title: The epidemiology of 'bewitchment' as a lay-reported cause of death in rural South Africa.
abstract: BACKGROUND
  Cases of premature death in Africa may be attributed to witchcraft. In such settings, medical registration of causes of death is rare. To fill this gap, verbal autopsy (VA) methods record signs and symptoms of the deceased before death as well as lay opinion regarding the cause of death; this information is then interpreted to derive a medical cause of death. In the Agincourt Health and Demographic Surveillance Site, South Africa, around 6% of deaths are believed to be due to 'bewitchment' by VA respondents.
  
  
  METHODS
  Using 6874 deaths from the Agincourt Health and Socio-Demographic Surveillance System, the epidemiology of deaths reported as bewitchment was explored, and using medical causes of death derived from VA, the association between perceptions of witchcraft and biomedical causes of death was investigated.
  
  
  RESULTS
  The odds of having one's death reported as being due to bewitchment is significantly higher in children and reproductive-aged women (but not in men) than in older adults. Similarly, sudden deaths or those following an acute illness, deaths occurring before 2001 and those where traditional healthcare was sought are more likely to be reported as being due to bewitchment. Compared with all other deaths, deaths due to external causes are significantly less likely to be attributed to bewitchment, while maternal deaths are significantly more likely to be.
  
  
  CONCLUSIONS
  Understanding how societies interpret the essential factors that affect their health and how health seeking is influenced by local notions and perceived aetiologies of illness and death could better inform sustainable interventions and health promotion efforts.
authors.affiliation: Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901-85 Umeå, Sweden. Edward.Fotrell@epiph.umu.se
authors.forename: Edward
authors.initials: E
authors.lastname: Fottrell
authors.forename: Stephen
authors.initials: S
authors.lastname: Tollman
authors.forename: Peter
authors.initials: P
authors.lastname: Byass
authors.forename: Frederick
authors.initials: F
authors.lastname: Golooba-Mutebi
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
mesh_terms: D000208:Acute Disease / Q000401:mortality; D000293:Adolescent; D000328:Adult; D001344:Autopsy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D002423:Cause of Death; D000529:Complementary Therapies / Q000379:methods; D003644:Death Certificates; D003645:Death, Sudden / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009073:Mozambique / Q000208:ethnology; D015999:Multivariate Analysis; D011159:Population Surveillance; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data; D014705:Verbal Behavior; D018599:Witchcraft / Q000523:psychology