A comparison of physicians and medical assistants in interpreting verbal autopsy interviews for allocating cause of neonatal death in Matlab, Bangladesh: can medical assistants be considered an alternative to physicians?

Hafizur R Chowdhury,Mohammed Yunus,Mohammed Ali,Nurul Alam,Peter K Streatfield,Sandra C Thompson

doi:10.1186/1478-7954-8-23

Abstract

ObjectiveThis study assessed the agreement between medical physicians in their interpretation of verbal autopsy (VA) interview data for identifying causes of neonatal deaths in rural Bangladesh.MethodsThe study was carried out in Matlab, a rural sub-district in eastern Bangladesh. Trained persons conducted the VA interview with the mother or another family member at the home of the deceased. Three physicians and a medical assistant independently reviewed the VA interviews to assign causes of death using the International Classification of Diseases - Tenth Revision (ICD-10) codes. A physician assigned cause was decided when at least two physicians agreed on a cause of death. Cause-specific mortality fraction (CSMF), kappa (k) statistic, sensitivity, specificity, and positive predictive values were applied to compare agreement between the reviewers.ResultsOf the 365 neonatal deaths reviewed, agreement on a direct cause of death was reached by at least two physicians in 339 (93%) of cases. Physician and medical assistant reviews of causes of death demonstrated the following levels of diagnostic agreement for the main causes of deaths: for birth asphyxia the sensitivity was 84%, specificity 93%, and kappa 0.77. For prematurity/low birth weight, the sensitivity, specificity, and kappa statistics were, respectively, 53%, 96%, and 0.55, for sepsis/meningitis they were 48%, 98%, and 0.53, and for pneumonia they were 75%, 94%, and 0.51.ConclusionThis study revealed a moderate to strong agreement between physician- assigned and medical assistant- assigned major causes of neonatal death. A well-trained medical assistant could be considered an alternative for assigning major causes of neonatal deaths in rural Bangladesh and in similar settings where physicians are scarce and their time costs more. A validation study with medically confirmed diagnosis will improve the performance of VA for assigning cause of neonatal death.

Highlights

Accurate information on cause of death in communities is important for effective planning and evaluation of various health care interventions [1,2]
This paper reports the diagnostic agreement between medical assistants and physicians in assigning cause of death by reviewing verbal autopsy (VA) interview data in the Matlab Health and Demographic Surveillance System (HDSS) during the period 2003-2004 [19]
Inter-rater variation, the medical assistant (MA) versus each individual physician, is an important criterion for judging the quality of the method for assigning cause of death, and Table 1 shows the variation among the physicians

Summary

Introduction

Accurate information on cause of death in communities is important for effective planning and evaluation of various health care interventions [1,2]. As the great majority of births and neonatal deaths in developing countries occur at home outside the formal health care setting, it is difficult to ascertain the cause of death. In such situations, verbal autopsy (VA) can be a valuable, low-cost and practical tool to ascertain cause of death. The VA methodology utilizes retrospective information collected during interviews with care givers or family members about the symptoms, signs, care seeking and other events related to the deceased and their illness or circumstances prior to death [7,8]. The method used to assign cause of death from the information obtained by VA should be appropriate, valid, reliable and inexpensive

Methods

Results

Discussion

Conclusion