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Bisrat H, Manyazewal T, Mohammed H, Shikur B, Yimer G. Validity of InterVA model versus physician review of verbal autopsy for tracking tuberculosis-related mortality in Ethiopia. BMC Infect Dis 2022; 22:200. [PMID: 35232392 PMCID: PMC8886901 DOI: 10.1186/s12879-022-07193-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In most African countries where a legitimate vital registration system is lacking, physicians often review verbal autopsy (VA) data to determine the cause of death, while there are concerns about the routine practicality, accuracy, and reliability of this procedure. In Ethiopia where the burden of tuberculosis (TB) remains unacceptably high, reliable VA data are needed to guide intervention strategies. This study aimed to validate the InterVA model against the physician VA in tracking TB-related mortality in Ethiopia. METHODS From a sample of deaths in Addis Ababa, Ethiopia, VAs were conducted on TB-related mortality, physician-certified verbal autopsy (PCVA) through multiple steps to ascertain the causes of death. InterVA model was used to interpret the causes of death. Estimates of TB-related deaths between physician reviews and the InterVA model were compared using Cohen's Kappa (k), Receiver-operator characteristic (ROC) curve analysis, sensitivity, and specificity to compare agreement between PCVA and InterVA. RESULTS A total of 8952 completed PCVA were used. The InterVA model had an optimal likelihood cut-off point sensitivity of 0.64 (95% CI: 59.0-69.0) and specificity of 0.95 (95% CI: 94.9-95.8). The area under the ROC curve was 0.79 (95% CI: 0.78-0.81). The level of agreement between physician reviews and the InterVA model to identifying TB-related mortality was moderate (k = 0.59, 95% CI: 0.57-0.61). CONCLUSION The InterVA model is a viable alternative to physician review for tracking TB-related causes of death in Ethiopia. From a public health perspective, InterVA helps to analyze the underlying causes of TB-related deaths cost-effectively using routine survey data and translate to policies and strategies in resource-constrained countries.
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Affiliation(s)
- Haileleuel Bisrat
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Hussen Mohammed
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Bilal Shikur
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Baum F, Musolino C, Gesesew HA, Popay J. New Perspective on Why Women Live Longer Than Men: An Exploration of Power, Gender, Social Determinants, and Capitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E661. [PMID: 33466763 PMCID: PMC7829786 DOI: 10.3390/ijerph18020661] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/03/2021] [Accepted: 01/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women live longer than men, even though many of the recognised social determinants of health are worse for women than men. No existing explanations account fully for these differences in life expectancy, although they do highlight the complexity and interaction of biological, social and health service factors. METHODS this paper is an exploratory explanation of gendered life expectancy difference (GLED) using a novel combination of epidemiological and sociological methods. We present the global picture of GLED. We then utilise a secondary data comparative case analysis offering explanations for GLED in Australia and Ethiopia. We combine a social determinant of health lens with Bourdieu's concepts of capitals (economic, cultural, symbolic and social). RESULTS we confirmed continuing GLED in all countries ranging from less than a year to over 11 years. The Australian and Ethiopian cases demonstrated the complex factors underpinning this difference, highlighting similarities and differences in socioeconomic and cultural factors and how they are gendered within and between the countries. Bourdieu's capitals enabled us to partially explain GLED and to develop a conceptual model of causal pathways. CONCLUSION we demonstrate the value of combing a SDH and Bourdieu's capital lens to investigate GLED. We proposed a theoretical framework to guide future research.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society & Equity, Flinders University, Adelaide 5042, Australia;
