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Dheresa M, Tura AK, Daraje G, Abebe M, Dingeta T, Shore H, Dessie Y, Yadeta TA. Trend and Determinants of Mortality Among Women of Reproductive Age: A Twelve-Year Open Cohort Study in Eastern Ethiopia. Front Glob Womens Health 2022; 2:762984. [PMID: 34970651 PMCID: PMC8712503 DOI: 10.3389/fgwh.2021.762984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: With only less than a decade left till 2030, it is essential to research the burden and trends of women of reproductive age (WRA) mortality in order to design appropriate interventions toward achieving goal three of the sustainable development goals (SDGs), good health and well-being. For several low-income countries, such data are often lacking or sometimes extrapolated from non-representative facility-based studies. In this paper, we presented trends, causes, and determinants of mortality among reproductive-age women under follow-up for 12 years through the Health and Demographic Surveillance System (HDSS) located in eastern Ethiopia. Methods: We used 12 years of (2008 to 2019) open cohort data of women aged 15–49 living in Kersa HDSS in Eastern Ethiopia. In the HDSS, data on socio-demographic and basic household conditions are recorded for every household member at enrollment, and data on vital events such as births, deaths, and migration were collected and updated biannually as the event happened. Mortality was determined by automated verbal autopsy (InterVA) algorism. We assessed trends in women's reproductive age mortality and the associated determinants using crude and adjusted Cox regression models. Results: In the 12-years cohort, we followed 74,790 women of reproductive age for 339,909.26 person-years-at-risk of observation (PYO), of whom 919 died. Overall, the standardized mortality rate was 270 per 100,000 PYO. There was a notable increase in mortality in the first 3 years (2009 to 2011) which then declined significantly (p = 0.0001) until 2019. Most of the deaths were caused by HIV/AIDS (27.88%) and pulmonary tuberculosis (10.62%). In the adjusted Cox regression analysis, the hazard of death was higher among rural residents (AHR, 2.03: 95% CI: 1.60–2.58), unemployed women (AHR, 1.50: 95% CI: 1.19–1.89), and women with no formal education (AHR, 1.24: 95% CI: 1.01–1.52). Conclusion: The study showed a high number of women of reproductive age are still dying mainly due to causes for which preventable strategies are known and have been successfully implemented. The study identified that the main causes of death were related to HIV/AIDS and tuberculosis, and there was a higher hazard of mortality among rural residents, unemployed women, and those with no formal education, who need effective implementation in achieving the SDG three.
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Affiliation(s)
- Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Kersa Health and Demographic Surveillance System, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Gamachis Daraje
- Kersa Health and Demographic Surveillance System, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Statistics, College of Computing and Informatics, Haramaya University, Harar, Ethiopia
| | - Mesfin Abebe
- Kersa Health and Demographic Surveillance System, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hirbo Shore
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Kersa Health and Demographic Surveillance System, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Bukhman G, Mocumbi AO, Atun R, Becker AE, Bhutta Z, Binagwaho A, Clinton C, Coates MM, Dain K, Ezzati M, Gottlieb G, Gupta I, Gupta N, Hyder AA, Jain Y, Kruk ME, Makani J, Marx A, Miranda JJ, Norheim OF, Nugent R, Roy N, Stefan C, Wallis L, Mayosi B. The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion. Lancet 2020; 396:991-1044. [PMID: 32941823 PMCID: PMC7489932 DOI: 10.1016/s0140-6736(20)31907-3] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/29/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Gene Bukhman
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anne E Becker
