Classifying perinatal mortality using verbal autopsy: is there a role for nonphysicians?

Engmann, Cyril; Ditekemena, John; Jehan, Imtiaz; Garces, Ana; Phiri, Mutinta; Thorsten, Vanessa; Mazariegos, Manolo; Chomba, Elwyn; Pasha, Omrana; Tshefu, Antoinette; McClure, Elizabeth M; Wallace, Dennis; Goldenberg, Robert L; Carlo, Waldemar A; Wright, Linda L; Bose, Carl

doi:10.1186/1478-7954-9-42

Population Health Metrics

Table 4 Comparison of maternal underlying cause reported by physician consensus (PC) to underlying cause reported by community coordinator (CC) for select causes of stillbirth (n = 134)

From: Classifying perinatal mortality using verbal autopsy: is there a role for nonphysicians?

Underlying COD, as determined by CC	Underlying COD, as determined by PC (reference standard)		Measures²
	Identified as COD	Not identified as COD	SE	SP	PPV	NPV	CSMF_PC (95% CI)	1-CSMF_PC	CSMF_CC (95% CI)	1-CSMF_CC	RD (95% CI)	Kappa (95% CI)
Antepartum hemorrhage	13	121	0.62	0.98	0.80	0.96	0.10 (0.04, 0.15)	0.90	0.07 (0.03, 0.12)	0.93	0.23 (0.00,0.57)	0.67 (0.44,0.9)
COD	8 (61.5)	2 (1.7)
Not COD	5 (38.5)	119 (98.3)
Maternal infection	50	84	0.64	0.94	0.86	0.81	0.37 (0.25, 0.50)	0.63	0.28 (0.17, 0.38)	0.72	0.26 (0.87,0.42)	0.62 (0.47,0.75)
COD	32 (64.0)	5 (6.0)
Not COD	18 (36.0)	79 (94.0)
Prematurity	9	125	0.44	0.86	0.19	0.96	0.07 (0.02, 0.11)	0.93	0.16 (0.08, 0.23)	0.84	1.33 (0.24,4.40)	0.19 (-0.02,0.4)
COD	4 (44.4)	17 (13.6)
Not COD	5 (55.6)	108 (86.4)
Maternal accident	7	127	0.57	0.99	0.80	0.98	0.05 (0.01, 0.09)	0.95	0.04 (0.00, 0.07)	0.96	0.29 (0.00,0.80)	0.65 (0.33,0.97)
COD	4 (57.1)	1 (0.8)
Not COD	3 (42.9)	126 (99.2)
Prolonged labor	15	119	0.53	0.98	0.80	0.94	0.11 (0.05, 0.17)	0.89	0.07 (0.03, 0.12)	0.93	0.33 (0.00,0.64)	0.6 (0.37,0.84)
COD	8 (53.3)	2 (1.7)
Not COD	7 (46.7)	117 (98.3)
Cord prolapse/complication	8	126	0.50	0.96	0.44	0.97	0.06 (0.02, 0.10)	0.94	0.07 (0.02, 0.11)	0.93	0.13 (0.00,1.67)	0.43 (0.13,0.74)
COD	4 (50.0)	5 (4.0)
Not COD	4 (50.0)	121 (96.0)
Malpresentation	4	130	0.50	0.98	0.40	0.98	0.03 (0.00, 0.06)	0.97	0.04 (0.00, 0.07)	0.96	0.25 (0.00,3.00)	0.42 (0.01,0.84)
COD	2 (50.0)	3 (2.3)
Not COD	2 (50.0)	127 (97.7)
Unknown/no cause	16	118	0.69	0.86	0.41	0.95	0.12 (0.06, 0.18)	0.88	0.20 (0.12, 0.29)	0.80	0.69 (0.12,1.83)	0.43 (0.23,0.62)
COD	11 (68.8)	16 (13.6)
Not COD	5 (31.3)	102 (86.4)
Other¹	12	122	0.25	0.94	0.30	0.93	0.09 (0.04, 0.14)	0.91	0.07 (0.03, 0.12)	0.93	0.17 (0.00,0.82)	0.21 0.05,0.47)
COD	3 (25.0)	7 (5.7)
Not COD	9 (75.0)	115 (94.3)

¹ Other includes multiple delivery, hypertension/eclampsia, post-term delivery, and other causes.
² Definitions of measures are provided in the methods section. Measures are as follows: sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), cause-specific mortality fraction (CSMF) of physician consensus (PC) and community coordinator (CC), and absolute relative difference of CSMF (RD). RD was calculated using the actual numeric values rather than the rounded CSMFs reported in the table.

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ISSN: 1478-7954

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