicians independently reviewed interview data and determined the probable cause of death without knowledge of maternal HIV-1 status or hospital records. The underlying causes of death assigned to the infants were analyzed to determine whether maternal HIV status could be predicted. RESULTS: There was good agreement among the physicians (kappa = 0.62) and 90% agreement between hospital records and the verbal autopsy diagnosis. Compared with children born to HIV-1-seronegative women, deaths in children born to HIV-1-seropositive mothers were more likely to be ascribed to a presumptive diagnosis of AIDS (37 versus 21%; P = 0.01). The sensitivity and specificity of verbal autopsies for identifying deaths associated with maternal HIV-1 infection ranged from 37 to 59% and from 69 to 79%, respectively, depending on the classification system used. The predictive positive value of a death believed to be consistent with pediatric HIV-1 infection was 26-30% and the predictive negative value was 85-90%. CONCLUSION: Verbal autopsies may be useful for distinguishing certain causes of death, but have limited utility for distinguishing deaths associated with maternal HIV-1 infection from deaths among children born to HIV-1-seronegative women.

Keywords: Acquired Immunodeficiency Syndrome/*MORTALITY/PATHOLOGY Autopsy/METHODS Cause of Death Child, Preschool Female Haiti/EPIDEMIOLOGY Human HIV Seropositivity Infant Pregnancy Pregnancy Complications, Infectious/EPIDEMIOLOGY Sensitivity and Specificity Support, U.S. Gov't, P.H.S. JOURNAL ARTICLE
940228
M9420763

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