Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal

Bruno Lankoandé,Géraldine Duthé,Abdramane Soura,Gilles Pison

doi:10.1080/16549716.2018.1475040

Abstract

ABSTRACTBackground: In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources. Little is known about population mobility at the end of life.Objective: To document the magnitude, motivations and associated factors of short-term mobility before death among adults over 15 years of age in Burkina Faso and Senegal.Methods: The study was based on deaths of adult residents reported in three Health and Demographic Surveillance System (HDSS) sites in urban (Ouagadougou) and semi-rural areas (Kaya) of Burkina Faso, and rural areas of Senegal (Mlomp). After excluding deaths from external causes, the analysis covered, respectively, 536 and 695 deaths recorded during the period 2012–2015 in Ouagadougou and Kaya. The period was extended to 2000–2015 in Mlomp, with a sample of 708 deaths. Binary logistic regressions were used to examine the effects of socio-demographic characteristics on place of death (health facility or not) and location of death (within or outside the HDSS).Results: In Mlomp, Kaya and Ouagadougou, respectively 20.6%, 5.3% and 5.9% of adults died outside the HDSS site. In Mlomp and Kaya, these deaths were more likely to occur in a health facility than deaths that occurred within the site. The reverse situation was found in Ouagadougou. Age is the strongest determinant of mobility before death in Mlomp and Kaya. In Mlomp, young adults (15–39) were 10 times more likely to die outside the site than adults in the 60–79 age group. In Ouagadougou, non-natives were three times more likely to die outside the city than natives.Conclusions: At the end of life, some rural residents move to urban areas for medical treatment while some urban dwellers return to their village for supportive care. These movements of dying individuals may affect the estimation of urban/rural mortality differentials.

Highlights

In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources
Regarding the association between place of death and location of death, different pictures emerged for each site (Table 1)
In the rural area of Mlomp, the differences in the proportions of health facility deaths by location of death were much larger, with 80.8% of deaths outside Mlomp occurring in health facilities

Summary

Introduction

In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources. The public health debate is centred on place of death as an indicator of quality of end-of-life care, with most people preferring to die at home rather than in hospitals or care homes [2]. In some countries such as Japan and Belgium, a large share of deaths still occur in hospitals, while in the USA and Canada, death at home or in nursing homes is tending to replace death in hospital [3,4,5,6,7]

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