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Acharya A, Chowdhury HR, Ihyauddin Z, Mahesh PKB, Adair T. Cardiovascular disease mortality based on verbal autopsy in low- and middle-income countries: a systematic review. Bull World Health Organ 2023; 101:571-586. [PMID: 37638359 PMCID: PMC10452938 DOI: 10.2471/blt.23.289802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 08/29/2023] Open
Abstract
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.
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Affiliation(s)
- Ajay Acharya
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | | | - Zulfikar Ihyauddin
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | - Pasyodun Koralage Buddhika Mahesh
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | - Tim Adair
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
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Meles GG, Ayele G, Gutema BT, Kondale M, Zerdo Z, Merdekios B, Tsalla T, Kote M, Baharu A, Bekele A, Gebremeskel F, Shegaze M, Gultie T. Causes and trends of adult mortality in southern Ethiopia: an eight-year follow up database study. BMC Infect Dis 2023; 23:29. [PMID: 36653766 PMCID: PMC9850514 DOI: 10.1186/s12879-023-07988-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
- Gebrekiros Gebremichael Meles
- grid.30820.390000 0001 1539 8988School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gistane Ayele
- grid.442844.a0000 0000 9126 7261School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Befikadu Tariku Gutema
- grid.442844.a0000 0000 9126 7261School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mekides Kondale
- grid.442844.a0000 0000 9126 7261School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Zerihun Zerdo
- grid.442844.a0000 0000 9126 7261Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Behailu Merdekios
- grid.442844.a0000 0000 9126 7261School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tsegaye Tsalla
- grid.442844.a0000 0000 9126 7261Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mesfin Kote
- grid.442844.a0000 0000 9126 7261School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Alazar Baharu
- grid.442844.a0000 0000 9126 7261Department of Computer Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Alemayehu Bekele
- grid.428935.10000 0000 9552 339XEthiopian Public Health Association, Addis Ababa, Ethiopia
| | - Feleke Gebremeskel
- grid.442844.a0000 0000 9126 7261School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mulugeta Shegaze
- grid.442844.a0000 0000 9126 7261School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia ,grid.27255.370000 0004 1761 1174School of Public Health, Cheeloo College of Medicine, ShandongUniversity, Jinan, Shandong 250012, China
| | - Teklemariam Gultie
- grid.442844.a0000 0000 9126 7261Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Aleme H, Mekonnen W, Worku A. Cause-Specific Mortality Fraction (CSMF) of adult mortality in Butajira, South Central Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000415. [PMID: 36962958 PMCID: PMC10021511 DOI: 10.1371/journal.pgph.0000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/11/2023] [Indexed: 03/14/2023]
Abstract
Cause- and context-specific mortality data are imperative to understand the extent of health problems in low-income settings, where national death registration and cause of death identification systems are at a rudimentary stage. Aiming to estimate cause-specific mortality fractions, adult (15+ years) deaths between January 2008 and April 2020 were extracted from the Butajira health and demographic surveillance system electronic database. The physician review and a computerized algorithm, InterVA (Interpreting Verbal Autopsy), methods were used to assign the likely causes of death from January 2008 to April 2017 (the first) and May 2017 to April 2020 (the second) phase of the surveillance period, respectively. Initially, adult mortality rates per 1000py across sex and age were summarized. A total of 1,625 deaths were captured in 280, 461 person-years, with an overall mortality rate of 5.8 (95%CI: 5.5, 6.0) per 1000py. Principally, mortality fractions for each specific cause of death were estimated, and for 1,571 deaths, specific causes were determined. During the first phase, the leading cause of death was tuberculosis (13.6%), followed by hypertension (6.6%) and chronic liver disease (5.9%). During the second phase, digestive neoplasms (17.3%), tuberculosis (12.1%), and stroke (9.4%) were the leading causes of death, respectively. Moreover, tuberculosis was higher among persons aged 50+ (15.0%), males (13.8%), and in rural areas (14.1%) during the first phase. Hypertensive diseases were higher among females (7.9%) and in urbanities. In the second phase, digestive neoplasms were higher in the age group of 50-64 years (25.4%) and females (19.0%), and stroke was higher in older adults (65+) (10%) and marginally higher among males (9.7%). Our results showed that tuberculosis and digestive neoplasms were the most common causes of death. Hence, prevention, early detection, and management of cases at all levels of the existing healthcare system should be prioritized to avert premature mortality.
