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...disposant registres incomplets. Dans certaines regions du monde, c'est meme la seule methode disponible pour obtenir des estimations de la distribution par causes des deces. Actuellement, l'autopsie verbale est couramment utilisee sur plus de 35 sites, principalement en Afrique et en Asie. Le present article expose brievement les procedures d'autopsie verbale et les resultats d'un bilan des outils d'autopsie verbale et des procedures operatoires utilises sur les sites de surveillance demographique et par les systemes d'enregistrement par sondage des faits d'etat civil. Il a ete demande a 36 sites de terrain de fournir des informations sur les procedures operatoires qu'ils appliquent : 18 questionnaires d'autopsie verbale et 10 listes de causes de deces utilises dans 13 pays ont ainsi ete examines. Le format et le contenu des questionnaires pour AV, des procedures operatoires de terrain, des listes de causes de deces et des procedures employees pour extraire les causes de deces des AV varient de maniere importante d'un site a I'autre. L'article analyse les consequences de I'application de methodes differentes et conclut a la necessite de definir des outils et des procedures d'autopsie verbale standards et fiables pour permettre des comparaisons precises aux niveaux national et international des donnees d'AV. L'etude attire aussi l'attention sur les etapes necessaires dans l'avenir au developpement d'une procedure d'autopsie verbale standard.
Resumen
Los datos sobre causas de defuncion obtenidos a partir de autopsias verbales (AV) son usados con creciente frecuencia con fines de planificacion de la salud, establecimiento de prioridades, seguimiento y evaluacion en los paises con sistemas de registro civil incompletos o inexistentes. En algunas regiones del mundo es el unico metodo disponible para poder estimar la distribucion de las causas de mortalidad. Hoy dia el metodo de las AV se utiliza sistematicamente en mas de 35 lugares, sobre todo en Africa y Asia. En este articulo presentamos un panorama general del sistema de las AV y los resultados de un analisis de los instrumentos de AV y los procedimientos operativos utilizados en los sitios de vigilancia demografica y los sistemas de registro de estadisticas vitales por muestreo. Solicitamos informacion a 36 sitios sobre el terreno acerca de los procedimientos operativos y examinamos 18 cuestionarios de autopsia verbal y 10 listas de causas de defuncion usadas en 13 paises. El formato y el contenido de los cuestionarios de AV, los procedimientos operativos sobre el terreno, las listas de las causas de defuncion y los procedimientos empleados para calcular las causas de mortalidad a partir de las AV diferian sustancialmente de un sitio a otro. Analizamos las consecuencias de utilizar distintos metodos y llegamos a la conclusion de que es necesario normalizar los instrumentos y los procedimientos de AV y hacerlos mas fiables si se desea hacer comparaciones mas precisas de los datos de AV en los planos nacional e internacional. Ponemos de relieve, ademas, las medidas adicionales que habria que adoptar para desarrollar un procedimiento de AV normalizado.
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Mots cles Autopsie/methodes; Entretien/methodes; Questionnaires; Cause deces; Pays en developpement (source: MeSH, INSERM).
Palabras clave Autopsia/metodos; Entrevistas/metodos; Cuestionarios; Causa de muerte; Paises en desarrollo (fuente: DeCS, BIREME).
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Introduction
Knowledge about the distribution of causes of death in populations is essential for public health planning, resource allocation and measuring the impact of interventions. However, particularly in high mortality settings, vital registration data are often missing, incomplete or inaccurate. Medically-certified cause-of-death data are available only for less than one-third of over 57 million deaths occurring worldwide annually. (1) Rapid improvement of poorly performing vital registration systems in many countries is not realistic. Although attaining good quality vital registration data should be a long-term goal, alternative methods of ascertaining and estimating cause-of-death distributions at the population level must be used in the interim.
Verbal autopsy (VA) has been widely used as a method of ascertaining causes of death in children in places where the majority of deaths occur without medical supervision. (2) There has been a growing interest in the use of VA in the context of disease surveillance and sample registration systems, particularly for causes of death in adults. (3) VA is an indirect method of ascertaining biomedical causes of death from information on symptoms, signs and circumstances preceding death, obtained from the deceased's caretakers. VA has been used not only to gather data on the cause-of-death structure of certain populations, but also in investigations of infectious disease outbreaks and risk factors for certain diseases, and in measuring the effect of public health interventions. (4-6) Currently, over 35 Demographic Surveillance Sites (DSS) in 18 countries, the Sample Registration System (SRS) sites in India, and the Disease Surveillance Points (DSP) system in China regularly use VA on a large scale, primarily to assess the cause-of-death structure of a defined population. (7-9)
A standard VA tool comprises a VA questionnaire, cause-of-death or mortality classification system, and diagnostic criteria (either expert or data-derived algorithms) for deriving causes of death. The VA process has several stages, and many factors can influence the cause-specific mortality fractions estimated through this process (Fig. 1). Although attempts have been made to standardize VA tools and procedures,...
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