Abstract
BackgroundTargeted global efforts to improve survival of young adults need information on mortality trends; contributions from health and demographic surveillance system (HDSS) are required.Methods and FindingsThis study aimed to explore changing trends in deaths among adolescents (15–19 years) and young adults (20–24 years), using census and verbal autopsy data in rural western Kenya using a HDSS. Mid-year population estimates were used to generate all-cause mortality rates per 100,000 population by age and gender, by communicable (CD) and non-communicable disease (NCD) causes. Linear trends from 2003 to 2009 were examined. In 2003, all-cause mortality rates of adolescents and young adults were 403 and 1,613 per 100,000 population, respectively, among females; and 217 and 716 per 100,000, respectively, among males. CD mortality rates among females and males 15–24 years were 500 and 191 per 100,000 (relative risk [RR] 2.6; 95% confidence intervals [CI] 1.7–4.0; p<0.001). NCD mortality rates in same aged females and males were similar (141 and 128 per 100,000, respectively; p = 0.76). By 2009, young adult female all-cause mortality rates fell 53% (χ2 for linear trend 30.4; p<0.001) and 61.5% among adolescent females (χ2 for linear trend 11.9; p<0.001). No significant CD mortality reductions occurred among males or for NCD mortality in either gender. By 2009, all-cause, CD, and NCD mortality rates were not significantly different between males and females, and among males, injuries equalled HIV as the top cause of death.ConclusionsThis study found significant reductions in adolescent and young adult female mortality rates, evidencing the effects of targeted public health programmes, however, all-cause and CD mortality rates among females remain alarmingly high. These data underscore the need to strengthen programmes and target strategies to reach both males and females, and to promote NCD as well as CD initiatives to reduce the mortality burden amongst both gender.
Highlights
While most global efforts to prevent mortality among young people focus on children below 5 years of age, there are significant health gains to be made among adolescent children and young adults, targeted efforts for this are hampered by a lack of data [1,2,3]
Aggregated international data suggest mortality rates among AYA in sub-Saharan Africa (SSA) vary by age, but generally rates rise after early adolescence (10–14 years) and peak in young adulthood (20–24 years) [1]
Socio-demographics Of 12,041 documented deaths occurring during the study period in adults aged 15 years and above in Asembo and Gem, 967 (8.0%) were among AYA (n = 293, 30.3% 15–19 years; n = 674, 69.7% 20–24 years, table 1)
Summary
While most global efforts to prevent mortality among young people focus on children below 5 years of age, there are significant health gains to be made among adolescent children and young adults, targeted efforts for this are hampered by a lack of data [1,2,3]. Of the estimated 2.6 million deaths occurring globally among adolescents and young adults (AYA) in 2004, two out of three deaths were in sub-Saharan Africa (SSA) and south-east Asia [1]. In 2004, disability adjusted life-years, comprising years of life disability as well as years of life lost, were 2.5 times higher in AYA aged 10–24 years in SSA compared with worldwide, and substantially higher than other low and middle income countries [3]. Targeted global efforts to improve survival of young adults need information on mortality trends; contributions from health and demographic surveillance system (HDSS) are required
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