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Affiliation(s)
- Hailelule Aleme
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubegzier Mekonnen
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Yizengaw HA, Ayele WM, Yalew AW. The trend and pattern of adult mortality in South-Central Ethiopia: analysis using the 2008-2019 data from Butajira Health and Demographic Surveillance System. Glob Health Action 2022; 15:2118180. [PMID: 36178408 PMCID: PMC9542780 DOI: 10.1080/16549716.2022.2118180] [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] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Hailelule Aleme Yizengaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubegzier Mekonnen Ayele
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku Yalew
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Owusu AY, Kushitor SB, Ofosu AA, Kushitor MK, Ayi A, Awoonor-Williams JK. Institutional mortality rate and cause of death at health facilities in Ghana between 2014 and 2018. PLoS One 2021; 16:e0256515. [PMID: 34496000 PMCID: PMC8425528 DOI: 10.1371/journal.pone.0256515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The epidemiological transition, touted as occurring in Ghana, requires research that tracks the changing patterns of diseases in order to capture the trend and improve healthcare delivery. This study examines national trends in mortality rate and cause of death at health facilities in Ghana between 2014 and 2018. METHODS Institutional mortality data and cause of death from 2014-2018 were sourced from the Ghana Health Service's District Health Information Management System. The latter collates healthcare service data routinely from government and non-governmental health institutions in Ghana yearly. The institutional mortality rate was estimated using guidelines from the Ghana Health Service. Percent change in mortality was examined for 2014 and 2018. In addition, cause of death data were available for 2017 and 2018. The World Health Organisation's 11th International Classification for Diseases (ICD-11) was used to group the cause of death. RESULTS Institutional mortality decreased by 7% nationally over the study period. However, four out of ten regions (Greater Accra, Volta, Upper East, and Upper West) recorded increases in institutional mortality. The Upper East (17%) and Volta regions (13%) recorded the highest increase. Chronic non-communicable diseases (NCDs) were the leading cause of death in 2017 (25%) and 2018 (20%). This was followed by certain infectious and parasitic diseases (15% for both years) and respiratory infections (10% in 2017 and 13% in 2018). Among the NCDs, hypertension was the leading cause of death with 2,243 and 2,472 cases in 2017 and 2018. Other (non-ischemic) heart diseases and diabetes were the second and third leading NCDs. Septicaemia, tuberculosis and pneumonia were the predominant infectious diseases. Regional variations existed in the cause of death. NCDs showed more urban-region bias while infectious diseases presented more rural-region bias. CONCLUSIONS This study examined national trends in mortality rate and cause of death at health facilities in Ghana. Ghana recorded a decrease in institutional mortality throughout the study. NCDs and infections were the leading causes of death, giving a double-burden of diseases. There is a need to enhance efforts towards healthcare and health promotion programmes for NCDs and infectious diseases at facility and community levels as outlined in the 2020 National Health Policy of Ghana.
