title: Deaths due to respiratory tract infections in Africa: a review of autopsy studies.
abstract: OBJECTIVE
  According to the WHO, lower respiratory tract infections are one of the most prevalent causes of death in Africa. Estimates based on verbal autopsies are inaccurate compared with the gold standard for determining cause of death, the anatomical postmortem. Here, we review all respiratory postmortem data available from Africa and assess disease prevalence by HIV status in both adults and children.
  
  
  RESULTS
  Pulmonary and extrapulmonary tuberculosis was detected in over 50% of HIV-infected adults, four to five-fold more prevalent than in HIV-uninfected cases. Overall tuberculosis was less prevalent in children, but was more prevalent in HIV-uninfected compared with HIV-infected children. Bacterial pneumonia was more prevalent in children than adults and was relatively unaffected by HIV status. Pneumocystis jirovecci and human cytomegalovirus pneumonia were detected almost exclusively in HIV-infected mortalities, twice as prevalent in children as in adults. Coinfections were common and correlation with premortem clinical diagnoses was low.
  
  
  CONCLUSIONS
  Respiratory tract infections are important causes of mortality in Africa. Of the 21 reviewed studies, only four studies (all adults) were undertaken in the last decade. There is hence an urgent need for new postmortem studies to monitor cause of death in new and emerging patient groups, such as those on antiretroviral therapy and HIV exposed uninfected children.
authors: University of Zambia and University College London Medical School Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.
authors: Matthew
authors: M
authors: Bates
authors: Victor
authors: V
authors: Mudenda
authors: Peter
authors: P
authors: Mwaba
authors: Alimuddin
authors: A
authors: Zumla
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D000349:Africa / Q000453:epidemiology; D001344:Autopsy; D002423:Cause of Death; D002648:Child; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000401:mortality; D014376:Tuberculosis / Q000453:epidemiology*