title: Validity of a Minimally Invasive Autopsy for Cause of Death Determination in Adults in Mozambique: An Observational Study.
abstract: BACKGROUND
  There is an urgent need to identify tools able to provide reliable information on the cause of death in low-income regions, since current methods (verbal autopsy, clinical records, and complete autopsies) are either inaccurate, not feasible, or poorly accepted. We aimed to compare the performance of a standardized minimally invasive autopsy (MIA) approach with that of the gold standard, the complete diagnostic autopsy (CDA), in a series of adults who died at Maputo Central Hospital in Mozambique.
  
  
  RESULTS
  In this observational study, coupled MIAs and CDAs were performed in 112 deceased patients. The MIA analyses were done blindly, without knowledge of the clinical data or the results of the CDA. We compared the MIA diagnosis with the CDA diagnosis of cause of death. CDA diagnoses comprised infectious diseases (80; 71.4%), malignant tumors (16; 14.3%), and other diseases, including non-infectious cardiovascular, gastrointestinal, kidney, and lung diseases (16; 14.3%). A MIA diagnosis was obtained in 100/112 (89.2%) cases. The overall concordance between the MIA diagnosis and CDA diagnosis was 75.9% (85/112). The concordance was higher for infectious diseases and malignant tumors (63/80 [78.8%] and 13/16 [81.3%], respectively) than for other diseases (9/16; 56.2%). The specific microorganisms causing death were identified in the MIA in 62/74 (83.8%) of the infectious disease deaths with a recognized cause. The main limitation of the analysis is that both the MIA and the CDA include some degree of expert subjective interpretation.
  
  
  CONCLUSIONS
  A simple MIA procedure can identify the cause of death in many adult deaths in Mozambique. This tool could have a major role in improving the understanding and surveillance of causes of death in areas where infectious diseases are a common cause of mortality.
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Paola
authors.initials: P
authors.lastname: Castillo
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.|Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Martínez
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.|Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Esperança
authors.initials: E
authors.lastname: Ussene
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.|Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Dercio
authors.initials: D
authors.lastname: Jordao
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.|Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Lucilia
authors.initials: L
authors.lastname: Lovane
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.|Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Mamudo R
authors.initials: MR
authors.lastname: Ismail
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.|Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Carla
authors.initials: C
authors.lastname: Carrilho
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.|Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Cesaltina
authors.initials: C
authors.lastname: Lorenzoni
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.|Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Fabiola
authors.identifier: http://orcid.org/0000-0002-6449-7779
authors.initials: F
authors.lastname: Fernandes
authors.affiliation: Department of Medicine, Maputo Central Hospital, Maputo, Mozambique.
authors.forename: Rosa
authors.identifier: http://orcid.org/0000-0002-8528-4350
authors.initials: R
authors.lastname: Bene
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil.
authors.forename: Antonio
authors.identifier: http://orcid.org/0000-0001-9409-7322
authors.initials: A
authors.lastname: Palhares
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil.
authors.forename: Luiz
authors.initials: L
authors.lastname: Ferreira
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lacerda
authors.affiliation: Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
authors.forename: Inacio
authors.initials: I
authors.lastname: Mandomando
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.|Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vila
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.|Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Juan Carlos
authors.identifier: http://orcid.org/0000-0001-9519-6082
authors.initials: JC
authors.lastname: Hurtado
authors.affiliation: Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
authors.forename: Khátia
authors.initials: K
authors.lastname: Munguambe
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
authors.forename: Maria
authors.initials: M
authors.lastname: Maixenchs
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Ariadna
authors.identifier: http://orcid.org/0000-0001-6648-7438
authors.initials: A
authors.lastname: Sanz
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.affiliation: Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
authors.forename: Eusebio
authors.initials: E
authors.lastname: Macete
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.|Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.|Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Ordi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001344:Autopsy / Q000379:methods*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009073:Mozambique; D055815:Young Adult