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Affiliation(s)
- Adobea Yaa Owusu
- Institute of Statistical, Social and Economic Research (ISSER), College of Humanities, University of Ghana, Legon, Ghana
- * E-mail: ,
| | | | | | - Mawuli Komla Kushitor
- Department of Health, Policy Planning, and Management, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Atsu Ayi
- Ghana Health Service, Accra, Ghana
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Manyeh AK, Amu A, Akpakli DE, Williams JE, Gyapong M. Estimating the rate and determinants of exclusive breastfeeding practices among rural mothers in Southern Ghana. Int Breastfeed J 2020; 15:7. [PMID: 32033567 PMCID: PMC7006185 DOI: 10.1186/s13006-020-0253-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 02/04/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The health benefits of exclusive breastfeeding practices in both the short and long term accrue to breastfed infants, mothers, families and the society at large. Despite the evidence of these benefits and adoption of various World Health Organization (WHO) strategies on promotion of exclusive breastfeeding by Ghana, the increase in the rate of exclusive breastfeeding has been very slow in the country. This study aimed to estimate the rate and investigate socio-economic and demographic determinants of 6 months exclusive breastfeeding in two rural districts in Southern Ghana. METHODS Pregnancy, childbirth, breastfeeding, demographic and socioeconomic information of 1870 women who were prospectively registered by the Dodowa Health and Demographic Surveillance System and gave birth between 1 January 2011 and 31 December 2013 was extracted. The proportion of 6 months exclusive breastfeeding among the study participants was estimated and the relationship between the dependent and the independent variables were explored using logistics regression model at 95% confidence level. RESULTS The proportion of mothers who exclusive breastfed for 6 months in the study was 71.0%. Mothers aged 25-29 and 30 + years are 93 and 91% respectively more likely to practice 6 months exclusive breastfeeding compared to those aged < 20 years (OR 1.93, 95% CI 1.25, 2.99, OR 1.91, 95% CI 1.91, 3.08). The odds of artisan mothers practicing 6 months exclusive breastfeeding is 36% less likely compared to those unemployed (OR 0.64, 95% CI 0.43, 0.96). There is a higher chance that 45% of mothers with a household size of more than five members to practice exclusive breastfeeding compared to those with household size of less than six (OR 1.45, 95% CI 1.16, 1.81). Women in the fishing district were 85% less likely to practice 6 months exclusive breastfeeding compared to those in farming district (OR 0.15, 95% CI 0.12, 0.20). CONCLUSION There is high rate of exclusive breastfeeding in the study area. Maternal age, type of occupation, household size and district of residence are determinants of 6 months exclusive breastfeeding among the study participants.
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Affiliation(s)
- Alfred Kwesi Manyeh
- Dodowa Health Research Centre, Dodowa, Ghana
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
- University of Health and Allied Sciences, Ho, Volta Region Ghana
| | - Alberta Amu
- Dodowa Health Research Centre, Dodowa, Ghana
- Ghana Health Service, Accra, Ghana
| | - David Etsey Akpakli
- Dodowa Health Research Centre, Dodowa, Ghana
- Ghana Health Service, Accra, Ghana
| | - John E. Williams
- Dodowa Health Research Centre, Dodowa, Ghana
- Ghana Health Service, Accra, Ghana
| | - Margaret Gyapong
- University of Health and Allied Sciences, Ho, Volta Region Ghana
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Manyeh AK, Amu A, Williams J, Gyapong M. Factors associated with the timing of antenatal clinic attendance among first-time mothers in rural southern Ghana. BMC Pregnancy Childbirth 2020; 20:47. [PMID: 31959137 PMCID: PMC6972022 DOI: 10.1186/s12884-020-2738-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is an important period to promote healthy behaviors, prevent and identify diseases early and treat them to maximize the health and development of both the woman and her unborn child. A new World Health Organization antenatal care model recommends the initiation of antenatal care visit within the first trimester of gestation. This study sought to examine the timing of initiation of antenatal care among first-time mothers and associated factors in rural Southern Ghana. METHODS Information on gestational age, timing of antenatal care, demographic and socioeconomic status of 1076 first-time mothers who gave birth in 2011 to 2013 in the Dodowa Health and Demographic Surveillance System were included in the study. The time of initiation of antenatal clinic attendance was calculated. The associations between dependent and independent variables were explored using logistic regression at 95% confidence interval in STATA version 14.2. RESULTS The mean gestational age at which the first-time mothers initiated antenatal care attendance was 3 month. Maternal age, level of education and household socioeconomic status were statistically significantly associated with timing of initiation of antenatal care attendance. CONCLUSION Although more than half of the study participants initiated ANC visit in the first trimester of pregnancy, a high proportion also started ANC attendance after the World Health Organization recommended period. Maternal age is significantly associated with timing of initiation of antenatal care visit among first-time mothers; older women were more likely to initiate antenatal care visit in the first trimester of gestation compared to the younger women.