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Kids, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Institute for Global Health & Development, Aga Khan University, South-Central Asia, East Africa, and UK
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matthew M Coates
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Gary Gottlieb
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Indrani Gupta
- Health Policy Research Unit, Institute of Economic Growth, Delhi, India
| | - Neil Gupta
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yogesh Jain
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrew Marx
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ole F Norheim
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Nobhojit Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, HBNI University, Government of India, Mumbai, India; Field Health Systems Laboratory, Bihar Technical Support Programme, CARE India, Madhubani, Bihar, India
| | - Cristina Stefan
- SingHealth Duke-NUS Global Health Institute (SDGHI), Duke-NUS Medical School, Singapore; African Medical Research and Innovation Institute, Cape Town, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Bongani Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Coates MM, Kamanda M, Kintu A, Arikpo I, Chauque A, Mengesha MM, Price AJ, Sifuna P, Wamukoya M, Sacoor CN, Ogwang S, Assefa N, Crampin AC, Macete EV, Kyobutungi C, Meremikwu MM, Otieno W, Adjaye-Gbewonyo K, Marx A, Byass P, Sankoh O, Bukhman G. A comparison of all-cause and cause-specific mortality by household socioeconomic status across seven INDEPTH network health and demographic surveillance systems in sub-Saharan Africa. Glob Health Action 2019; 12:1608013. [PMID: 31092155 PMCID: PMC6534200 DOI: 10.1080/16549716.2019.1608013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: Understanding socioeconomic disparities in all-cause and cause-specific mortality can help inform prevention and treatment strategies. Objectives: To quantify cause-specific mortality rates by socioeconomic status across seven health and demographic surveillance systems (HDSS) in five countries (Ethiopia, Kenya, Malawi, Mozambique, and Nigeria) in the INDEPTH Network in sub-Saharan Africa. Methods: We linked demographic residence data with household survey data containing living standards and education information we used to create a poverty index. Person-years lived and deaths between 2003 and 2016 (periods varied by HDSS) were stratified in each HDSS by age, sex, year, and number of deprivations on the poverty index (0–8). Causes of death were assigned to each death using the InterVA-4 model based on responses to verbal autopsy questionnaires. We estimated rate ratios between socioeconomic groups (2–4 and 5–8 deprivations on our poverty index compared to 0–2 deprivations) for specific causes of death and calculated life expectancy for the deprivation groups. Results: Our pooled data contained almost 3.5 million person-years of observation and 25,038 deaths. All-cause mortality rates were higher among people in households with 5–8 deprivations on our poverty index compared to 0–2 deprivations, controlling for age, sex, and year (rate ratios ranged 1.42 to 2.06 across HDSS sites). The poorest group had consistently higher death rates in communicable, maternal, neonatal, and nutritional conditions (rate ratios ranged 1.34–4.05) and for non-communicable diseases in several sites (1.14–1.93). The disparities in mortality between 5–8 deprivation groups and 0–2 deprivation groups led to lower life expectancy in the higher-deprivation groups by six years in all sites and more than 10 years in five sites. Conclusions: We show large disparities in mortality on the basis of socioeconomic status across seven HDSS in sub-Saharan Africa due to disparities in communicable disease mortality and from non-communicable diseases in some sites. Life expectancy gaps between socioeconomic groups within sites were similar to the gaps between high-income and lower-middle-income countries. Prevention and treatment efforts can benefit from understanding subpopulations facing higher mortality from specific conditions.
