GUADALAJARA, Mexico – In places where a person can get sick with tuberculosis but never get diagnosed, or get diagnosed, but never treated, with their illness never reported, and where a person can die young without ever coming in contact with a health system, the uncertainties surrounding the true impacts of the TB continue all the way to ends of the lives it takes, a speaker here noted in final day session.
Those are places where determining the toll of chronic and infectious diseases is of urgent importance — to inform the allocations of limited resources, improve health planning and policy to meet communities’ needs, and increase the odds of longevity among vulnerable populations, Dr. Quique Bassat of the University of Barcelona said. But, he added, the same obstacles to care and diagnoses also challenge identifying correctly the causes of deaths.
With clinical diagnoses missing or based on guess work, so-called verbal autopsies — information provided by family or friends — are often relied on to identify possible causes of deaths in low-income settings, where few or no pathologists are available to carry out classic, surgical autopsies, Dr. Bassat said. But verbal autopsies also are unreliable in the absence of knowledge of underlying factors, without symptoms.
Dr. Bassat was there to discuss findings from a 2013-2015 study in Maputo, Mozambique of an alternative — minimally invasive autopsies — that, drawing samples from organs using fine needles, and compared to surgical autopsies, showed the potential to provide correct diagnoses of illnesses leading to patients’ deaths in a majority of cases, particularly for infectious diseases.
Relatively inexpensive, and significantly more accepted than full autopsies, the method could improve disease surveillance in places where death rates are high but knowledge of what causes deaths has remained incomplete Dr. Bassat said. And among more than 100 people whose causes of death were determined during the study, the leading killer was tuberculosis.