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Affiliation(s)
- Alfred Kwesi Manyeh
- Dodowa Health Research Centre, Dodowa, Ghana. .,Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg, South Africa. .,Centre for Health Policy and Implementation Research, Institute for Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana. .,INDEPTH Network, Accra, Ghana.
| | - Alberta Amu
- Dodowa Health Research Centre, Dodowa, Ghana.,INDEPTH Network, Accra, Ghana.,Ghana Health Service, Accra, Ghana
| | - John Williams
- Dodowa Health Research Centre, Dodowa, Ghana.,INDEPTH Network, Accra, Ghana.,Ghana Health Service, Accra, Ghana
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Institute for Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Manyeh AK, Amu A, Williams J, Gyapong M. Factors associated with the timing of antenatal clinic attendance among first-time mothers in rural southern Ghana. BMC Pregnancy Childbirth 2020. [PMID: 31959137 DOI: 10.1186/s12884-020-2738-0.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is an important period to promote healthy behaviors, prevent and identify diseases early and treat them to maximize the health and development of both the woman and her unborn child. A new World Health Organization antenatal care model recommends the initiation of antenatal care visit within the first trimester of gestation. This study sought to examine the timing of initiation of antenatal care among first-time mothers and associated factors in rural Southern Ghana. METHODS Information on gestational age, timing of antenatal care, demographic and socioeconomic status of 1076 first-time mothers who gave birth in 2011 to 2013 in the Dodowa Health and Demographic Surveillance System were included in the study. The time of initiation of antenatal clinic attendance was calculated. The associations between dependent and independent variables were explored using logistic regression at 95% confidence interval in STATA version 14.2. RESULTS The mean gestational age at which the first-time mothers initiated antenatal care attendance was 3 month. Maternal age, level of education and household socioeconomic status were statistically significantly associated with timing of initiation of antenatal care attendance. CONCLUSION Although more than half of the study participants initiated ANC visit in the first trimester of pregnancy, a high proportion also started ANC attendance after the World Health Organization recommended period. Maternal age is significantly associated with timing of initiation of antenatal care visit among first-time mothers; older women were more likely to initiate antenatal care visit in the first trimester of gestation compared to the younger women.
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Affiliation(s)
- Alfred Kwesi Manyeh
- Dodowa Health Research Centre, Dodowa, Ghana. .,Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg, South Africa. .,Centre for Health Policy and Implementation Research, Institute for Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana. .,INDEPTH Network, Accra, Ghana.
| | - Alberta Amu
- Dodowa Health Research Centre, Dodowa, Ghana.,INDEPTH Network, Accra, Ghana.,Ghana Health Service, Accra, Ghana
| | - John Williams
- Dodowa Health Research Centre, Dodowa, Ghana.,INDEPTH Network, Accra, Ghana.,Ghana Health Service, Accra, Ghana
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Institute for Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Manyeh AK, Amu A, Akpakli DE, Williams J, Gyapong M. Socioeconomic and demographic factors associated with caesarean section delivery in Southern Ghana: evidence from INDEPTH Network member site. BMC Pregnancy Childbirth 2018; 18:405. [PMID: 30326869 PMCID: PMC6191905 DOI: 10.1186/s12884-018-2039-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/03/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In recent years, caesarean section rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate caesarean section rate and the associated short- and long-term risks. This study sought to identify the rate of caesarean section and associated factors in two districts in rural southern Ghana. METHODS Pregnancy, birth, and socio-demographic information of 4948 women who gave birth between 2011 and 2013 were obtained from the database of Dodowa Health and Demographic Surveillance System. The rate of C-section was determined and the associations between independent and dependent variables were explored using logistic regression. The analyses were done in STATA 14.2 at 95% confidence interval. RESULTS The overall C-section rate for the study period was 6.59%. Women aged 30-34 years were more than twice likely to have C-section compared to those < 20 year (OR: 2.16, 95% CI: 1.20-3.90). However, women aged 34 years and above were more than thrice likely to undergo C-section compared to those < 20 year (OR: 3.73, 95% CI: 1.45-5.17). The odds of having C-section was 65 and 79% higher for participants with Primary and Junior High level schooling respectively (OR: 1.65, 95% CI: 1.08-2.51, OR:1.79, 95%CI: 1.19-2.70). The likelihood of having C-section delivery reduced by 60, 37, and 35% for women with parities 2, 3 and 3+ respectively (OR:0.60, 95% CI: 0.43-0.83, OR: 0.37, 95% CI: 0.25-0.56, OR:0.35, 95% CI: 0.25-0.54). There were increased odds of 36, 52, 83% for women who belong to poorer, middle, and richer wealth quintiles respectively (OR: 1.36, 95%CI: 0.85-2.18, OR: 1.52, 95% CI: 0.97-2.37, OR: 1.83, 95% CI: 1.20-2.80). Participants who belonged to the richest wealth quintile were more than 2 times more likely to have C-section delivery (OR: 2.14, 95%CI: 1.43-3.20). The odds of having C-section delivery reduced by 76% for women from Ningo-Prampram district (OR: 0.76, 95% CI: 0.59.0.96). Women whose household heads have Junior High level and above of education were 45% more likely to have C-section delivery (OR: 1.45, 95% CI: 1.09-1.93). CONCLUSION Age of mother, educational level, parity, household socioeconomic status, district of residence, and level of education of household head are associated with caesarean section delivery.