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Affiliation(s)
- Matthew M Coates
- a Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change , Harvard Medical School , Boston , USA
| | | | - Alexander Kintu
- c Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA
| | - Iwara Arikpo
- b INDEPTH Network , Accra , Ghana.,d Cross River Health & Demographic Surveillance System (CRHDSS) , University of Calabar , Calabar , Nigeria
| | - Alberto Chauque
- b INDEPTH Network , Accra , Ghana.,e Centro de Investigação em Saúde da Manhiça (CISM) , Mozambique
| | - Melkamu Merid Mengesha
- b INDEPTH Network , Accra , Ghana.,f College of Health and Medical Sciences , Haramaya University , Harar , Ethiopia
| | - Alison J Price
- b INDEPTH Network , Accra , Ghana.,g Department of Population Health , London School of Hygiene & Tropical Medicine , London , UK.,h Malawi Epidemiology and Intervention Research Unit , Lilongwe , Malawi
| | - Peter Sifuna
- b INDEPTH Network , Accra , Ghana.,i US Army Medical Research Directorate-Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI) , Kisumu , Kenya
| | - Marylene Wamukoya
- b INDEPTH Network , Accra , Ghana.,j African Population and Health Research Center , Nairobi , Kenya
| | - Charfudin N Sacoor
- b INDEPTH Network , Accra , Ghana.,e Centro de Investigação em Saúde da Manhiça (CISM) , Mozambique
| | - Sheila Ogwang
- b INDEPTH Network , Accra , Ghana.,i US Army Medical Research Directorate-Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI) , Kisumu , Kenya
| | - Nega Assefa
- b INDEPTH Network , Accra , Ghana.,f College of Health and Medical Sciences , Haramaya University , Harar , Ethiopia
| | - Amelia C Crampin
- b INDEPTH Network , Accra , Ghana.,g Department of Population Health , London School of Hygiene & Tropical Medicine , London , UK.,h Malawi Epidemiology and Intervention Research Unit , Lilongwe , Malawi
| | - Eusebio V Macete
- b INDEPTH Network , Accra , Ghana.,e Centro de Investigação em Saúde da Manhiça (CISM) , Mozambique
| | - Catherine Kyobutungi
- b INDEPTH Network , Accra , Ghana.,j African Population and Health Research Center , Nairobi , Kenya
| | - Martin M Meremikwu
- b INDEPTH Network , Accra , Ghana.,d Cross River Health & Demographic Surveillance System (CRHDSS) , University of Calabar , Calabar , Nigeria
| | - Walter Otieno
- b INDEPTH Network , Accra , Ghana.,i US Army Medical Research Directorate-Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI) , Kisumu , Kenya.,k Department of Paediatrics and Child Health , Maseno University School of Medicine , Kisumu , Kenya
| | | | - Andrew Marx
- a Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change , Harvard Medical School , Boston , USA
| | - Peter Byass
- b INDEPTH Network , Accra , Ghana.,m Department of Epidemiology and Global Health , Umeå University , Umeå , Sweden.,n Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,o Institute of Applied Health Sciences , University of Aberdeen , Aberdeen , Scotland
| | - Osman Sankoh
- b INDEPTH Network , Accra , Ghana.,p Statistics Sierra Leone , Freetown , Sierra Leone.,q College of Medicine and Allied Health Sciences , University of Sierra Leone , New England , Sierra Leone.,r School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Gene Bukhman
- a Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change , Harvard Medical School , Boston , USA.,s Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,t Partners In Health , Boston , MA , USA
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Orazulike NC, Alegbeleye JO, Obiorah CC, Nyengidiki TK, Uzoigwe SA. A 3-year retrospective review of mortality in women of reproductive age in a tertiary health facility in Port Harcourt, Nigeria. Int J Womens Health 2017; 9:769-775. [PMID: 29081673 PMCID: PMC5652918 DOI: 10.2147/ijwh.s138052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose To determine the causes of death and associated risk factors among women of reproductive age (WRA) in a tertiary institution in Port Harcourt, Nigeria. Patients and methods This was a retrospective survey of all deaths in women aged 15–49 years at the University of Port Harcourt Teaching Hospital that occurred from January 1, 2013 to December 31, 2015. Data retrieved from ward registers, death registers, and death certificates were analyzed with Epi Info version 7. Comparison of socioeconomic and demographic risk factors for maternal and nonmaternal deaths was done using a multivariate logistic regression model. Results There were 340 deaths in the WRA group over the 3-year period. The majority (155 [45.6%]) of the women were aged 30–39 years. There were 265 (77.9%) nonmaternal deaths and 75 (22.1%) maternal deaths. Among the nonmaternal deaths, 124 (46.8%) had infectious diseases, with human immunodeficiency virus being the most common cause of infection in this group. Breast cancer (13 [4.9%]), cervical cancer (12 [4.5%]), and ovarian cancer (11 [4.2%]) were the most common malignant neoplasms observed. Hypertensive disorders of pregnancy (31 [41.3%]) and puerperal sepsis (20 [26.7%]) were the most common causes of maternal deaths. Age and occupation were significantly associated with deaths in WRA (p<0.05). Older women aged >30 years (odd ratio =1.86, 95% CI =1.07–3.23) and employed women (odds ratio =2.55, 95% CI =1.46–4.45) were more likely to die from nonmaternal than maternal causes. Conclusion Most of the deaths were nonmaternal. Infectious diseases, diseases of the circulatory system, and malignant neoplasms were the major causes of death among WRA, with maternal deaths accounting for approximately a quarter. Public health programs educating women on safer sex practices, early screening for cancers, benefits of antenatal care, and skilled attendants at delivery will go a long way to reducing preventable causes of deaths among these women.
