Sarimawar, Lamria, Yuana, Suhardi, S.Kosen, C.Rao, T.Adair NIHRD and Univ. of Queensland.

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