title: High death rates in health care workers and teachers in Malawi.
abstract: High death rates are reported in health care workers (HCWs) and teachers in urban areas of Malawi. The present study was carried out to determine the annual death rate in HCWs and primary school teachers working in semi-urban and rural areas of Malawi, and to try to ascertain the main causes of death. Forty district and mission hospitals in Malawi were visited. A record was made of the number of clinical and nursing-based HCWs in each hospital in 1999, the number of deaths in that calendar year and reported causes of death. A record was also made of the number of teachers working in 4 primary schools nearest to each hospital in 1999, the number of deaths in that calendar year and reported causes of death. There were 2979 HCWs, of whom 60 (2.0%) died. There were 4367 teachers of whom 101 (2.3%) died. Annual death rates, calculated per 100,000 people, were significantly higher in male HCWs compared with female HCWs (2495 versus 1770, RR 1.17, 95% CI 1.14-1.20, P < 0.001), and significantly higher in female teachers compared with male teachers (2521 versus 1934, RR 1.14, 95% CI 1.11-1.17, P < 0.001). In male HCWs and teachers the highest death rates were in those aged 35-44 years. In female HCWs and teachers, the highest death rates were in those aged 25-34 years and 35-44 years, respectively. Reported causes of death in HCWs were tuberculosis (TB) in 47%, chronic illness in 45% and acute illness in the remainder, while in teachers the causes were TB in 27%, chronic illness in 49% and acute illness in 25%. Chronic illness, thought to be due to AIDS, and TB were the common causes of death. The current high death rates from AIDS and TB will have a crippling toll on the health and education sectors, and effective ways of reducing these death rates must be found.
authors.affiliation: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. adharries@malawi.net
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.forename: N J
authors.initials: NJ
authors.lastname: Hargreaves
authors.forename: F
authors.initials: F
authors.lastname: Gausi
authors.forename: J H
authors.initials: JH
authors.lastname: Kwanjana
authors.forename: F M
authors.initials: FM
authors.lastname: Salaniponi
mesh_terms: D000208:Acute Disease / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D002908:Chronic Disease / Q000401:mortality*; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012423:Rural Health; D017678:Sex Distribution; D015996:Survival Rate; D013663:Teaching / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000401:mortality; D014504:Urban Health