Disease-specific mortality burdens in a rural Gambian population using verbal autopsy, 1998–2007

Abstract

ObjectiveTo estimate and evaluate the cause-of-death structure and disease-specific mortality rates in a rural area of The Gambia as determined using the InterVA-4 model.DesignDeaths and person-years of observation were determined by age group for the population of the Farafenni Health and Demographic Surveillance area from January 1998 to December 2007. Causes of death were determined by verbal autopsy (VA) using the InterVA-4 model and ICD-10 disease classification. Assigned causes of death were classified into six broad groups: infectious and parasitic diseases; cancers; other non-communicable diseases; neonatal; maternal; and external causes. Poisson regression was used to estimate age and disease-specific mortality rates, and likelihood ratio tests were used to determine statistical significance.ResultsA total of 3,203 deaths were recorded and VA administered for 2,275 (71%). All-age mortality declined from 15 per 1,000 person-years in 1998–2001 to 8 per 1,000 person-years in 2005–2007. Children aged 1–4 years registered the most marked (74%) decline from 27 to 7 per 1,000 person-years. Communicable diseases accounted for half (49.9%) of the deaths in all age groups, dominated by acute respiratory infections (ARI) (13.7%), malaria (12.9%) and pulmonary tuberculosis (10.2%). The leading causes of death among infants were ARI (5.59 per 1,000 person-years [95% CI: 4.38–7.15]) and malaria (4.11 per 1,000 person-years [95% CI: 3.09–5.47]). Mortality rates in children aged 1–4 years were 3.06 per 1,000 person-years (95% CI: 2.58–3.63) for malaria, and 1.05 per 1,000 person-years (95% CI: 0.79–1.41) for ARI. The HIV-related mortality rate in this age group was 1.17 per 1,000 person-years (95% CI: 0.89–1.54). Pulmonary tuberculosis and communicable diseases other than malaria, HIV/AIDS and ARI were the main killers of adults aged 15 years and over. Stroke-related mortality increased to become the leading cause of death among the elderly aged 60 years or more in 2005–2007.ConclusionsMortality in the Farafenni HDSS area was dominated by communicable diseases. Malaria and ARI were the leading causes of death in the general population. In addition to these, diarrhoeal disease was a particularly important cause of death among children under 5 years of age, as was pulmonary tuberculosis among adults aged 15 years and above.

Effect of maternal death on child survival in rural West Africa: 25 years of prospective surveillance data in The Gambia

“…For any such event, these are then validated with the village reporter. However it is still possible that the number of deaths, and more specifically neonatal deaths[ 25 ], may have been underestimated, possibly resulting in an underestimation of the association.…”

Pattern of all-causes and cause-specific mortality in an area with progressively declining malaria burden in Korogwe district, north-eastern Tanzania

“…Over the 7-year period, the study observed significant number of deaths and cause-specific mortality. Overall, mortality rates in the area were lower compared to those previously reported in other parts of Tanzania [37, 38] and sub-Saharan Africa [39–42]. The main reasons for declining trends in mortality, apart from the decline in malaria burden, could include socio-economic development, improved health services, such as the establishment of primary health care, provision of preventive services and immunization.…”

Prevalence of Cardiovascular Disease Risk Factors in the Gambia: A Systematic Review

“…Almost half of the population is under the age of 15 years, and in 2016 life expectancy was estimated at 61 and 63 years for males and females, respectively [12]. The only available data on CVD in the Gambia, derived from a health and demographic surveillance system, show that stroke went from being the third most frequent cause of death among the 60+ age group in 1998-2001 to the top cause of death in 2005-2007 [13].…”