Mortality reduction associated with HIV/AIDS care and antiretroviral treatment in rural Malawi: evidence from registers, coffin sales and funerals.
BACKGROUND
To report on the trend in all-cause mortality in a rural district of Malawi that has successfully scaled-up HIV/AIDS care including antiretroviral treatment (ART) to its population, through corroborative evidence from a) registered deaths at traditional authorities (TAs), b) coffin sales and c) church funerals.


RESULTS
Retrospective study in 5 of 12 TAs (covering approximately 50% of the population) during the period 2000-2007. A total of 210 villages, 24 coffin workshops and 23 churches were included. There were a total of 18,473 registered deaths at TAs, 15781 coffins sold, and 2762 church funerals. Between 2000 and 2007, there was a highly significant linear downward trend in death rates, sale of coffins and church funerals (X(2) for linear trend: 338.4 P<0.0001, 989 P<0.0001 and 197, P<0.0001 respectively). Using data from TAs as the most reliable source of data on deaths, overall death rate reduction was 37% (95% CI:33-40) for the period. The mean annual incremental death rate reduction was 0.52/1000/year. Death rates decreased over time as the percentage of people living with HIV/AIDS enrolled into care and ART increased. Extrapolating these data to the entire district population, an estimated 10,156 (95% CI: 9786-10259) deaths would have been averted during the 8-year period.


CONCLUSIONS
Registered deaths at traditional authorities, the sale of coffins and church funerals showed a significant downward trend over a 8-year period which we believe was associated with the scaling up HIV/AIDS care and ART.
Mwagomba
Beatrice
B
Thyolo District Health Services, Ministry of Health and Population, Thyolo, Malawi.
Zachariah
Rony
R
Massaquoi
Moses
M
Misindi
Dalitso
D
Manzi
Marcel
M
Mandere
Bester C
BC
Bemelmans
Marielle
M
Philips
Mit
M
Kamoto
Kelita
K
Schouten
Eric J
EJ
Harries
Anthony D
AD
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000191:economics / Q000401:mortality*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D003132:Commerce / Q000191:economics*; D003625:Data Collection; D003644:Death Certificates; D006801:Humans; D008295:Malawi; D010343:Patient Admission; D005791:Patient Care; D012042:Registries / Q000706:statistics & numerical data*; D012423:Rural Health / Q000706:statistics & numerical data*
Int J Epidemiol. 2005 Jun;34(3):586-92
15737970
Sex Transm Infect. 2008 Aug;84 Suppl 1:i24-i30
18647862
Lancet. 2008 May 10;371(9624):1603-11
18468544
AIDS. 2006 May 12;20(8):1163-9
16691068
Trop Med Int Health. 2005 Dec;10(12):1242-50
16359404
J Acquir Immune Defic Syndr. 1999 May 1;21(1):59-64
10235515
Lancet. 1998 Nov 28;352(9142):1725-30
9848347
Lancet. 2002 Jul 13;360(9327):119-29
12126821
AIDS. 1997 May;11(6):801-7
9143613
PLoS One. 2008;3(11):e3729
19008957
AIDS. 2003 May 23;17(8):1209-16
12819523
AIDS. 2009 Feb 20;23(4):511-8
19169138
Bull World Health Organ. 2009 Oct;87(10):754-62
19876542
AIDS. 2003 May 2;17(7):1053-61
12700456
AIDS. 2004 Apr 9;18(6):887-95
15060436
AIDS. 2006 Nov 28;20(18):2355-60
17117022
Trans R Soc Trop Med Hyg. 2007 Jan;101(1):79-84
16962622
Trop Med Int Health. 2000 Nov;5(11):824-31
11123832
Bull World Health Organ. 2005 Mar;83(3):171-7
15798840
Lancet. 2006 Mar 11;367(9513):817-24
16530575