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Affiliation(s)
| | | | - Christopher C Obiorah
- Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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Aghazadeh J, Motlagh ME, EntezarMahdi R, Eslami M, Mohebbi I, Yousefzadeh H, Farrokh-Eslamlou H. Cause-specific mortality among women of reproductive age: Results from a population-based study in an Iranian community. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 14:7-12. [PMID: 29195638 DOI: 10.1016/j.srhc.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/13/2017] [Accepted: 08/17/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE OF STUDY This study was conducted to evaluate the levels, patterns, and causes of mortality among women of reproductive age in Northwestern Iran. METHODS Deaths were determined for females resident in West Azerbaijan Province of Iran and who died between March 2013 to February 2014 using reproductive age mortality survey (RAMOS). Causes of death were ascertained by verbal autopsy (VA) and classified based on the International Classification of Diseases, tenth revision (ICD-10). Overall and cause-specific mortality rates (MRs) per 100,000 women with 95% confidence intervals were calculated. RESULTS A total of 510 deaths were detected, and VA interviews were conducted with the relatives of the deceased Cases; overall MR was 56.59 per 100,000 women (95% CI: 56.49-56.69). The highest MR was observed in suicide cases (MR=10.21per 100,000women, 95% CI: 10.15-10.27), accounting for 18% of all deaths. The most common method of suicide was self-inflicted burns (45.6%), followed by deaths due to breast cancer (MR=4.22per 100,000women, 95% CI: 4.18-4.26), which accounted for the most cancer-related mortality. All-cause mortality was associated with age, area of residence, marital status, level of education, and ethnic (religious) status relationship (P<0.001). CONCLUSION Suicide, especially self-immolation, was the main cause of death among women of reproductive age, and both suicides and breast cancer are major public health problems for this group of women.
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Affiliation(s)
| | | | - Rasool EntezarMahdi
- Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran.
| | - Mohammad Eslami
- Family and School Health Department, Ministry of Health and Medical Education, Tehran, Iran.
| | - Iraj Mohebbi
- Department of Occupational Health, Urmia University of Medical Sciences, Urmia, Iran.
| | - Hasan Yousefzadeh
- Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
| | - Hamidreza Farrokh-Eslamlou
- Reproductive Health Research Center, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
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Tlou B, Sartorius B, Tanser F. Space-time patterns in maternal and mother mortality in a rural South African population with high HIV prevalence (2000-2014): results from a population-based cohort. BMC Public Health 2017; 17:543. [PMID: 28578674 PMCID: PMC5457561 DOI: 10.1186/s12889-017-4463-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 05/24/2017] [Indexed: 01/01/2023] Open
Abstract
Background International organs such as, the African Union and the South African Government view maternal health as a dominant health prerogative. Even though most countries are making progress, maternal mortality in South Africa (SA) significantly increased between 1990 and 2015, and prevented the country from achieving Millennium Development Goal 5. Elucidating the space-time patterns and risk factors of maternal mortality in a rural South African population could help target limited resources and policy guidelines to high-risk areas for the greatest impact, as more generalized interventions are costly and often less effective. Methods Population-based mortality data from 2000 to 2014 for women aged 15–49 years from the Africa Centre Demographic Information System located in the Umkhanyakude district of KwaZulu-Natal Province, South Africa were analysed. Our outcome was classified into two definitions: Maternal mortality; the death of a woman while pregnant or within 42 days of cessation of pregnancy, regardless of the duration and site of the pregnancy, from any cause related to or exacerbated by the pregnancy or its management but not from unexpected or incidental causes; and ‘Mother death’; death of a mother whilst child is less than 5 years of age. Both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection respectively were used to identify clusters of maternal mortality events in both space and time. Results The overall maternal mortality ratio was 650 per 100,000 live births, and 1204 mothers died while their child was less than or equal to 5 years of age, of a mortality rate of 370 per 100,000 children. Maternal mortality declined over the study period from approximately 600 per 100,000 live births in 2000 to 400 per 100,000 live births in 2014. There was no strong evidence of spatial clustering for maternal mortality in this rural population. However, the study identified a significant spatial cluster of mother deaths in childhood (p = 0.022) in a peri-urban community near the national road. Based on our multivariable logistic regression model, HIV positive status (Adjusted odds ratio [aOR] = 2.5, CI 95%: [1.5–4.2]; primary education or less (aOR = 1.97, CI 95%: [1.04–3.74]) and parity (aOR = 1.42, CI 95%: [1.24–1.63]) were significant predictors of maternal mortality. Conclusions There has been an overall decrease in maternal and mother death between 2000 and 2014. The identification of a clear cluster of mother deaths shows the possibility of targeting intervention programs in vulnerable communities, as population-wide interventions may be ineffective and too costly to implement.
