Changement de protocole dans la méthode d'autopsie verbale et mesure de la mortalité palustre en milieu rural sénégalais

In rural Senegal, three populations have been followed up since several decades and the malaria mortality trend has been observed since the mid-1980s. However, limits are associated with the verbal autopsy method used to determine causes of death, especially deaths due to malaria. A change in protocol occurred in recent years in two of these three sites with the involvement of two physicians (instead of only one) in the diagnosis. The objective is here to measure its potential impact on diagnosis of malaria deaths. Five hundred and fifteen diagnoses reported on child deaths occurred from 2000 to 2005 have been analysed. We have identified, on the basis of a multinomial logistic regression model, factors affecting the determination of malaria deaths among the characteristics of the child, the death, the illness and its symptoms, and we also took into account method factors. Factors related to the method do not play on the malaria diagnosis. This result insures the continuity of the series on malaria mortality statistics since 2000 in the two sites despite changes in the method. However, the new protocol leads to vanish possibility of having deaths among ill-defined or unknown causes. In the African context of absence of health statistics, data obtained through the verbal autopsy method in demographic surveillance system can provide accurate information in the epidemiological field, even regarding malaria.