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.
|