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Affiliation(s)
- B Tlou
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - B Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - F Tanser
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute University of KwaZulu-Natal, Mtubatuba, South Africa.,Centre for the AIDS Programme of Research in South Africa- CAPRISA, University of KwaZulu-Natal, Congella, South Africa
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7
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Tlou B, Sartorius B, Tanser F. Spatial-temporal dynamics and structural determinants of child and maternal mortality in a rural, high HIV burdened South African population, 2000-2014: a study protocol. BMJ Open 2016; 6:e010013. [PMID: 27421296 PMCID: PMC4964211 DOI: 10.1136/bmjopen-2015-010013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Child (infant and under-5) and maternal mortality rates are key indicators for assessing the health status of populations. South Africa's maternal and child mortality rates are high, and the country mirrors the continental trend of slow progress towards its Millennium Development Goals. Rural areas are often more affected regarding child and maternal mortalities, specifically in areas with a high HIV burden. This study aims to understand the factors affecting child and maternal mortality in the Africa Centre Demographic Surveillance Area (DSA) from 2003 to 2014 towards developing tailored interventions to reduce the deaths in resource poor settings. This will be done by identifying child and maternal mortality 'hotspots' and their associated risk factors. METHODS AND ANALYSIS This retrospective study will use data for 2003-2014 from the Africa Centre Demographic Information System (ACDIS) in rural KwaZulu-Natal Province, South Africa. All homesteads in the study area have been mapped to an accuracy of <2 m, all deaths recorded and the assigned cause of death established using a verbal autopsy interview. Advanced spatial-temporal clustering techniques (both regular (Kulldorff) and irregular (FleXScan)) will be used to identify mortality 'hotspots'. Various advanced statistical modelling approaches will be tested and used to identify significant risk factors for child and maternal mortality. Differences in attributability and risk factors profiles in identified 'hotspots' will be assessed to enable tailored intervention guidance/development. This multicomponent study will enable a refined intervention model to be developed for typical rural populations with a high HIV burden. ETHICS Ethical approval was received from the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (BE 169/15).
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Affiliation(s)
- B Tlou
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
| | - B Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
| | - F Tanser
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
- Centre for the AIDS Programme of Research in South Africa- CAPRISA, University of KwaZulu-Natal, Congella, South Africa
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8
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Probst C, Parry CDH, Rehm J. Socio-economic differences in HIV/AIDS mortality in South Africa. Trop Med Int Health 2016; 21:846-55. [PMID: 27118253 DOI: 10.1111/tmi.12712] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To quantify socio-economic differences in the risk of HIV/AIDS mortality in South Africa for different measures of socio-economic status. METHODS Systematic literature search in Web of Knowledge and PubMed. Measures of relative risk (RR) were pooled separately for education, income, assets score and employment status as measures of socio-economic status, using inverse-variance weighted DerSimonian-Laird random effects meta-analyses. RESULTS Ten studies were eligible for inclusion comprising over 175 000 participants and 6700 deaths. For income (RR 1.55, 95% confidence interval (CI) 1.15-2.09), assets score (RR 1.63, 95% CI 1.12-2.36) and employment status (RR 1.52, 95% CI 1.21-1.92), persons of low socio-economic status had an over 50% higher risk of dying from HIV/AIDS. The RR of 1.10 for education was not significant (95% CI 0.74-1.65). CONCLUSIONS Future research should identify effective strategies to reduce HIV/AIDS mortality and alleviate the consequences of HIV/AIDS deaths, particularly for poorer households.