| | - Connie Musolino
- Southgate Institute for Health, Society & Equity, Flinders University, Adelaide 5042, Australia;
| | - Hailay Abrha Gesesew
- College of Medicine and Public Health, Flinders University, Adelaide 5048, Australia;
- Epidemiology, School of Health Sciences, Mekelle University, Mekelle 231, Ethiopia
| | - Jennie Popay
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster LA1 4YW, UK;
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Abera SF, Gebru AA, Biesalski HK, Ejeta G, Wienke A, Scherbaum V, Kantelhardt EJ. Social determinants of adult mortality from non-communicable diseases in northern Ethiopia, 2009-2015: Evidence from health and demographic surveillance site. PLoS One 2017; 12:e0188968. [PMID: 29236741 PMCID: PMC5728486 DOI: 10.1371/journal.pone.0188968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 11/16/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION In developing countries, mortality and disability from non-communicable diseases (NCDs) is rising considerably. The effect of social determinants of NCDs-attributed mortality, from the context of developing countries, is poorly understood. This study examines the burden and socio-economic determinants of adult mortality attributed to NCDs in eastern Tigray, Ethiopia. METHODS We followed 45,982 adults implementing a community based dynamic cohort design recording mortality events from September 2009 to April 2015. A physician review based Verbal autopsy was used to identify the most probable causes of death. Multivariable Cox proportional hazards regression was performed to identify social determinants of NCD mortality. RESULTS Across the 193,758.7 person-years, we recorded 1,091 adult deaths. Compared to communicable diseases, NCDs accounted for a slightly higher proportion of adult deaths; 33% vs 34.5% respectively. The incidence density rate (IDR) of NCD attributed mortality was 194.1 deaths (IDR = 194.1; 95% CI = 175.4, 214.7) per 100,000 person-years. One hundred fifty-seven (41.8%), 68 (18.1%) and 34 (9%) of the 376 NCD deaths were due to cardiovascular disease, cancer and renal failure, respectively. In the multivariable analysis, age per 5-year increase (HR = 1.35; 95% CI: 1.30, 1.41), and extended family and non-family household members (HR = 2.86; 95% CI: 2.05, 3.98) compared to household heads were associated with a significantly increased hazard of NCD mortality. Although the difference was not statistically significant, compared to poor adults, those who were wealthy had a 15% (HR = 0.85; 95% CI: 0.65, 1.11) lower hazard of mortality from NCDs. On the other hand, literate adults (HR = 0.35; 95% CI: 0.13, 0.9) had a significantly decreased hazard of NCD attributed mortality compared to those adults who were unable to read and write. The effect of literacy was modified by age and its effect reduced by 18% for every 5-year increase of age among literate adults. CONCLUSION In summary, the study indicates that double mortality burden from both NCDs and communicable diseases was evident in northern rural Ethiopia. Public health intervention measures that prioritise disadvantaged NCD patients such as those who are unable to read and write, the elders, the extended family and non-family household co-residents could significantly reduce NCD mortality among the adult population.
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Affiliation(s)
- Semaw Ferede Abera
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, Mekelle, Ethiopia
| | - Alemseged Aregay Gebru
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, Mekelle, Ethiopia
| | - Hans Konrad Biesalski
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Gebisa Ejeta
- Department of Agronomy, Purdue University, West Lafayette, Indiana, United States of America
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| | - Veronika Scherbaum
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
- Department of Gynaecology, Faculty of Medicine, Martin-Luther University, Halle, Germany
