Share This Article:

Accuracy of Physicians in Diagnosing HIV and AIDS-Related Death in the Adult Population of Addis Ababa, Ethiopia

Abstract Full-Text HTML Download Download as PDF (Size:250KB) PP. 89-96
DOI: 10.4236/wja.2012.22012    3,399 Downloads   5,758 Views   Citations


Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur at home. Objective: To evaluate the accuracy of physician reviewers of verbal autopsies in diagnosing HIV and AIDS-related deaths in the adult population of Addis Ababa, the capital of Ethiopia. Methods: This study was done within the context of a burial surveillance system in Addis Ababa. Trained interviewers completed a standard verbal autopsy questionnaire and an independent panel of physicians reviewed the completed form to assign cause of death. Physicians' review was compared to a reference standard constructed based on prospectively collected HIV-serostatus and patients' hospital record. Sensitivity and specificity were calculated to validate the physicians' verbal autopsy diagnoses against reference standards. Results: Physicians accurately identified AIDS-related deaths with sensitivity and specificity of 0.88 (95% CI: 0.80 - 0.93) and 0.77 (95% CI: 0.64 - 0.87), respectively. Generally, there was high level of agreement (Cohen's Kappa Statistic (K > 0.6) between the first two physicians with some yearly variations. In 2008 and 2009 there was an almost perfect agreement (K > 0.80). Conclusion: This study demonstrated the agreement level between two independent physicians in diagnosing AIDS-related death is very high and thus using a single verbal autopsy coder is practical for programmatic purposes in countries where there is critical shortage of doctors.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

T. Araya, B. Tensou, G. Davey and Y. Berhane, "Accuracy of Physicians in Diagnosing HIV and AIDS-Related Death in the Adult Population of Addis Ababa, Ethiopia," World Journal of AIDS, Vol. 2 No. 2, 2012, pp. 89-96. doi: 10.4236/wja.2012.22012.