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Affiliation(s)
- Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Charles D H Parry
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Abstract
OBJECTIVES Empirical estimates of the number of HIV/AIDS deaths are important for planning, budgeting, and calibrating models. However, there is an extensive misattribution of HIV/AIDS as an underlying cause-of-death. This study estimates the true numbers of AIDS deaths from South African vital statistics between 1997 and 2010. METHODS Individual-level cause-of-death data were grouped according to a local burden of disease list and source causes (i.e. causes under which AIDS deaths are misclassified) that recorded a rapid increase. After adjusting for completeness of registration, the mortality rate of the source causes, by age and sex, was regressed on the lagged HIV prevalence to estimate the rate of increase correlated with HIV. Background trends in the source-cause mortality rates were estimated from the trend experienced among 75-84 year olds. RESULTS Of 214 causes considered, 19 were identified as potential sources for cause misattribution. High proportions of deaths from tuberculosis, lower respiratory infections (mostly pneumonia), diarrhoeal diseases, and ill-defined natural causes were estimated to be HIV-related, with only 7% of the estimated AIDS deaths being recorded as HIV. Estimated HIV/AIDS deaths increased rapidly, then reversed after 2006, totalling 2.8 million deaths over the whole period. The number was lower than model estimates from Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Burden of Disease Study. CONCLUSION Empirically based estimates confirm the considerable loss of life from HIV/AIDS and should be used for calibrating models of the AIDS epidemic which generally appear too low for infants but too high for other ages. Doctors are urged to specify HIV on death notifications to provide reliable cause-of-death statistics.
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Myers B, Jones HE, Doherty IA, Kline TL, Key ME, Johnson K, Wechsberg WM. Correlates of lifetime trauma exposure among pregnant women from Cape Town, South Africa. Int J Ment Health Addict 2015; 13:307-321. [PMID: 27087804 DOI: 10.1007/s11469-015-9544-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A cross-sectional survey of 298 pregnant women from Cape Town, South Africa was conducted to examine socio-demographic, reproductive health, mental health, and relationship correlates of lifetime trauma exposure and whether these correlates vary as a function of age. Overall, 19.8% of participants reported trauma exposure. We found similarities and differences in correlates of trauma exposure among women in emerging adulthood and older women. Prior termination of pregnancy was associated with trauma exposure in both age groups. Difficulties in resolving arguments, lifetime substance use, and a prior sexually transmitted infection were associated with trauma exposure among women in emerging adulthood. In contrast, depression and awareness of substance abuse treatment programmes were associated with trauma exposure among older women. These findings highlight the need for interventions that prevent and treat trauma exposure among vulnerable women. Such interventions should be tailored to address the correlates of trauma exposure in each age group.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hendrée E Jones
- UNC Horizons Program, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, USA; Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Irene A Doherty
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Tracy L Kline
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Mary E Key
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wendee M Wechsberg
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA; Gillings Global School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Psychology in the Public Interest, North Carolina State University, North Carolina, USA; Psychiatry and Behavioral Sciences, Duke University School of Medicine, North Carolina, USA
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11
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Mutevedzi PC, Newell ML. Review: [corrected] The changing face of the HIV epidemic in sub-Saharan Africa. Trop Med Int Health 2014; 19:1015-28. [PMID: 24976370 DOI: 10.1111/tmi.12344] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The widespread roll-out of antiretroviral therapy (ART) has substantially changed the face of human immunodeficiency virus (HIV). Timely initiation of ART in HIV-infected individuals dramatically reduces mortality and improves employment rates to levels prior to HIV infection. Recent findings from several studies have shown that ART reduces HIV transmission risk even with modest ART coverage of the HIV-infected population and imperfect ART adherence. While condoms are highly effective in the prevention of HIV acquisition, they are compromised by low and