Verbal Autopsy, Clinical Records and Minimally Invasive Autopsy: Relevance to the Evaluation of Malaria-Specific Mortality in Endemic Areas

[This text has been written by Jaume Ordi, Research Professor; Natalia Rakislova, Assistant Researcher; and Vima Delgado, Project Manager, at ISGlobal]

Global malaria mortality estimates are hindered by the low reliability of verbal autopsy and clinical records, the main sources used to obtain information on causes of death in low-income countries. We recently conducted a study, published in BMJ Global Health, which aimed to determine the accuracy of these tools. We also assessed the accuracy of minimally invasive autopsy (MIA) —a needle-based postmortem sampling technique developed and validated by ISGlobal to identify malaria-specific mortality in deceased patients from Mozambique—which has been shown to be a viable alternative to complete diagnostic autopsy. We compared the results obtained with verbal autopsy, clinical records and MIA against those of complete diagnostic autopsy, the gold standard for determining cause of death.

Global malaria mortality estimates are hindered by the low reliability of verbal autopsy and clinical records, the main sources used to obtain information on causes of death in low-income countries

Our study was conducted at Maputo Central Hospital (Mozambique), a tertiary-level public hospital that serves as a referral centre for other hospitals in the south of the country. The Maputo urban area has low malaria transmission, although some of the outlying suburbs and surrounding peri-urban and rural areas have moderately stable transmission.

The study found that MIA had high sensitivity and specificity for the identification of malaria-specific deaths, nearly identical to that of complete diagnostic autopsy, the gold standard. However, verbal autopsy and clinical records had serious limitations in recognising malaria infection as cause of death in an endemic setting.

The study found that MIA had high sensitivity and specificity for the identification of malaria-specific deaths, nearly identical to that of complete diagnostic autopsy, the gold standard

MIA, implemented in selected surveillance sites, could be used to help medical personnel reduce clinical diagnostic errors, improve the quality and performance of current verbal autopsy tools, mathematically modulate the data provided by verbal autopsy and ultimately improve disease-specific statistics.

More information

Read the full study here:

Rakislova N, Jordao D, Ismail MR, et al. Accuracy of verbal autopsy, clinical data and minimally invasive autopsy in the evaluation of malaria-specific mortality: an observational study. BMJ Global Health 2021;6:e005218.