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Weldearegawi B, Melaku YA, Abera SF, Ashebir Y, Haile F, Mulugeta A, Eshetu F, Spigt M. Infant mortality and causes of infant deaths in rural Ethiopia: a population-based cohort of 3684 births. BMC Public Health 2015; 15:770. [PMID: 26260495 PMCID: PMC4531534 DOI: 10.1186/s12889-015-2090-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background Ethiopia has made large-scale healthcare investments to improve child health and survival. However, there is insufficient population level data on the current estimates of infant mortality rate (IMR) in the country. The aim of this study was to measure infant mortality rate, investigate risk factors for infant deaths and identify causes of death in a rural population of northern Ethiopia. Methods Live births to a cohort of mothers under the Kilite Awlaelo Health and Demographic Surveillance System were followed up to their first birthday or death, between September 11, 2009 and September 10, 2013. Maternal and infant characteristics were collected at baseline and during the regular follow-up visit. Multiple-Cox regression was used to investigate risk factors for infant death. Causes of infant death were identified using physician review verbal autopsy method. Results Of the total 3684 infants followed, 174 of them died before their first birthday, yielding an IMR of 47 per 1000 live births (95 % CI: 41, 54) over the four years of follow-up. About 96 % of infants survived up to their first birthday, and 56 % of infant deaths occurred during the neonatal period. Infants born to mothers aged 15–19 years old had higher risk of death (HR = 2.68, 95 % CI: 1. 74, 4.87) than those born to 25–29 years old. Infants of mothers who attained a secondary school and above had 56 % lower risk of death (HR = 0.44, 95 % CI: 0.24, 0.81) compared to those whose mothers did not attend formal education. Sepsis, prematurity and asphyxia and acute lower respiratory tract infections were the commonest causes of death. Conclusion The IMR for the four-year period was lower than the national and regional estimates. Our findings suggest the need to improve the newborn care, and empower teenagers to delay teenage pregnancy and attain higher levels of education.
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Affiliation(s)
- Berhe Weldearegawi
- Department of Public Health, Mekelle University, Mekelle, Ethiopia. .,Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | | | | | - Yemane Ashebir
- Department of Public Health, Mekelle University, Mekelle, Ethiopia.
| | - Fisaha Haile
- Department of Public Health, Mekelle University, Mekelle, Ethiopia.
| | - Afework Mulugeta
- Department of Public Health, Mekelle University, Mekelle, Ethiopia.
| | | | - Mark Spigt
- Department of Public Health, Mekelle University, Mekelle, Ethiopia. .,CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
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Weldearegawi B, Melaku YA, Dinant GJ, Spigt M. How much do the physician review and InterVA model agree in determining causes of death? A comparative analysis of deaths in rural Ethiopia. BMC Public Health 2015; 15:669. [PMID: 26173990 PMCID: PMC4503295 DOI: 10.1186/s12889-015-2032-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/07/2015] [Indexed: 11/24/2022] Open
Abstract
Background Despite it is costly, slow and non-reproducible process, physician review (PR) is a commonly used method to interpret verbal autopsy data. However, there is a growing interest to adapt a new automated and internally consistent method called InterVA. This study evaluated the level of agreement in determining causes of death between PR and the InterVA model. Methods Verbal autopsy data for 434 cases collected between September 2009 and November 2012, were interpreted using both PR and the InterVA model. Cohen’s kappa statistic (κ) was used to compare the level of chance corrected case-by-case agreement in the diagnosis reached by the PR and InterVA model. Results Both methods gave comparable cause specific mortality fractions of communicable diseases (36.6 % by PR and 36.2 % by the model), non-communicable diseases (31.1 % by PR and 38.2 % by the model) and accidents/injuries (12.9 % by PR and 10.1 % by the model). The level of case-by-case chance corrected concordance between the two methods was 0.33 (95 % CI for κ = 0.29–0.34). The highest and lowest agreements were seen for accidents/injuries and non-communicable diseases; with κ = 0.75 and κ = 0.37, respectively. Conclusion If the InterVA were used in place of the existing PR process, the overall diagnosis would be fairly similar. The methods had better agreement in important public health diseases like; TB, perinatal causes, and pneumonia/sepsis; and lower in cardiovascular diseases and neoplasms. Therefore, both methods need to be validated against a gold-standard diagnosis of death. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2032-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Berhe Weldearegawi