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Affiliation(s)
- Alfred Kwesi Manyeh
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Alberta Amu
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Ghana Health Service, Accra, Ghana
| | - David Etsey Akpakli
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Ghana Health Service, Accra, Ghana
| | - John Williams
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Ghana Health Service, Accra, Ghana
| | - Margarete Gyapong
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Centre for Health Policy and Implementation Research, Institute for Health Research, University of Health and Allied Sciences, Volta Region, Ho, Ghana
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10
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Joshi R, Faruqui N, Nagarajan SR, Rampatige R, Martiniuk A, Gouda H. Reporting of ethics in peer-reviewed verbal autopsy studies: a systematic review. Int J Epidemiol 2018; 47:255-279. [PMID: 29092034 DOI: 10.1093/ije/dyx216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction Verbal autopsy (VA) is a method that determines the cause of death by interviewing a relative of the deceased about the events occurring before the death, in regions where medical certification of cause of death is incomplete. This paper aims to review the ethical standards reported in peer-reviewed VA studies. Methods A systematic review of Medline and Ovid was conducted by two independent researchers. Data were extracted and analysed for articles based on three key areas: Institutional Review Board (IRB) clearance and consenting process; data collection and management procedures, including: time between death and interview; training and education of interviewer, confidentiality of data and data security; and declarations of funding and conflict of interest. Results The review identified 802 articles, of which 288 were included. The review found that 48% all the studies reported having IRB clearance or obtaining consent of participants. The interviewer training and education levels were reported in 62% and 21% of the articles, respectively. Confidentiality of data was reported for 14% of all studies, 18% did not report the type of respondent interviewed and 51% reported time between death and the interview for the VA. Data security was reported in 8% of all studies. Funding was declared in 63% of all studies and conflict of interest in 42%. Reporting of all these variables increased over time. Conclusions The results of this systematic review show that although there has been an increase in ethical reporting for VA studies, there still remains a large gap in reporting.