inconsistent usage; male medical circumcision substantially reduces HIV transmission but uptake remains relatively low; ART during pregnancy, delivery and breastfeeding can virtually eliminate mother-to-child transmission but implementation is challenging, especially in resource-limited settings. The current HIV prevention recommendations focus on a combination of preventions approach, including ART as treatment or pre- or post-exposure prophylaxis together with condoms, circumcision and sexual behaviour modification. Improved survival in HIV-infected individuals and reduced HIV transmission risk is beginning to result in limited HIV incidence decline at population level and substantial increases in HIV prevalence. However, achievements in HIV treatment and prevention are threatened by the challenges of lifelong adherence to preventive and therapeutic methods and by the ageing of the HIV-infected cohorts potentially complicating HIV management. Although current thinking suggests prevention of HIV transmission through early detection of infection immediately followed by ART could eventually result in elimination of the HIV epidemic, controversies remain as to whether we can treat our way out of the HIV epidemic.
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Affiliation(s)
- Portia C Mutevedzi
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
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12
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Slaymaker E, Todd J, Marston M, Calvert C, Michael D, Nakiyingi-Miiro J, Crampin A, Lutalo T, Herbst K, Zaba B. How have ART treatment programmes changed the patterns of excess mortality in people living with HIV? Estimates from four countries in East and Southern Africa. Glob Health Action 2014; 7:22789. [PMID: 24762982 PMCID: PMC3999950 DOI: 10.3402/gha.v7.22789] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/24/2014] [Accepted: 03/11/2014] [Indexed: 11/18/2022] Open
Abstract
Background Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries. We report the excess deaths observed in PLWH before and after the introduction of ART. We use data from five longitudinal studies in Malawi, South Africa, Tanzania, and Uganda, members of the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). Methods Individual data from five demographic surveillance sites that conduct HIV testing were used to estimate mortality attributable to HIV, calculated as the difference between the mortality rates in PLWH and HIV-negative people. Excess deaths in PLWH were standardized for age and sex differences and summarized over periods before and after ART became generally available. An exponential regression model was used to explore differences in the impact of ART over the different sites. Results 127,585 adults across the five sites contributed a total of 487,242 person years. Before the introduction of ART, HIV-attributable mortality ranged from 45 to 88 deaths per 1,000 person years. Following ART availability, this reduced to 14–46 deaths per 1,000 person years. Exponential regression modeling showed a reduction of more than 50% (HR =0.43, 95% CI: 0.32–0.58), compared to the period before ART was available, in mortality at ages 15–54 across all five sites. Discussion Excess mortality in adults living with HIV has reduced by over 50% in five communities in sub-Saharan Africa since the advent of ART. However, mortality rates in adults living with HIV are still 10 times higher than in HIV-negative people, indicating that substantial improvements can be made to reduce mortality further. This analysis shows differences in the impact across the sites, and contrasts with developed countries where mortality among PLWH on ART can be similar to that of the general population. Further research is urgently needed to establish why the different impacts on mortality were observed and how the care and treatment programmes in these countries can be more effective in reducing mortality further.
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Affiliation(s)
- Emma Slaymaker
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK;
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK; TAZAMA Project, National Institute for Medical Research, Mwanza, Tanzania
| | - Milly Marston
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Calvert
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Denna Michael
- TAZAMA Project, National Institute for Medical Research, Mwanza, Tanzania
| | - Jessica Nakiyingi-Miiro
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Research Unit on AIDS, Entebbe, Uganda
| | - Amelia Crampin
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK; Karonga Prevention Study, Chilumba, Malawi
| | - Tom Lutalo
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Kobus Herbst
- The Africa Centre for Health and Population Studies, University of KwaZulu-Natal (UKZN), Somkhele, South Africa
| | - Basia Zaba
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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