- Department of Public Health, Mekelle University, Mekelle, Ethiopia. .,Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | | | - Geert Jan Dinant
- CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
| | - Mark Spigt
- Department of Public Health, Mekelle University, Mekelle, Ethiopia. .,CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
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Melaku YA, Weldearegawi B, Tesfay FH, Abera SF, Abraham L, Aregay A, Ashebir Y, Eshetu F, Haile A, Lakew Y, Kinsman J. Poor linkages in maternal health care services-evidence on antenatal care and institutional delivery from a community-based longitudinal study in Tigray region, Ethiopia. BMC Pregnancy Childbirth 2014; 14:418. [PMID: 25524400 PMCID: PMC4279812 DOI: 10.1186/s12884-014-0418-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 12/05/2014] [Indexed: 11/26/2022] Open
Abstract
Background Progress towards attaining the maternal mortality and maternal health targets set by Millennium Development Goal 5 has been slow in most African countries. Assessing antenatal care and institutional delivery service utilization and their determinants is an important step towards improving maternal health care services. Methods Data were drawn from the longitudinal database of Kilite-Awlaelo Health and Demographic Surveillance System. A total of 2361 mothers who were pregnant and who gave birth between September 2009 and August 2013 were included in the analysis. Potential variables to explain antenatal care and institutional delivery service utilization were extracted, and descriptive statistics and logistic regression were used to determine the magnitude of maternal health care service utilization and associated factors, respectively. Results More than three-quarters, 76% [95% CI: 74.8%-78.2%] (n = 1806), of mothers had undergone at least one antenatal care visit during their previous pregnancy. However, only 27% [95% CI: 25.3%-28.9%] (n = 639) of mothers gave birth at a health institution. Older mothers, urban residents, mothers with higher education attainment, and farmer mothers were more likely to use antenatal care. Institutional delivery services were more likely to be used among older mothers, urban residents, women with secondary education, mothers who visited antenatal care, and mothers with lower parity. Conclusions Despite a relatively high proportion of mothers attending antenatal care services at least once, we found low levels of institutional delivery service utilization. Health service providers in Kilite-Awlaelo should be particularly vigilant regarding the additional maternal health needs of rural and less educated women with high parity.
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Affiliation(s)
- Yohannes Adama Melaku
- Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia.
| | - Berhe Weldearegawi
- Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia.
| | - Fisaha Haile Tesfay
- Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia.
| | - Semaw Ferede Abera
- Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia.
| | - Loko Abraham
- Department of Medicine, Mekelle University, College of Health Sciences, Mekelle, Ethiopia.
| | - Alemseged Aregay
- Department of Nursing, Mekelle University, College of Health Sciences, Mekelle, Ethiopia.
| | - Yemane Ashebir
- Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia.
| | - Friehiwot Eshetu
- Center for Disease Control and Prevention, CDC-Ethiopia, Addis Ababa, Ethiopia.
| | - Ashenafi Haile
- Center for Disease Control and Prevention, CDC-Ethiopia, Addis Ababa, Ethiopia.
| | - Yihunie Lakew
- Ethiopian Public Health Association (EPHA), Addis Ababa, Ethiopia.
| | - John Kinsman
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, 901 85, Sweden.
