Abstract
ObjectiveTo determine causes of death and associated risk factors in women of reproductive age in rural South Africa.MethodsDeaths and person-years of observation (pyo) were determined for females (aged 15–49 years) resident in 15,526 households in a rural South African Demographic and Health Surveillance site from 2000 to 2009. Cause of death was ascertained by verbal autopsy and ICD-10 coded; causes were categorized as HIV/TB, non-communicable, communicable/maternal/perinatal/nutrition, injuries, and undetermined (unknown). Characteristics of women were obtained from regularly updated household visits, while HIV and self-reported health status was obtained from the annual HIV surveillance. Overall and cause-specific mortality rates (MRs) with 95% confidence intervals (CI) were calculated. The Weibull regression model (HR, 95% CI) was used to determine risk factors associated with mortality.Results A total of 42,703 eligible women were included; 3,098 deaths were reported for 212,607 pyo. Overall MRwas 14.6 deaths/1,000 pyo (95% CI: 14.1–15.1), peaking in 2003 (MR 18.2/1,000 pyo, 95% CI: 16.4–20.1) and declining thereafter (2009: MR 9.6/1,000 pyo, 95% CI: 8.4–10.9). Mortality was highest for HIV/TB (MR 10.6/1,000 pyo, 95% CI: 10.2–11.1), accounting for 73.1% of all deaths, ranging from 61.2% in 2009 to 82.7% in 2002. Adjusting for education level, marital status, age, employment status, area of residence, and migration, all-cause mortality was associated with external migration (adjusted hazard ratio, or aHR), 1.70, 95% CI: 1.41–2.05), self-reported poor health status (aHR 8.26, 95% CI: 2.94–23.15), and HIV-infection (aHR 7.84, 95% CI: 6.26–9.82); external migration and HIV infection were also associated with causes of mortality other than HIV/TB (aHR 1.62, 95% CI: 1.12–2.34 and aHR 2.59, 95% CI: 1.79–3.75).ConclusionHIV/TB was the leading cause of death among women of reproductive age, although rates declined with the rollout of HIV treatment in the area from 2004. Women's age, external migration status and HIV-positive status were significantly associated with all-cause and cause-specific mortality.
Highlights
Mortality data all deaths reported in the household surveillance are followed by a verbal autopsy (VA) interview with the closest caregiver of the deceased, for this study we looked at residents for causes of mortality since only resident episodes are taken into account while computing person time and mortality rates (MRs)
Most deaths occurred in women aged 25Á29 years (21.1%) and most participants lived in a rural setting (Table 1)
Causes of death HIV/TB-related causes of death were most common with a MR of 10.64 per 1,000 person-years, contributing almost 73% of all deaths to women of reproductive age over the entire period (Table 2)
Summary
The Africa Centre for Health and Population Studies is located near the market town of Mtubatuba in the uMkhanyakude district of KwaZulu-Natal. The surveillance area covers an area of 438 km, and within each surveillance round a population of approximately 90,000 people, of whom about two-thirds are resident in approximately 11,000 households [8]. The Africa Centre collects information on both resident and nonresident household members and makes a distinction between membership and residency. Household membership is self-defined on the basis of links to other household members while residency implies residing at a physical structure within the surveillance area at a particular point in time [8]. Since 2003, adults aged 15 years and over, identified as residents in the household surveillance, are asked to participate in an annual HIV and health surveillance [17]. More information about the Africa Centre operations and profile is available elsewhere [8, 17, 18]
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