RESEARCH ARTICLE Validity of a minimally invasive autopsy tool for cause of death determination in pediatric deaths in Mozambique: An observational study Quique Bassat 1,2,3☯ *, Paola Castillo 1,4☯ , Miguel J. Martı ´nez 1,5☯ , Dercio Jordao 6 , Lucilia Lovane 6 , Juan Carlos Hurtado 1,5 , Tacilta Nhampossa 2,7 , Paula Santos Ritchie 7 , So ´ nia Bandeira 7 , Calvino Sambo 7 , Valeria Chicamba 7 , Mamudo R. Ismail 6,8 , Carla Carrilho 6,8 , Cesaltina Lorenzoni 6,8 , Fabiola Fernandes 6 , Pau Cistero ´ 1 , Alfredo Mayor 1,2 , Anelsio Cossa 2 , Inacio Mandomando 2 , Mireia Navarro 1 , Isaac Casas 1 , Jordi Vila 1,5 , Kha ´ tia Munguambe 2 , Maria Maixenchs 1,2 , Ariadna Sanz 1 , Llorenc ¸ Quinto ´ 1 , Eusebio Macete 2 , Pedro Alonso 1 , Clara Mene ´ndez 1,2,9‡ , Jaume Ordi 1,4‡ 1 ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain, 2 Centro de Investigac ¸ ão em Sau ´ de de Manhic ¸a, Maputo, Mozambique, 3 Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain, 4 Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain, 5 Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain, 6 Department of Pathology, Maputo Central Hospital, Maputo, Mozambique, 7 Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique, 8 Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique, 9 Consorcio de Investigacio ´ n Biome ´ dica en Red de Epidemiologı ´a y Salud Pu ´ blica, Madrid, Spain ☯ These authors contributed equally to this work. ‡ These authors are joint senior authors on this work. * quique.bassat@isglobal.org Abstract Background In recent decades, the world has witnessed unprecedented progress in child survival. How- ever, our knowledge of what is killing nearly 6 million children annually in low- and middle- income countries remains poor, partly because of the inadequacy and reduced precision of the methods currently utilized in these settings to investigate causes of death (CoDs). The study objective was to validate the use of a minimally invasive autopsy (MIA) approach as an adequate and more acceptable substitute for the complete diagnostic autopsy (CDA) for pediatric CoD investigation in a poor setting. Methods and findings In this observational study, the validity of the MIA approach in determining the CoD was assessed in 54 post-neonatal pediatric deaths (age range: 1 mo to 15 y) in a referral hospi- tal of Mozambique by comparing the results of the MIA with those of the CDA. Concordance in the category of disease obtained by the two methods was evaluated by the Kappa statis- tic, and the sensitivity, specificity, and positive and negative predictive values of the MIA diagnoses were calculated. PLOS Medicine | https://doi.org/10.1371/journal.pmed.1002317 June 20, 2017 1 / 16 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Bassat Q, Castillo P, Martı ´nez MJ, Jordao D, Lovane L, Hurtado JC, et al. (2017) Validity of a minimally invasive autopsy tool for cause of death determination in pediatric deaths in Mozambique: An observational study. PLoS Med 14(6): e1002317. https://doi.org/10.1371/journal. pmed.1002317 Academic Editor: Peter Byass, Umeå Centre for Global Health Research, Umeå University, SWEDEN Received: January 16, 2017 Accepted: May 9, 2017 Published: June 20, 2017 Copyright: © 2017 Bassat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Additional data are available upon request, in accordance with the consortium agreement signed by the CaDMIA project partnership. Data use and transfer are monitored by ISGlobal’s Biostatistics and Data Management Unit (contact e-mail: cubioesdm@isglobal.org).