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Melaku YA, Weldearegawi B, Aregay A, Tesfay FH, Abreha L, Abera SF, Bezabih AM. Causes of death among females-investigating beyond maternal causes: a community-based longitudinal study. BMC Res Notes 2014; 7:629. [PMID: 25208473 PMCID: PMC4174652 DOI: 10.1186/1756-0500-7-629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/05/2014] [Indexed: 11/04/2022] Open
Abstract
Background In developing countries, investigating mortality levels and causes of death among all age female population despite the childhood and maternal related deaths is important to design appropriate and tailored interventions and to improve survival of female residents. Methods Under Kilite-Awlealo Health and Demographic Surveillance System, we investigated mortality rates and causes of death in a cohort of female population from 1st of January 2010 to 31st of December 2012. At the baseline, 33,688 females were involved for the prospective follow-up study. Households under the study were updated every six months by fulltime surveillance data collectors to identify vital events, including deaths. Verbal Autopsy (VA) data were collected by separate trained data collectors for all identified deaths in the surveillance site. Trained physicians assigned underlining causes of death using the 10th edition of International Classification of Diseases (ICD). We assessed overall, age- and cause-specific mortality rates per 1000 person-years. Causes of death among all deceased females and by age groups were ranked based on cause specific mortality rates. Analysis was performed using Stata Version 11.1. Results During the follow-up period, 105,793.9 person-years of observation were generated, and 398 female deaths were recorded. This gave an overall mortality rate of 3.76 (95% confidence interval (CI): 3.41, 4.15) per 1,000 person-years. The top three broad causes of death were infectious and parasitic diseases (1.40 deaths per 1000 person-years), non-communicable diseases (0.98 deaths per 1000 person-years) and external causes (0.36 per 1000 person-years). Most deaths among reproductive age female were caused by Human Deficiency Virus/Acquired Immune Deficiency Virus (HIV/AIDS) and tuberculosis (0.14 per 1000 person-years for each cause). Pregnancy and childbirth related causes were responsible for few deaths among women of reproductive age—3 out of 73 deaths (4.1%) or 5.34 deaths per 1,000 person-years. Conclusions Communicable diseases are continued to be the leading causes of death among all age females. HIV/AIDS and tuberculosis were major causes of death among women of reproductive age. Together with existing efforts to prevent pregnancy and childbirth related deaths, public health and curative interventions on other causes, particularly on HIV/AIDS and tuberculosis, should be strengthened.
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Affiliation(s)
- Yohannes Adama Melaku
- Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
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Melaku YA, Sahle BW, Tesfay FH, Bezabih AM, Aregay A, Abera SF, Abreha L, Zello GA. Causes of death among adults in northern Ethiopia: evidence from verbal autopsy data in health and demographic surveillance system. PLoS One 2014; 9:e106781. [PMID: 25188025 PMCID: PMC4154754 DOI: 10.1371/journal.pone.0106781] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 08/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In countries where registration of vital events is lacking and the proportion of people who die at home without medical care is high, verbal autopsy is used to determine and estimate causes of death. METHODS We conducted 723 verbal autopsy interviews of adult (15 years of age and above) deaths from September 2009 to January 2013. Trained physicians interpreted the collected verbal autopsy data, and assigned causes of death according to the international classification of diseases (ICD-10). We did analysis of specific as well as broad causes of death (i.e. non-communicable diseases, communicable diseases and external causes of death) by sex and age using Stata version 11.1. We performed logistic regression to identify socio-demographic predictors using odds ratio with 95% confidence interval and a p-value of 0.05. FINDINGS Tuberculosis, cerebrovascular diseases and accidental falls were leading specific causes of death accounting for 15.9%, 7.3% and 3.9% of all deaths. Two hundred sixty three (36.4% [95% CI: 32.9, 39.9]), 252 (34.9% [95% CI: 31.4, 38.4]) and 89 (12.3% [95% CI: 10.1, 14.9]) deaths were due to non-communicable, communicable diseases, and external causes, respectively. Females had 1.5 times (AOR = 1.53 [95% CI: 1.10, 2.15]) higher odds of dying due to communicable diseases than males. The odds of dying due to external causes were 4 times higher among 15-49 years of age (AOR = 4.02 [95% CI: 2.25, 7.18]) compared to older ages. Males also had 1.7 times (AOR = 1.70 [95% CI: 1.01, 2.85]) higher odds of dying due to external causes than females. CONCLUSION Tuberculosis, cerebrovascular diseases and accidental falls were the top three causes of death among adults. Efforts to prevent tuberculosis and cerebrovascular diseases related deaths should be improved and safety efforts to reduce accidents should also receive attention.
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Affiliation(s)
- Yohannes Adama Melaku
- Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Fisaha Haile Tesfay
- Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Alemseged Aregay
- Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Semaw Ferede Abera
- Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Loko Abreha
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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