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Affiliation(s)
- Rohina Joshi
- George Institute for Global Health
- University of New South Wales
- University of Sydney, Sydney, NSW, Australia
| | - Neha Faruqui
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Alex Martiniuk
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | - Hebe Gouda
- School of Public Health
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, QLD, Australia
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11
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Herrera S, Enuameh Y, Adjei G, Ae-Ngibise KA, Asante KP, Sankoh O, Owusu-Agyei S, Yé Y. A systematic review and synthesis of the strengths and limitations of measuring malaria mortality through verbal autopsy. Malar J 2017; 16:421. [PMID: 29058621 PMCID: PMC5651608 DOI: 10.1186/s12936-017-2071-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/16/2017] [Indexed: 01/08/2023] Open
Abstract
Background Lack of valid and reliable data on malaria deaths continues to be a problem that plagues the global health community. To address this gap, the verbal autopsy (VA) method was developed to ascertain cause of death at the population level. Despite the adoption and wide use of VA, there are many recognized limitations of VA tools and methods, especially for measuring malaria mortality. This study synthesizes the strengths and limitations of existing VA tools and methods for measuring malaria mortality (MM) in low- and middle-income countries through a systematic literature review. Methods The authors searched PubMed, Cochrane Library, Popline, WHOLIS, Google Scholar, and INDEPTH Network Health and Demographic Surveillance System sites’ websites from 1 January 1990 to 15 January 2016 for articles and reports on MM measurement through VA. Inclusion criteria: article presented results from a VA study where malaria was a cause of death; article discussed limitations/challenges related to measurement of MM through VA. Two authors independently searched the databases and websites and conducted a synthesis of articles using a standard matrix. Results The authors identified 828 publications; 88 were included in the final review. Most publications were VA studies; others were systematic reviews discussing VA tools or methods; editorials or commentaries; and studies using VA data to develop MM estimates. The main limitation were low sensitivity and specificity of VA tools for measuring MM. Other limitations included lack of standardized VA tools and methods, lack of a ‘true’ gold standard to assess accuracy of VA malaria mortality. Conclusions Existing VA tools and methods for measuring MM have limitations. Given the need for data to measure progress toward the World Health Organization’s Global Technical Strategy for Malaria 2016–2030 goals, the malaria community should define strategies for improving MM estimates, including exploring whether VA tools and methods could be further improved. Longer term strategies should focus on improving countries’ vital registration systems for more robust and timely cause of death data. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-2071-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samantha Herrera
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | - Yeetey Enuameh
- Kintampo Health Research Centre, Kintampo, Ghana.,School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - George Adjei
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | - Osman Sankoh
- INDEPTH Network, 38 & 40 Mensah Wood Street, East Legon, Accra, Ghana.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Mathematics and Statistics, Njala University, Njala, Sierra Leone
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Kintampo, Ghana.,Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Yazoume Yé
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA
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12
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Kebede Y, Andargie G, Gebeyehu A, Awoke T, Yitayal M, Mekonnen S, Wubshet M, Azmeraw T, Lakew Y, Alemu K. Tuberculosis and HIV are the leading causes of adult death in northwest Ethiopia: evidence from verbal autopsy data of Dabat health and demographic surveillance system, 2007-2013. Popul Health Metr 2017; 15:27. [PMID: 28716042 PMCID: PMC5513201 DOI: 10.1186/s12963-017-0139-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 06/23/2017] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Reliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system. METHODS Causes of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose. RESULTS Communicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death. CONCLUSION Tuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.
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Affiliation(s)
- Yigzaw Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PoBox, 196, Gondar, Ethiopia
| | - Gashaw Andargie
- Department of Health Service Management, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Abebaw Gebeyehu
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PoBox, 196, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Service Management, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mamo Wubshet
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Temesgen Azmeraw
- Dabat Health and Demographic Surveillance Site, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yihunie Lakew
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PoBox, 196, Gondar, Ethiopia
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13
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Manyeh AK, Akpakli DE, Kukula V, Ekey RA, Narh-Bana S, Adjei A, Gyapong M. Socio-demographic determinants of skilled birth attendant at delivery in rural southern Ghana. BMC Res Notes 2017; 10:268. [PMID: 28693617 PMCID: PMC5504761 DOI: 10.1186/s13104-017-2591-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/30/2017] [Indexed: 11/26/2022] Open
Abstract
Background Maternal mortality is the subject of the United Nations’ fifth Millennium Development Goal, which is to reduce the maternal mortality ratio by three quarters from 1990 to 2015. The giant strides made by western countries in dropping of their maternal mortality ratio were due to the recognition given to skilled attendants at delivery. In Ghana, nine in ten mothers receive antenatal care from a health professional whereas only 59 and 68% of deliveries are assisted by skilled personnel in 2008 and 2010 respectively. This study therefore examines the determinants of skilled birth attendant at delivery in rural southern Ghana. Methods This study comprises of 1874 women of reproductive age who had given birth 2 years prior to the study whose information were extracted from the Dodowa Health and Demographic Surveillance System. The univariable and multivariable associations between exposure variables (risk factors) and skilled birth attendant at delivery were explored using logistic regression. Results Out of a total of 1874 study participants, 98.29% of them receive antenatal care services during pregnancy and only 68.89% were assisted by skilled person at their last delivery prior to the survey. The result shows a remarkable influence of maternal age, level of education, parity, socioeconomic status and antenatal care attendance on skilled attendants at delivery. Conclusion Although 69% of women in the study had skilled birth attendants at delivery, women from poorest households, higher parity, uneducated, and not attending antenatal care and younger women were more likely to deliver without a skilled birth attendants at delivery. Future intervention in the study area to bridge the gap between the poor and least poor women, improve maternal health and promote the use of skilled birth at delivery is recommended.
