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

Tekebash Araya, Biruk Tensou, Gail Davey, Yemane Berhane

Addis Ababa Mortality Surveillance Program (AAMSP), Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
School of Public Health, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Addis Ababa Mortality Surveillance Program (AAMSP), Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
School of Public Health, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
School of Public Health, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Brighton & Sussex Medical School, Falmer Campus, University of Sussex, Brighton, UK.

DOI: 10.4236/wja.2012.22012                

Abstract

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.

Keywords

Physician Accuracy; HIV-Serostatus; Verbal Autopsy; Diagnosis; HIV and AIDS-Related Death; Burial Surveillance; Cemetery; Addis Ababa; Ethiopia

Conflicts of Interest

The authors declare no conflicts of interest.

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