title: Lay diagnosis of causes of death for monitoring AIDS mortality in Addis Ababa, Ethiopia.
abstract: Lay diagnoses of death collected at burial sites were validated against two 'gold standards': the hospital discharge diagnosis of causes of death obtained by a surveillance of hospital deaths (including autopsy results) and the physician review of verbal autopsies (VAs) that were carried out for a sample of cemetery records. The diagnostic indicators of the lay diagnoses were then used to provide estimates of the share of AIDS-attribuTable mortality. The verbal autopsy results provide an independent estimate of the percentage of AIDS deaths. From a total of 21,274 burial records, 2546 hospital discharge diagnoses, 1480 outcomes of autopsies and 200 adult verbal autopsies were gathered over a period of 1 year starting from February 2001. Independent of the gold standard, lay diagnoses such as lung disease and cold have a specificity of about 90% and a combined sensitivity of about 55% in determining AIDS mortality. Without a significant loss in specificity, the sensitivity increases to 60-65% when diarrhoea, TB, herpes zoster and mental or nerve problem are included. We thus conclude that even in the presence of a reluctance to talk of HIV/AIDS, lay diagnosis of causes of death can be used for monitoring AIDS mortality. Lung disease and cold, in particular, have become well-known euphemisms for AIDS in the community. The share of AIDS deaths in the adult population (20-54) is estimated at 68%, without noticeable differences between men and women. Our results confirm the high impact of HIV/AIDS on mortality as was estimated by epidemiological projections for Addis Ababa.
authors.affiliation: Department of Community Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Tekebash
authors.initials: T
authors.lastname: Araya
authors.forename: Georges
authors.initials: G
authors.lastname: Reniers
authors.forename: Ab
authors.initials: A
authors.lastname: Schaap
authors.forename: Derege
authors.initials: D
authors.lastname: Kebede
authors.forename: Abera
authors.initials: A
authors.lastname: Kumie
authors.forename: Nico
authors.initials: N
authors.lastname: Nagelkerke
authors.forename: Roel
authors.initials: R
authors.lastname: Coutinho
authors.forename: Eduard
authors.initials: E
authors.lastname: Sanders
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000401:mortality; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D003139:Common Cold / Q000175:diagnosis; D003141:Communicable Diseases / Q000175:diagnosis; D003644:Death Certificates; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012680:Sensitivity and Specificity; D017678:Sex Distribution