title: Tuberculosis and tuberculosis/HIV/AIDS-associated mortality in Africa: the urgent need to expand and invest in routine and research autopsies.
abstract: Frequently quoted statistics that tuberculosis and human immunodeficiency virus (HIV)/AIDS are the most important infectious causes of death in high-burden countries are based on clinical records, death certificates, and verbal autopsy studies. Causes of death ascertained through these methods are known to be grossly inaccurate. Most data from Africa on mortality and causes of death currently used by international agencies have come from verbal autopsy studies, which only provide inaccurate estimates of causes of death. Autopsy rates in most sub-Saharan African countries have declined over the years, and actual causes of deaths in the community and in hospitals in most sub-Saharan African countries remain unknown. The quality of cause-specific mortality statistics remains poor. The effect of various interventions to reduce mortality rates can only be evaluated accurately if cause-specific mortality data are available. Autopsy studies could have particular relevance to direct public health interventions, such as vaccination programs or preventive therapy, and could also allow for study of background levels of subclinical tuberculosis disease, Mycobacterium tuberculosis-HIV coinfection, and other infectious and noncommunicable diseases not yet clinically manifest. Autopsies performed soon after death may represent a unique opportunity to understand the pathogenesis of M. tuberculosis and the pathogenesis of early deaths after initiation of antiretroviral therapy. The few autopsies performed so far for research purposes have yielded invaluable information and insights into tuberculosis, HIV/AIDS, and other opportunistic infections. Accurate cause-specific mortality data are essential for prioritization of governmental and donor investments into health services to reduce morbidity and mortality from deadly infectious diseases such as tuberculosis and HIV/AIDS. There is an urgent need for reviving routine and research autopsies in sub-Saharan African countries.
authors.affiliation: University of Zambia and University College London Medical School, (UNZA-UCLMS), Research and Training Project, Lusaka, Zambia.
authors.forename: Victor
authors.initials: V
authors.lastname: Mudenda
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lucas
authors.forename: Aaron
authors.initials: A
authors.lastname: Shibemba
authors.forename: Justin
authors.initials: J
authors.lastname: O'Grady
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
authors.forename: Nathan
authors.initials: N
authors.lastname: Kapata
authors.forename: Samana
authors.initials: S
authors.lastname: Schwank
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaba
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.forename: Michael
authors.initials: M
authors.lastname: Hoelscher
authors.forename: Markus
authors.initials: M
authors.lastname: Maeurer
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D001344:Autopsy / Q000191:economics*; D002423:Cause of Death; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D006801:Humans; D007258:Informed Consent; D012106:Research / Q000191:economics; D012107:Research Design; D012307:Risk Factors; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology