Trend and causes of adult mortality in Kersa health and demographic surveillance system (Kersa HDSS), eastern Ethiopia: verbal autopsy method

Cardiovascular disease mortality based on verbal autopsy in low- and middle-income countries: a systematic review

Objective

To conduct a systematic review of verbal autopsy studies in low- and middle-income countries to estimate the fraction of deaths due to cardiovascular disease.

Method

We searched MEDLINE®, Embase® and Scopus databases for verbal autopsy studies in low- and middle-income countries that reported deaths from cardiovascular disease. Two reviewers screened the studies, extracted data and assessed study quality. We calculated cause-specific mortality fractions for cardiovascular disease for each study, both overall and according to age, sex, geographical location and type of cardiovascular disease.

Findings

We identified 42 studies for inclusion in the review. Overall, the cardiovascular disease cause-specific mortality fractions for people aged 15 years and above was 22.9%. This fraction was generally higher for males (24.7%) than females (20.9%), but the pattern varied across World Health Organization regions. The highest cardiovascular disease mortality fraction was reported in the Western Pacific Region (26.3%), followed by the South-East Asia Region (24.1%) and the African Region (12.7%). The cardiovascular disease mortality fraction was higher in urban than rural populations in all regions, except the South-East Asia Region. The mortality fraction for ischaemic heart disease (12.3%) was higher than that for stroke (8.7%). Overall, 69.4% of cardiovascular disease deaths were reported in people aged 65 years and above.

Conclusion

The burden of cardiovascular disease deaths outside health-care settings in low- and middle-income countries is substantial. Increasing coverage of verbal autopsies in these countries could help fill gaps in cardiovascular disease mortality data and improve monitoring of national, regional and global health goals.

Patterns of Medical Admissions and Predictors of Mortality in Ayder Comprehensive Specialized Hospital, Northern Ethiopia: A Prospective Observational Study

Background

Previous works show that noncommunicable diseases (NCDs) are on the rise in developing nations, including Ethiopia, in the background of preexisting communicable diseases (CDs). Data on hospital admission in sub-Saharan Africa are scarce, particularly prospectively collected, and hence this study was done to close the gap in acquiring accurate diagnosis usually faced with retrospective data. We aimed to describe medical admission patterns, their outcomes and determinants at Ayder Comprehensive Specialized Hospital (ACSH) in Tigray, Ethiopia.

Methods

Data were collected prospectively from November 1, 2017 to October 31, 2018 for all medical admissions. Sociodemographic profiles, final diagnosis, outcome of hospitalization, and complications were recorded using a data-abstraction checklist. Data were analyzed using SPSS 26.

Results

There were 2084 medical admissions over 1 year. Median age was 45 years (IQR 31). A majority (1107, 53.1%) were male. The age-group 25-34 years had the most admissions (19.0%). NCDs constituted 68.2% of admissions. According to the International Classification of Diseases, patients were admitted most frequently due to disease of the circulatory system (36.7%) followed by infectious or parasitic diseases (24.1%). Of NCDs, cardiovascular diseases contributed to 53.9%, followed by cancers (8.6%). Of CDs, HIV/AIDS contributed to 31.3%, followed by tuberculosis (22.8%). A total of 1375 (66%) were discharged improved, while 311 (14.9%) died. On multivariate analysis, the in-hospital mortality was significantly higher (18.7%) for CDs than NCDs (13.2%, AOR 1.8, 95% CI 1.4-2.3; P<0.001). Bed occupancy of ACSH medical wards and ICU was 54%.

Conclusion

NCDs were leading causes of medical admissions in ACSH. The presence of CDs and the development of complications were associated with higher risk of death. Attention should be given by policy-makers to curb the higher morbidity from NCDs and mortality from CDs.

Causes and trends of adult mortality in southern Ethiopia: an eight-year follow up database study

BACKGROUND

Broad and specific causes of adult mortalities are often neglected indicators of wellbeing in low-income countries like Ethiopia due to lack of strong vital statistics. Thus, this database study aimed to assess the causes of adult mortality using demographic surveillance data.

METHODS

An 8-year (12 September 2009-11 September 2017) surveillance data from the Arba Minch Health and Demographic Surveillance Site was used for this study. Verbal autopsy methods and ICD codes were used to identify the causes of the adult deaths. The collected data were entered to the database by data clerks. We used Microsoft Excel and STATA version 16 software for data cleaning and analysis. Chi-squared test was used to see the significances of the trend analyses.

RESULT

From the 943 adult deaths from 2009 to 2017 in the Health and Demographic Surveillance Site in southern Ethiopia, more than half of them were females. The specific leading cause of death in the adults were tuberculosis (16.8%), malaria (9.7%), and intestinal infectious diseases (9.6%). Communicable diseases (49.2%, 95% C.I 45.7, 52.7) accounted for about half of the deaths followed by non-communicable diseases (35%, 95% C.I 31.7, 38.4) where both categories showed an increasing trend.

CONCLUSION

Although pieces of evidences are showing the shift from communicable diseases to non-communicable diseases as the major causes of adult death in developing countries, this study showed that communicable diseases are still the major causes of adult deaths. Efforts and emphasis should be given to control infectious diseases such as tuberculosis and malaria.

The trend and pattern of adult mortality in South-Central Ethiopia: analysis using the 2008-2019 data from Butajira Health and Demographic Surveillance System

Background

Understanding context-specific temporal trends in mortality is essential for setting health policy priorities.

Objective

To investigate the trends and distribution of deaths due to communicable and non-communicable diseases and external causes in South-Central Ethiopia.

Method

All adult deaths captured by the Butajira Health and Demographic Surveillance System between January 2008 and December 2019 were included. A verbal autopsy method of collecting cause of death data was used. Physician review and a computerised algorithm, InterVA, were used to determine the cause of death. Coding was undertaken using the World Health Organization's International Classification of Diseases. Trends in adult mortality rate and proportional mortality were estimated by major cause of death categories. Significant trends were analysed using the Mann–Kendall statistical test with a significance set at P < 0.05. Deaths were also disaggregated by age, sex, and residence.

Results

There were 1,612 deaths in 279,681 person-years; 811 (50.3%) were females. The median age at death was 65 years. The proportional adult mortality and adult mortality rates (per 1000 person-years) attributed to communicable diseases, non-communicable diseases, and external causes were 31.1%, 58.9%, and 6.0%, and 1.9, 3.4, and 0.4, respectively. Adult mortality due to communicable diseases showed a declining trend (tau, the measure of the strength and direction of association, = −0.52; P < 0.05), whereas the trend increased for non-communicable diseases (tau = 0.67, P < 0.05) and external causes (tau = 0.29, P > 0.05). Moreover, death rates were pronounced in the 65+ age group and rural areas but comparable among males and females.

Conclusion

The trend in deaths due to communicable diseases declined but increased for non-communicable diseases and external causes with significant public health burdens. These findings will provide essential input in formulating health policy reforms to reduce premature mortality.

Pattern and Trends in Adult Hospitalization/Admission and Mortality Among Medical Ward Inpatients at Gadarif Hospital in Eastern Sudan: A Four-Year Retrospective Study

Purpose

Sub-Saharan Africa suffers from a dual impact of communicable (CDs) and non-communicable diseases (NCDs). There is scarce data on causes, trends of admission, and deaths among patients in Sudan. We aimed to determine the causes, trends of admission, and mortality among adult patients admitted to Gadarif Hospital in Eastern Sudan.

Patients and Methods

The medical records of adult patients admitted to Gadarif medical wards from January 2017 to December 2020 were reviewed for age, gender, causes of admission, and outcomes. Multivariate Cox regression analysis was used to analysis factors (age, sex, years, and disease) associated with the mortality.

Results

Of the 7230 patients who were admitted, 2221 (34.7%) were females and 5009 (69.3%) were males. The median age (interquartile range, IQR) was 47.0 (35.0) years. Of these 7230 patients, 3167 (43.8%) and 4063 (56.2%) patients were admitted with CDs and NCDs, respectively. Cardiovascular diseases (18.4%), snakebites (12.9%), and visceral leishmaniasis (12.0%) were the most common causes of admission. The overall in-patient adult deaths were 674 (9.3%). Cardiovascular diseases (22.3%), neurological diseases (16.9%), sepsis (15.9%), renal diseases (13.9%), and snakebites (8.3%) were the most common causes of inpatient mortality. Malignancy (20.7%), sepsis (20.9%), neurological diseases (17.4%), and cardiovascular diseases (13.8%) comprised the highest case fatality rates among the admitted patients. Using a Cox regression model (adjusted), age (adjusted hazard ratio = 1.02, 95% confidence interval = 1.01‒1.03) was associated with increased mortality hazard. However, the gender and years of admission were not associated with increased mortality hazard.

Conclusion

Admissions and mortality rates for CDs and NCDs are high compared with other African countries. Preventive measures are required to avert the high burden of these diseases. Health care systems in Sudan need to be prepared to deal with the dual burden of the diseases.

Breast cancer morbidity and mortality in rural Ethiopia: data from 788 verbal autopsies

INTRODUCTION

In Ethiopia, breast cancer is the leading cause of cancer among women. Little is known about the duration of disease and symptoms of patients who died from breast cancer in rural Ethiopia. The objective of this study was to assess breast cancer mortality with a particular focus on the self-reported duration of illness including suffering of symptoms, and need for medical care.

METHODS

The cause of death was determined among randomly selected Ethiopian women residing in western Ethiopia. A modified standard verbal autopsy (VA) questionnaire was completed by women whose sisters had died. The questionnaires were reviewed by two independent local physicians to assign a cause of death. We analyzed pattern of cause of deaths, duration of suffering, symptoms, and treatment received.

RESULT

In our study, the age at death was very similar to other population-based data from Ethiopia. We found 32% of 788 deaths were caused by communicable diseases, 12.1% by neoplasms, and 9.4% by pregnancy/maternal mortality. Breast cancer was the second leading neoplasm, responsible for 21 (2.7%) of all deaths (95% CI 1.5-3.7%), and was among the top five causes of non-communicable deaths. The median age of breast cancer death was 37 years, younger than for other causes of death. The median duration of illness with breast cancer was around 1 year. This was substantially more compared to the duration of infectious diseases, but less than the duration of reproductive neoplasms, diabetes, and epilepsy.

DISCUSSION/CONCLUSION

Breast cancer deaths are common causes of death in women of rural Ethiopia. When assessing the total duration of illness according to specific causes of death, breast and other cancers accounted for a large share of the burden. This has practical implications and highlights the need for palliative care for cancer patients. Substantial efforts are necessary to improve early detection and treatment for breast cancer to reduce premature death in women.

Uncertainties in the path to 2030: Increasing trends of under-five mortality in the aftermath of Millennium Development Goal in Eastern Ethiopia

Background

Although Ethiopia was applauded for achieving the Millennium Development Goal (MDG) target of reducing child mortality, whether the gains sustained beyond the MDG era was rarely studied. In this study, we reported the trends and determinants of under-five mortality (U5M) from 2015 to 2020 in a population based cohort under the Kersa Health and Demographic Surveillance System (HDSS), eastern Ethiopia.

Methods

We followed pregnant women and their pregnancy outcomes from 2015 to 2020. Each year, data related to death and live births among the follow up population was retrieved. Automated verbal autopsy (InterVA-4) was used to assign the cause of death and Stata 14 was used for analysis. U5M rate was calculated as death among under five children divided by all live births during the study period and described per 1000 live births along with 95% Confidence Interval (CI). A multivariable Cox proportional regression model was used to identify determinant of U5M using adjusted hazard ratio (AHR). Finally, P value <0.05 was considered for declaring statistically significant association.

Results

From January 2015 to December 2020, a total of 28 870 live births were registered under the Kersa HDSS, of whom 1335 died before their fifth birthday. The overall U5M rate was 46.3 per 1000 live births (95% confidence interval (CI) = 43.79-48.79), with significant increase from 27.9 in 2015 to 54.7 in 2020 (P < 0.041). Diarrheal diseases, acute respiratory tract infection including pneumonia, meningitis and encephalitis, and HIV related deaths were the leading causes of U5M. The hazard of death was higher among children born to poor household (AHR = 1.52; 95% CI = 1.27-1.81), rural residents (AHR = 6.0; 95% CI = 3.65-9.91), born to adolescent mothers (AHR = 1.41; 95% CI = 1.02-1.95), whose mother didn’t receive antenatal care (AHR = 1.43; 95% CI = 1.21-1.69), were born preterm (AHR = 14.1; 95% CI = 9.96-19.89) and had low birth-weight (AHR = 1.74; 95% CI = 1.39-2.18).

Conclusion

We found high level of U5M rate with an increasing trend in the aftermath of the praised MDG4 achievement. Achieving the ambitious U5M of 25 per 1000 live births by 2030 requires addressing diarrheal disease, and respiratory tract infections, and HIV/AIDS. Reasons behind the persistent increase over the study period require further inquiry.

Trends and causes of adult mortality from 2007 to 2017 using verbal autopsy method, Addis Ababa, Ethiopia

OBJECTIVES

We aim to analyse the trends and causes of mortality among adults in Addis Ababa.

SETTING

This analysis was conducted using verbal autopsy data from the Addis Ababa Mortality Surveillance in Addis Ababa, Ethiopia.

PARTICIPANTS

All deceased adults aged 15 years and above between 2007-2012 and 2015-2017 were included in the analysis.

OUTCOME MEASURES

We collected verbal autopsy and conducted physician review to ascertain cause of death.

RESULT

A total of 7911 data were included in this analysis. Non-communicable disease (NCD) accounted for 62.8% of adult mortality. Mortality from communicable diseases, maternal conditions and nutritional deficiencies followed this by accounting for 30.3% of total mortality. Injury accounted for 6.8% of total mortality. We have observed a significant decline in mortality attributed to group one cause of death (43.25% in 2007 to 12.34% in 2017, p<0.001). However, we observed a significant increase in mortality attributed to group II cause of death (from 49.95% in 2007 to 81.17% in 2017, p<0.001). The top five leading cause of death in 2017 were cerebrovascular disease (12.8%), diabetes mellitus (8.1%), chronic liver disease (6.3%), hypertension (5.7%), ischaemic heart disease (5.7%) and other specified neoplasm (5.2%).

CONCLUSION

We documented an epidemiological shift in cause of mortality from communicable diseases to NCD over 10 years. There is a great progress in reducing mortality due to communicable diseases over the past years. However, the burden of NCDs call for actions for improving access to quality health service, improved case detection and community education to increase awareness. Integrating NCD intervention in to a well-established and successful programme targeting communicable diseases in the country might be beneficial for improving provision of comprehensive healthcare.

Causes of morbidity and mortality among patients admitted in a tertiary hospital in southern Nigeria: A 6 year evaluation

BACKGROUND

Data on morbidity and mortality are essential in assessing disease burden, monitoring and evaluation of health policies. The aim of this study is to describe the causes of morbidity and mortality in the wards of University of Calabar Teaching Hospital (UCTH).

METHODS

The study took a retrospective approach evaluating causes of morbidity and mortality from 2012-2017. Causes of death were documented based on International Classification of Disease 10 (ICD-10). Data were retrieved from health records department, UCTH.

RESULTS

Overall, 2,198 deaths were recorded out of the 49,287 admissions during the study period giving a mortality rate of 4.5% comprising 1,152 (52.4%) males and 1,046 (47.6%) females. A greater number of males were admitted via accident and emergency. Age group 15-45 years had the highest number of admissions (57.9%) and deaths (37.7%), while age group >65 years recorded the highest number of deaths per admission (9.7% mortality rate). The broad leading causes of death were infectious and parasitic disease and diseases of the circulatory system (cardiovascular diseases) accounting for 22.7% and 15.8% of all deaths, respectively. However, diseases of the circulatory system recorded the highest number of deaths per admission (13.7% mortality rate). Overall, infectious diseases were the chief cause of mortality in adults while conditions originating from perinatal period were the major cause of death in children. Septicemia (6.0%), stroke (4.2%), liver diseases (4.1%), tuberculosis (3.7%), diabetes (3.6%) and HIV/AIDS (3.4%) were the specific leading cases of deaths. Sepsis, chronic diseases of the tonsil and adenoids and malaria were the specific leading causes of death in children, while sepsis, stroke and liver diseases were the leading cause of death in adults.

CONCLUSION

Most causes of deaths in this study are preventable. This study revealed double burden of communicable and non-communicable diseases.

Adult mortality in sub-Saharan Africa: cross-sectional study of causes of death in Zambia

OBJECTIVE

To describe the age-sex pattern and socio-economic differentials in causes of death among adults between the ages of 15 and 59 years in Zambia.

METHODS

Using data from the 2010-2012 Zambia sample vital registration with verbal autopsy survey, we calculated the percentage share of causes of death, the age-/sex cause-specific death ratio and cause-eliminated life expectancy at age 15.

RESULTS

HIV/AIDS was the leading cause of death across all socio-economic subgroups contributing 40.7% of total deaths during the study period. This was followed by deaths due to injury and accidents (11.2%). Cause-specific death ratios due to HIV/AIDS increased by age and peaked in the 35-39 age group and were higher among females than males. The second-leading cause of death was injuries and accidents for males and tuberculosis for females. The third-leading cause of death was cardiovascular diseases for females and tuberculosis for males. Cause of death patterns varied notably by socio-economic characteristics. Deaths attributable to non-communicable diseases were more evident in adults aged 45-59 years. Eliminating HIV/AIDS in Zambia as a cause of death could raise life expectancy at age 15 by 5.7 years for males and by 6.4 years for females.

CONCLUSION

HIV/AIDS-related health programmes and interventions should be further supported and strengthened, as they would significantly contribute to the reduction in adult mortality in Zambia.

Short-term clinical outcomes of patients admitted with chronic liver disease to selected teaching hospitals in Ethiopia

BACKGROUND

Chronic liver disease (CLD) is a progressive destruction of liver tissue with subsequent necrosis that persists for at least 6 months. In Ethiopia, despite the high burden report, data on CLD is limited. The objective of this study was to assess short-term clinical outcomes in patients admitted with chronic liver disease to three tertiary teaching hospitals in Ethiopia and to identify predictors of mortality.

METHODS

A cohort of 109 patients admitted with CLD to three tertiary teaching hospitals in Ethiopia, were prospectively followed from the time of admission to 30-days of hospital discharge. The study was conducted from April 1, 2018, to October 5, 2018. Kaplan-Maier curve was used to estimate survival and cox-regression analysis to identify predictors of mortality.

RESULT

A total of 109 patients (80% male) diagnosed with CLD were included. Median age of the participants was 38(IQR, 30-48). The overall median length of hospital stay was 7(IQR, 4-11) days. Of the total, 39(35.8%) patients were HBsAg positive, and 12(11%) patients were anti-HCV positive. The 30-day mortality was 38(34.9%), and most of the deaths, 31(81.6%) occurred before hospital discharge. Hepatic encephalopathy at admission; being with unidentified risk factor/etiologies of CLD and total bilirubin level were independent predictors of in-hospital mortality. Patients with hepatic encephalopathy at admission had approximately 11 times increased risk of death as compared to patients without hepatic encephalopathy at admission. Similarly, the hazard of mortality was 5.8 times higher in those patients with unidentified risk factor/etiology as compared to others. The risk of dying had also increased with an increase in bilirubin (1.188[95% CI, 1.0719-1.316]) level.

CONCLUSION

Approximately one-quarter of patients with CLD died during their hospital stay, and the risk of death continued after hospital discharge. Hepatic encephalopathy at admission, unidentified risk factor/etiology and increased level of total bilirubin are poor prognostic factors. Given that more than one third the patients had HBV-infection, access to antiviral drugs could help improve the prognosis of patients with end-stage liver disease in Ethiopia, as well as prevent the progression of the disease if initiated earlier.

Exploring Research Topics and Trends in Nursing-related Communication in Intensive Care Units Using Social Network Analysis

This study used social network analysis to identify the main research topics and trends in nursing-related communication in intensive care units. Keywords from January 1967 to June 2016 were extracted from PubMed using Medical Subject Headings terms. Social network analysis was performed using Gephi software. Research publications and newly emerging topics in nursing-related communication in intensive care units were classified into five chronological phases. After the weighting was adjusted, the top five keyword searches were "conflict," "length of stay," "nursing continuing education," "family," and "nurses." During the most recent phase, research topics included "critical care nursing," "patient handoff," and "quality improvement." The keywords of the top three groups among the 10 groups identified were related to "neonatal nursing and practice guideline," "infant or pediatric and terminal care," and "family, aged, and nurse-patient relations," respectively. This study can promote a systematic understanding of communication in intensive care units by identifying topic networks. Future studies are needed to conduct large prospective cohort studies and randomized controlled trials to verify the effects of patient-centered communication in intensive care units on patient outcomes, such as length of hospital stay and mortality.

Unexplained chronic liver disease in Ethiopia: a cross-sectional study

BACKGROUND

Hepatitis B virus (HBV) infection is assumed to be the major cause of chronic liver disease (CLD) in sub-Saharan Africa. The contribution of other aetiological causes of CLD is less well documented and hence opportunities to modulate other potential risk factors are being lost. The aims of this study were to explore the aetiological spectrum of CLD in eastern Ethiopia and to identify plausible underlying risk factors for its development.

METHODS

A cross-sectional study was undertaken between April 2015 and April 2016 in two public hospitals in Harar, eastern Ethiopia. The study population comprised of consenting adults with clinical and radiological evidence of chronic liver disease. The baseline evaluation included: (i) a semi-structured interview designed to obtain information about the ingestion of alcohol, herbal medicines and local recreational drugs such as khat (Catha edulis); (ii) clinical examination; (iii) extensive laboratory testing; and, (iv) abdominal ultrasonography.

RESULTS

One-hundred-and-fifty patients with CLD (men 72.0%; median age 30 [interquartile range 25-40] years) were included. CLD was attributed to chronic HBV infection in 55 (36.7%) individuals; other aetiological agents were identified in a further 12 (8.0%). No aetiological factors were identified in the remaining 83 (55.3%) patients. The overall prevalence of daily khat use was 78.0%, while alcohol abuse, defined as > 20 g/day in women and > 30 g/day in men, was rare (2.0%). Histological features of toxic liver injury were observed in a subset of patients with unexplained liver injury who underwent liver biopsy.

CONCLUSION

The aetiology of CLD in eastern Ethiopia is largely unexplained. The widespread use of khat in the region, together with histopathological findings indicating toxic liver injury, suggests an association which warrants further investigation.