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Affiliation(s)
| | - David Etsey Akpakli
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra, Ghana.,Ghana Health Services, Accra, Ghana
| | - Vida Kukula
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra, Ghana.,Ghana Health Services, Accra, Ghana
| | | | - Solomon Narh-Bana
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra, Ghana.,Ghana Health Services, Accra, Ghana
| | - Alexander Adjei
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra, Ghana.,Shai-Osudoku District Hospital, Dodowa, Ghana.,Ghana Health Services, Accra, Ghana
| | - Margaret Gyapong
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra, Ghana.,Ghana Health Services, Accra, Ghana
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14
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Manyeh AK, Kukula V, Odonkor G, Ekey RA, Adjei A, Narh-Bana S, Akpakli DE, Gyapong M. Socioeconomic and demographic determinants of birth weight in southern rural Ghana: evidence from Dodowa Health and Demographic Surveillance System. BMC Pregnancy Childbirth 2016; 16:160. [PMID: 27417308 PMCID: PMC4946169 DOI: 10.1186/s12884-016-0956-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) is one of the major factors affecting child morbidity and mortality worldwide. It also results in substantial costs to the health sector and imposes a significant burden on the society as a whole. This study seeks to investigate the determinants of low birth weight and the incidence of LBW in southern rural Ghana. METHODS Pregnancy, birth, demographic and socioeconomic information of 6777 mothers who gave birth in 2011, 2012, and 2013 and information on their babies were extracted from a database. The database of Dodowa Health and Demographic Surveillance System is a longitudinal follow-up of over 24,000 households. The incidence of LBW was calculated and the univariable and multivariable associations between exposure variables and outcome were explored using logistic regression. STATA 11 was used for the analyses. RESULT The results revealed that 40.21 % of the infants were not weighed at birth and the incidence of LBW for 2011 to 2013 was 8.72, 7.04 and 7.52 % respectively. Women aged 20-24, 25-29, 30-34 years were more than twice more likely to have babies weighing ≥2.5 kg compared to those <20 years (OR:2.32, 95 % CI:1.65-3.26, OR:2.73, 95 % CI:1.96-3.79, OR:2.87, 95 % CI:2.06-4.01) and mothers who were >34 years were more than three times more likely to have babies weighed ≥2.5 kg (OR: 3.59, 95 % CI:2.56-5.04). Mothers who were civil servants were 77 % more likely to have babies weighed ≥2.5 kg (OR: 1.77, 95 % CI: 1.99-2.87) compared to those who were unemployed. After adjusting for other explanation variables, mothers from poorer households were 30 % more likely to have babies who weighed ≥2.5 kg (OR: 1.30, 95 % CI: 1.01-1.66) compared to those from the poorest households. Women with parity2 and parity > 3 were 30 % and 81 % more likely to have babies weighing ≥2.5 kg (OR: 1.30, 95 % CI: 1.03-1.63, OR: 1.81, 95 % CI: 1.38-2.35) compared to those with parity1. Male infants were 52 % more likely to weigh ≥2.5 kg at birth (OR: 1.52, 95 % CI: 1.32-1.76) compared to females. CONCLUSION Our study revealed that having infant birth weight ≥ 2.5 kg is highly associated with socioeconomic status of women household, the gender of an infant, parity, occupation and maternal age.
