title: Adult mortality and probable cause of death in rural northern Malawi in the era of HIV treatment.
abstract: OBJECTIVE
  Developing countries are undergoing demographic transition with a shift from high mortality caused by communicable diseases (CD) to lower mortality rates caused by non-communicable diseases (NCD). HIV/AIDS has disrupted this trend in sub-Saharan Africa. However, in recent years, HIV-associated mortality has been reduced with the introduction of widely available antiretroviral therapy (ART). Side effects of ART may lead to increased risk of cardiovascular diseases, raising the prospects of an accelerated transition towards NCD as the primary cause of death. We report population-based data to investigate changes in cause of death owing to NCD during the first 4 years after introduction of HIV treatment.
  
  
  METHODS
  We analysed data from a demographic surveillance system in Karonga district, Malawi, from September 2004 to August 2009. ART was introduced in mid-2005. Clinician review of verbal autopsies conducted 2-6 weeks after a death was used to establish a single principal cause of death.
  
  
  RESULTS
  Over the entire period, there were 905 deaths, AIDS death rate fell from 505 to 160/100,000 person-years, and there was no evidence of an increase in NCD rates. The proportion of total deaths attributable to AIDS fell from 42% to 17% and from NCD increased from 37% to 49%.
  
  
  CONCLUSIONS
  Our findings show that 4 years after the introduction of ART into HIV care in Karonga district, all-cause mortality has fallen dramatically, with no evidence of an increase in deaths owing to NCD.
authors.affiliation: Karonga Prevention Study, Chilumba, Malawi. menard.chihana@kpsmw.org
authors.forename: Menard
authors.initials: M
authors.lastname: Chihana
authors.forename: Sian
authors.initials: S
authors.lastname: Floyd
authors.forename: Anna
authors.initials: A
authors.lastname: Molesworth
authors.forename: Amelia C
authors.initials: AC
authors.lastname: Crampin
authors.forename: Ndoliwe
authors.initials: N
authors.lastname: Kayuni
authors.forename: Alison
authors.initials: A
authors.lastname: Price
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
authors.forename: Andreas
authors.initials: A
authors.lastname: Jahn
authors.forename: Hazzie
authors.initials: H
authors.lastname: Mvula
authors.forename: Albert
authors.initials: A
authors.lastname: Dube
authors.forename: Bagrey
authors.initials: B
authors.lastname: Ngwira
authors.forename: Judith R
authors.initials: JR
authors.lastname: Glynn
authors.forename: Neil
authors.initials: N
authors.lastname: French
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002423:Cause of Death / Q000639:trends*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012424:Rural Population / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents