Cause-specific mortality at INDEPTH Health and Demographic Surveillance System Sites in Africa and Asia: concluding synthesis

Abstract

This synthesis brings together findings on cause-specific mortality documented by means of verbal autopsies applied to over 110,000 deaths across Africa and Asia, within INDEPTH Network sites.MethodsDevelopments in computerised methods to assign causes of death on the basis of data from verbal autopsy (VA) interviews have made possible these standardised analyses of over 110,000 deaths from 22 African and Asian Health and Demographic Surveillance System sites in the INDEPTH Network. In addition to previous validations of the InterVA-4 probabilistic model, these wide-ranging analyses provide further evidence of the applicability of this approach to assigning the cause of death. Plausible comparisons with existing knowledge of disease patterns, as well as substantial correlations with out-of-model parameters such as time period, country, and other independent data sources were observed.FindingsSubstantial variations in mortality between sites, and in some cases within countries, were observed. A number of the mortality burdens revealed clearly constitute grounds for public health actions. At an overall level, these included high maternal and neonatal mortality rates. More specific examples were childhood drowning in Bangladesh and homicide among adult males in eastern and southern Africa. Mortality from non-communicable diseases, particularly in younger adulthood, is an emerging cause for concern. INDEPTH’s approach of documenting all deaths in particular populations, and successfully assigning causes to the majority, is important for formulating health policies.Future directionsThe pooled dataset underlying these analyses is available at the INDEPTH Data Repository for further analysis. INDEPTH will continue to fill cause-specific mortality knowledge gaps across Africa and Asia, which will also serve as a baseline for post-2015 development goals. The more widespread use of similar VA methods within routine civil registration systems is likely to become an important medium-term strategy in many countries.

Injury-related gaining momentum as external causes of deaths in Ethiopian health and demographic surveillance sites: evidence from verbal autopsy study

“…In a rural population in KwaZulu-Natal, South Africa, injury accounted 8% of all specific causes of death. In Bangladesh, causes of death were dominated by childhood drowning and by transport-related deaths and intentional injuries elsewhere [10]. …”

“…In some cases, geographic location appeared to play a direct role. A number of the mortality burdens revealed clearly constitute grounds for public health actions [10]. …”

“…Three sets of VA forms including, for deaths up to 28 completed days of life-neonatal period; deaths to children between 4 weeks and 14 years of age; and deaths to persons aged 15 years and above [10,11] were used. The VA data collection questionnaires were translated into local languages including Amharic, Oromefa and Tigrenga .…”

Difficulties in estimating the human burden of canine rabies

“…As many rabies victims die away from the health system, hospital records are less likely to include them and verbal autopsy records can only effectively differentiate rabies deaths if a history of an animal bite is included. Health and Demographic Surveillance Systems (Sankoh and Byass, 2014) which are standardized longitudinal surveys used in field sites around the world that provide estimates of death rates and cause of death through verbal autopsy techniques (Sankoh and Byass, 2014), do not typically include probing for dog bites. Without the history of an animal bite, rabies can be misclassified with other causes of neurological encephalitis, such as cerebral malaria (Mallewa et al, 2007).…”

Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study

“…Globally, the INDEPTH Network surveillance sites study the life events of approximately 3 million people through on-going demographic surveillance. The network was set up in 1998 and has developed tools to measure, map and track the socio-demographic impact of cause-specific morbidity and mortality in LMIC populations using comparable methodologies in different countries 7, 8 .…”