title: Mortality reduction associated with HIV/AIDS care and antiretroviral treatment in rural Malawi: evidence from registers, coffin sales and funerals.
abstract: 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.
authors.affiliation: Thyolo District Health Services, Ministry of Health and Population, Thyolo, Malawi.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mwagomba
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.forename: Moses
authors.initials: M
authors.lastname: Massaquoi
authors.forename: Dalitso
authors.initials: D
authors.lastname: Misindi
authors.forename: Marcel
authors.initials: M
authors.lastname: Manzi
authors.forename: Bester C
authors.initials: BC
authors.lastname: Mandere
authors.forename: Marielle
authors.initials: M
authors.lastname: Bemelmans
authors.forename: Mit
authors.initials: M
authors.lastname: Philips
authors.forename: Kelita
authors.initials: K
authors.lastname: Kamoto
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Schouten
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
mesh_terms: 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*
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