[1] A. D. Lopez, O. Ahmad, M. Guillot, B. D. Ferguson, J. Salomon, C. J. L. Murray and K. H. Hill, “World Mortality in 2000: Life Tables for 191 Countries,” World Health Organization, Geneva, 2002.
[2] P. W. Setel, B. M. Sarah, S. Simon, M. Lene, J. D. Prabhat, S. Susan and A. Carla, “A Scandal of Invisibility. Making Everyone Count by Counting Everyone,” The Lancet, Vol. 370, No. 9598, 2007, pp. 1526-1537. doi:10.1016/S0140-6736(07)61307-5
[3] C. J. L. Murray, A. D. Lopez, “The Global Burden of Disease,” The Harvard School of Public Health on Behalf of the World Health Organization and the World Bank, Boston, 1996.
[4] C. D. Mathers, F. Ma, M. Inoue, C. Rao and A. D. Lopez, “Counting the Dead and What They Died of: An Assessment of the Global Status of Cause of Death Data,” Bulletin of the World Health Organization, Vol. 83, No. 3, 2005, pp. 171-177.
[5] K. Kahn, S. M. Tollman, M. Garenne and J. S. Gear, “Validation and Application of Verbal Autopsies in a Rural Area of South Africa,” Tropical Medicine and International Health, Vol. 5, No. 11, 2000, pp. 824-831.
[6] A. D. Lopez, “Cause of Death: Assessment of Global Pattern of Mortality around 1985,” World Health Statistics Quarterly, Vol. 43, No. 2, 1990, pp. 91-104.
[7] A. M. Sibai, “Mortality Certification and Cause-of-Death Reporting in Developing Countries,” Bulletin of the World Health Organization, Vol. 82, No. 2, 2004, p. 83.
[8] P. Byass, “Who needs cause-of-death data?” PLoS Medicine, Vol. 4, No. 11, 2007, p. e333. doi:10.1371/journal.pmed.0040333
[9] D. Chandramohan, G. H. Maude, L. C. Rodrigues and R. J. Hayes, “Verbal Autopsies for Adult Deaths: Issues in Their Development and Validation,” International Journal of Epidemiology,” Vol. 23, No. 2, 1994, pp. 213-222. doi:10.1093/ije/23.2.213
[10] N. Soleman, D. Chandramohan and K. Shibuya, “Verbal Autopsy: Current Practices and Challenges,” Bulletin of the World Health Organization, Vol. 84, No. 3, 2006, pp. 239-245. doi:10.2471/BLT.05.027003
[11] E. Fottrell and P. Byass, “Verbal Autopsy: Methods in Transition,” Epidemiologic Reviews, Vol. 32, No. 1, 2010, pp. 38-55. doi:10.1093/epirev/mxq003
[12] M. A. Quigley, D. Chandramohan and L. C. Rodrigues, “Diagnostic Accuracy of Physician Review, Expert Algorithms and Data-Derived Algorithms in Adult Verbal Autopsies,” International Journal of Epidemiology, Vol. 28, No. 6, 1999, pp. 1081-1087. doi:10.1093/ije/28.6.1081
[13] P. W. Setel, O. Sankoh, C. Rao, V. A. Velkoff, C. Mathers, Y. Gonghuan, Y. Hemed, P. Jha and A. D. Lopez, “Sample Registration of Vital Events with verbal Autopsy: A Renewed Commitment to Measuring and Monitoring Vital Statistics,” Bulletin of the World Health Organization, Vol. 83, No. 8, 2005, pp. 611-617.
[14] B. Lopman, B. Lopman, A. Cook, J. Smith, G. Chawira, M. Urassa, Y. Kumogola, R Isingo, C. Ihekweazu, J. Ruwende, M. N. Dege, S. Gregson, B. Zaba and J. T. Boerma,” Verbal Autopsy Can Consistently Measure AIDS Mortality: A Validation Study in Tanzania and Zimbabwe,” Journal of Epidemiology and Community Health, Vol. 64, No. 4, 2009, pp. 330-334. doi:10.1136/jech.2008.081554
[15] P. W. Setel, D. R. Whiting, Y. Hemed, D. Chandramohan, L. J. Wolfson, K. G. Alberti and A. D. Lopez, “Validity of Verbal Autopsy Procedures for Determining Cause of Death in Tanzania,” Tropical Medicine and International Health, Vol. 11, No. 5, 2006, pp. 681-696. doi:10.1111/j.1365-3156.2006.01603.x
[16] R. Joshi, A. D. Lopez, S. MacMahon, S. Reddy, R. Dandona, L. Dandona and B. Neal, “Verbal Autopsy Coding: Are Multiple Coders Better than One?” Bulletin of the World Health Organization, Vol. 87, No. 1, 2009, pp. 51-57. doi:10.2471/BLT.08.051250
[17] G. Reniers, T. Araya, G. Davey, N. Nagelkerke, Y. Berhane, R. A. Coutinho and E. J. Sanders, “Steep Declines in AIDS Mortality following the Introduction of Antiretroviral Therapy in Addis Ababa, Ethiopia,” AIDS, Vol. 23, No. 4, 2009, pp. 511-518. doi:10.1097/QAD.0b013e32832403d0
