1. Sarimawar, Lamria, Yuana, Suhardi, S.Kosen, C.Rao, T.Adair NIHRD and Univ. of Queensland

2.  IMRSSP IS AIMED TO DEVELOP THE COD REGISTRATION SYSTEM  USING VA QUESTIONNAIRE FOR DEATH CASES AT HOME  VALIDITY TEST OF SOME PREVALENT DISEASES AS UCOD FROM THE VA QUESTIONNAIRE  THREE GROUPS OF VA: 0-28DAYS, 29DAYS- BELOW 5 YRS, 5 YEARS AND OVER  VA QUESTIONNAIRE USED BY PARAMEDICS AND WELL TRAINED DOCTORS FROM PHC

3.  THE EXPECTED RESULT IS TO FIND OUT WHETHER THE VA QUESTIONNAIRE IS ACCURATE AS AN INSTRUMENT TO DIAGNOSE THE UCOD BASED ON THE RELATED SIGNS AND SYMPTOMS  THE DISEASES TRIALED ARE (18 DISEASES): PERINATAL CONDITIONS, BRONCHOPNEUMONIA, MATERNAL CONDITION, TBC, DIARRHOEA, DENGUE, MALIGNANT NEOPLASM OF GI TRACT, LUNG, BREAST, CERVIX, DM, IHD, HHD/CHF/DC, STROKE, PNEUMONIA, COPD, HEPATIC CIRRHOSIS, INJURY.

4.  N SAMPLE 924 DEATH CASES: 13 HOSPITALS IN JAKARTA AND SOLO  18 PREVALENT DISEASES SELECTED FROM MED RECORD, AND ARE REGARDED OF GOLD STANDARD  THE IMRSSP INTERVIEWERS ASKING THE FAMILY OF THE DECEASED FOR SIGNS & SYMPTOMS USING VA QUESTIONNAIRE  REVIEWERS DETERMINE THE UCOD BASED ON ICD-10

5.  TO DESCRIBE A DIAGNOSTIC TEST IS USED SENSITIVITY & POSITIF PREDICTIVE VALUE (PPV)  SENSITIVITY: PROBABILITY OF X-DISEASE DIAGNOSED BY VA TOOL AMONG X-DISEASE DEATH CASES DIAGNOSED IN THE HOSPITAL (GS); FORMULA a/(a+c)  PPV: THE PROBABILITY OF X-DISEASE DIAGNOSED BY HOSPITAL AS A GOLD STANDARD AMONG X- DISEASE DEATH CASES DIAGNOSE BY VA; FORMULA: a/(a+b)

7.  OUT OF 924 DEATH CASES FROM MED.RECORD, 464 CASES VISITED & INTERVIEWED COMPLETELY (50.8%) DISTRIBUTION OF DEATH CASES N (464) PERCENTAGE < 28 DAYS357.5 29 DAYS-<5 YEARS245.2 5-14 YEARS143.0 15-44 YEARS7315.7 45-54 YEARS7415.9 55 YEARS AND UP24452.6

8.  THE DISEASES W/ HIGH SENSITIVITY (80%+): BRONCHOPNEUMONIA (NEONATAL), CA CERVIX  MEDIUM SENSITIVITY (70-80%): DIARRHOEA, DENGUE, CA OF LUNG, MATERNAL COMPLICATION, INJURY  LOW SENSITIVITY (60-70%): TB, CA OF GI TRACT, CA OF BREAST, STROKE  VERY LOW SENSITIVITY (<60%): DM, IHD, CHF, PNEUMONIA, COPD, CIRRHOSIS HEPATIS.

9. THE DISEASES W/ HIGH SENSITIVITY AND HIGH PPV ARE:  CONDITIONS IN PERINATAL PERIOD  BRONCHOPNEUMONIA IN NEONATAL  DENGUE  MATERNAL COMPLICATION

10.  HOSPITAL DIAGNOSES NOT FULLY GOLD STANDARD (DIFFICULT TO DETERMINE THE UCOD) E.C. UN CHRONOLOGICAL NARRATIONS, LACK OF DISTINCT INFORMATION ON PREVIOUS SYMPTOMS  THE N OF SAMPLE OF SEVERAL DISEASES ARE TO SMALL

11.  EXTRA CARE SHOULD BE TAKEN WHEN INTERPRETING THE SENSITIVITY AND PPV TEST FOR CERTAIN COD DISEASES WITH ONLY TOO FEW SAMPLES OF CASES (<20)  THE MOH SHOULD DETERMINE THE RULES TO IMPLEMENTATE THE STANDARDIZED MORTALITY RR IN HOSPTAL

12. THANK YOU