Abstract
ABSTRACT Background: Seasonal patterns of mortality have been identified in Sub-Saharan Africa but their changes over time are not well documented. Objective: Based on death notification data from Antananarivo, the capital city of Madagascar, this study assesses seasonal patterns of all-cause and cause-specific mortality by age groups and evaluates how these patterns changed over the period 1976–2015. Methods: Monthly numbers of deaths by cause were obtained from death registers maintained by the Municipal Hygiene Office in charge of verifying deaths before the issuance of burial permits. Generalized Additive Mixed regression models (GAMM) were used to test for seasonality in mortality and its changes over the last four decades, controlling for long-term trends in mortality. Results: Among children, risks of dying were the highest during the hot and rainy season, but seasonality in child mortality has significantly declined since the mid-1970s, as a result of declines in the burden of infectious diseases and nutritional deficiencies. In adults aged 60 and above, all-cause mortality rates are the highest in the dry and cold season, due to peaks in cardiovascular diseases, with little change over time. Overall, changes in the seasonality of all-cause mortality have been driven by shifts in the hierarchy of causes of death, while changes in the seasonality within broad categories of causes of death have been modest. Conclusion: Shifts in disease patterns brought about by the epidemiological transition, rather than changes in seasonal variation in cause-specific mortality, are the main drivers of trends in the seasonality of all-cause mortality.
Highlights
Seasonal patterns of mortality have been identified in Sub-Saharan Africa but their changes over time are not well documented
We examine whether changes in seasonal variation can be ascribed to changes in the seasonality of cause-specific mortality or shifts in the hierarchy of causes of death
Due to shifts in the age structure of the population and the decline in under-five mortality, the two younger age groups experienced a downward trend while the two older age groups showed an upward trend in their monthly mortality counts (Figure 2)
Summary
Seasonal patterns of mortality have been identified in Sub-Saharan Africa but their changes over time are not well documented. Conclusion: Shifts in disease patterns brought about by the epidemiological transition, rather than changes in seasonal variation in cause-specific mortality, are the main drivers of trends in the seasonality of all-cause mortality. Food intake can vary substantially seasonally, from fluctuations in access to fruit and vegetables through to the emergence of a ‘hungry season’ in the most severe cases, where poor rural families are unable to maintain body weight and function throughout the year [2]. Both non-infectious and infectious causes of mortality will be modulated by such underlying biology. Seasonal patterns of human behavior have been shown to be a key driver of infections, with seasonal aggregation due to school terms [7] or seasonal migration [8] increasing the magnitude of measles transmission
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