[18] E. J. Sanders, T. Araya, D. Kebede, A. J. Schaap, N. D. Nagelkerke and R. A. Coutinho, “Mortality Impact of AIDS in Addis Ababa, Ethiopia,” AIDS, Vol. 17, No. 8, 2003, pp. 1209-1216. doi:10.1097/00002030-200305230-00013
[19] T. Araya, B. Tensou, G. Davey and Y. Berhane, “Burial Surveillance Detected Significant Reduction in HIV-Related Deaths in Addis Ababa, Ethiopia,” Tropical Medicine and International Health, Vol. 16, No. 12, 2011, pp. 1483-1489. doi:10.1111/j.1365-3156.2011.02867.x
[20] A. Pankhurst and D. Hailemariam, “The Iddir in Ethiopia: Historical Development, Social Function, and Potential Role in HIV/AIDS Prevention and Control,” Northeast African Studies, (ISSN 0740-9133), Vol. 7, No. 2, 2000, pp. 35-58.
[21] D. Hailemariam, “Indigenous Social Insurance as an Alternative Financing Mechanism for Health Care in Ethiopia (the Case of Eders),” Social Science and Medicine, Vol. 56, No. 8, 2003, pp. 1719-1726. doi:10.1016/S0277-9536(02)00166-1
[22] INDEPTH Network, “Standardized VA Questionnaire,” 2009.
[23] WHO, “International Statistical Classification of Diseases and Related Health Problems. Version 10,” World Health Organization, Geneva, 1993.
[24] J. R. Landis and G. G. Koch, “The Measurement of Observer Agreement for Categorical Data,” Biometrics, Vol. 33, No. 1, 1977, pp. 159-174.
[25] K. Lulu and Y. Berhane, “The Use of Simplified Verbal Autopsy in Identifying Causes of Adult Death in a Predominantly Rural Population in Ethiopia”, BMC Public Health, Vol. 5, 2005, p. 58. doi:10.1186/1471-2458-5-58
[26] H. D. Kalter, R. H. Gray, R. E. Black and S. A. Gultian, “Validation of Postmortem Interviews to Ascertain Selected Causes of Death in Children,” International Journal of Epidemiology, Vol. 19, No. 2, 1990, pp. 380-386. doi:10.1093/ije/19.2.380
[27] D. Chandramohan, G. H. Maude, L. C. Rodrigues and R. J. Hayes, “Verbal Autopsies for Adult Deaths: Their Development and Validation in a Multicentre Study,” Tropical Medicine and International Health, Vol. 3, No. 6, 1998, pp. 436-446. doi:10.1046/j.1365-3156.1998.00255.x
[28] D. R. Marsh, S. Sadruddin, F. F. Fikree, C. Krishnan and G. L. Dramstadt, “Validation of Verbal Autopsy to Determine the Cause of 137 Neonatal Deaths in Karachi, Pakistan,” Paediatric Perinatal Epidemiology, Vol. 17, No. 2, 2003, pp. 132-142. doi:10.1046/j.1365-3016.2003.00475.x
[29] C. C. Mobley, J. T. Boerma, S. Titus, B. Lohrke, K. Shangula and R. E. Black, “Validation Study of a Verbal Autopsy Method for Causes of Childhood Mortality in Namibia,” Journal of Tropical Pediatrics, Vol. 42, No. 6, 1996, pp. 365-369. doi:10.1093/tropej/42.6.365
[30] C. Coldham, D. Ross, M. Quigly, Z. Segura and D. Chandramohan, “Prospective Validation of a Standardized Questionnaire for Estimating Childhood Mortality and Morbidity Due to Pneumonia and Diarrhoea,” Tropical Medicine and International Health, Vol. 5, No. 2, 2000, pp.134-144. doi:10.1046/j.1365-3156.2000.00505.x
[31] J. Lawn, K. Shibuya and C. Stein, “No Cry at Birth: Global Estimates of Intrapartum Stillbirths and Intrapartum-Related Neonatal Deaths,” Bulletin of the World Health Organization, Vol. 83, No. 6, 2005, pp. 409-417.
[32] M. Anker, “The Effect of Misclassification Error on Reported Cause-Specific Mortality Fractions from Verbal Autopsy,” International Journal of Epidemiology, Vol. 26, No. 5, 1997, pp. 1090-1096. doi:10.1093/ije/26.5.1090
[33] Central Statistical Agency. Ethiopia Population Census Commission, “Summary and Statistical Report of the 2007, Population and Housing Census of Ethiopia. Population Size by Age and Sex,” Addis Ababa, 2008, p. 13.
[34] Central Statistical Agency, Ethiopia and ICF International Calverton, “Ethiopia Demographic and Health Survey, 2011,” Addis Ababa, Calverton, 2012.

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.