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)

Verbal Autopsy based diagnoses X disease Non-X diseases Total Gold standard (hospital diagnoses) X disease Non-X disease Total a c a+c b d b+d a+b c+d a+b+c+d

 OUT OF 924 DEATH CASES FROM MED.RECORD, 464 CASES VISITED & INTERVIEWED COMPLETELY (50.8%) DISTRIBUTION OF DEATH CASES < 28 DAYS 29 DAYS-<5 YEARS 5-14 YEARS 15-44 YEARS 45-54 YEARS N (464) 35 24 14 73 74 PERCENTAGE 7.5

5.2

3.0

15.7

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