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Affiliation(s)
| | - Vida Kukula
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Ghana.,Ghana Health Services, Accra, Ghana
| | - Gabriel Odonkor
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Ghana
| | | | - Alexander Adjei
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Ghana.,Shai-Osudoku District Hospital, Dodowa, Ghana.,Ghana Health Services, Accra, Ghana
| | - Solomon Narh-Bana
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Ghana.,Ghana Health Services, Accra, Ghana
| | - David Etsey Akpakli
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Ghana.,Ghana Health Services, Accra, Ghana
| | - Margaret Gyapong
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Ghana.,Ghana Health Services, Accra, Ghana
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15
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Streatfield PK, Khan WA, Bhuiya A, Alam N, Sié A, Soura AB, Bonfoh B, Ngoran EK, Weldearegawi B, Jasseh M, Oduro A, Gyapong M, Kant S, Juvekar S, Wilopo S, Williams TN, Odhiambo FO, Beguy D, Ezeh A, Kyobutungi C, Crampin A, Delaunay V, Tollman SM, Herbst K, Chuc NTK, Sankoh OA, Tanner M, Byass P. Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Glob Health Action 2014; 7:25362. [PMID: 25377324 PMCID: PMC4220126 DOI: 10.3402/gha.v7.25362] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Because most deaths in Africa and Asia are not well documented, estimates of mortality are often made using scanty data. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering all deaths over time and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE To build a large standardised mortality database from African and Asian sites, detailing the relevant methods, and use it to describe cause-specific mortality patterns. DESIGN Individual demographic and verbal autopsy (VA) data from 22 INDEPTH sites were collated into a standardised database. The INDEPTH 2013 population was used for standardisation. The WHO 2012 VA standard and the InterVA-4 model were used for assigning cause of death. RESULTS A total of 111,910 deaths occurring over 12,204,043 person-years (accumulated between 1992 and 2012) were registered across the 22 sites, and for 98,429 of these deaths (88.0%) verbal autopsies were successfully completed. There was considerable variation in all-cause mortality between sites, with most of the differences being accounted for by variations in infectious causes as a proportion of all deaths. CONCLUSIONS This dataset documents individual deaths across Africa and Asia in a standardised way, and on an unprecedented scale. While INDEPTH sites are not constructed to constitute a representative sample, and VA may not be the ideal method of determining cause of death, nevertheless these findings represent detailed mortality patterns for parts of the world that are severely under-served in terms of measuring mortality. Further papers explore details of mortality patterns among children and specifically for NCDs, external causes, pregnancy-related mortality, malaria, and HIV/AIDS. Comparisons will also be made where possible with other findings on mortality in the same regions. Findings presented here and in accompanying papers support the need for continued work towards much wider implementation of universal civil registration of deaths by cause on a worldwide basis.
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Affiliation(s)
- P Kim Streatfield
- Matlab HDSS, Bangladesh; International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana
| | - Wasif A Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana; Bandarban HDSS, Bangladesh
| | - Abbas Bhuiya
- INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nurul Alam
- INDEPTH Network, Accra, Ghana; AMK HDSS, Bangladesh; Centre for Population, Urbanisation and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Ali Sié
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Abdramane B Soura
- INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso
| | - Bassirou Bonfoh
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Eliezer K Ngoran
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; Université Félix Houphoët-Boigny, Abidjan, Côte d'Ivoire
| | - Berhe Weldearegawi
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Momodou Jasseh
- INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Abraham Oduro
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Margaret Gyapong
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana
| | - Shashi Kant
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Juvekar
- INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Siswanto Wilopo
- INDEPTH Network, Accra, Ghana; Purworejo HDSS, Indonesia; Department of Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Thomas N Williams
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Medicine, Imperial College, St. Mary's Hospital, London
| | - Frank O Odhiambo
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Donatien Beguy
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Alex Ezeh
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Catherine Kyobutungi
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Amelia Crampin
- INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; Karonga Prevention Study, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Valérie Delaunay
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Stephen M Tollman
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Kobus Herbst
- INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa
| | - Nguyen T K Chuc
- INDEPTH Network, Accra, Ghana; FilaBavi HDSS, Vietnam; Health System Research, Hanoi Medical University, Hanoi, Vietnam
| | - Osman A Sankoh
- INDEPTH Network, Accra, Ghana; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hanoi Medical University, Hanoi, Vietnam;
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Peter Byass
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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