title: Mortality trends from 2003 to 2009 among adolescents and young adults in rural Western Kenya using a health and demographic surveillance system.
abstract: BACKGROUND
  Targeted global efforts to improve survival of young adults need information on mortality trends; contributions from health and demographic surveillance system (HDSS) are required.
  
  
  RESULTS
  This study aimed to explore changing trends in deaths among adolescents (15-19 years) and young adults (20-24 years), using census and verbal autopsy data in rural western Kenya using a HDSS. Mid-year population estimates were used to generate all-cause mortality rates per 100,000 population by age and gender, by communicable (CD) and non-communicable disease (NCD) causes. Linear trends from 2003 to 2009 were examined. In 2003, all-cause mortality rates of adolescents and young adults were 403 and 1,613 per 100,000 population, respectively, among females; and 217 and 716 per 100,000, respectively, among males. CD mortality rates among females and males 15-24 years were 500 and 191 per 100,000 (relative risk [RR] 2.6; 95% confidence intervals [CI] 1.7-4.0; p<0.001). NCD mortality rates in same aged females and males were similar (141 and 128 per 100,000, respectively; p = 0.76). By 2009, young adult female all-cause mortality rates fell 53% (χ(2) for linear trend 30.4; p<0.001) and 61.5% among adolescent females (χ(2) for linear trend 11.9; p<0.001). No significant CD mortality reductions occurred among males or for NCD mortality in either gender. By 2009, all-cause, CD, and NCD mortality rates were not significantly different between males and females, and among males, injuries equalled HIV as the top cause of death.
  
  
  CONCLUSIONS
  This study found significant reductions in adolescent and young adult female mortality rates, evidencing the effects of targeted public health programmes, however, all-cause and CD mortality rates among females remain alarmingly high. These data underscore the need to strengthen programmes and target strategies to reach both males and females, and to promote NCD as well as CD initiatives to reduce the mortality burden amongst both gender.
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom. pennyph@liverpool.ac.uk
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Phillips-Howard
authors.forename: Frank O
authors.initials: FO
authors.lastname: Odhiambo
authors.forename: Mary
authors.initials: M
authors.lastname: Hamel
authors.forename: Kubaje
authors.initials: K
authors.lastname: Adazu
authors.forename: Marta
authors.initials: M
authors.lastname: Ackers
authors.forename: Anne M
authors.initials: AM
authors.lastname: van Eijk
authors.forename: Vincent
authors.initials: V
authors.lastname: Orimba
authors.forename: Anja van't
authors.initials: Av
authors.lastname: Hoog
authors.forename: Caryl
authors.initials: C
authors.lastname: Beynon
authors.forename: John
authors.initials: J
authors.lastname: Vulule
authors.forename: Mark A
authors.initials: MA
authors.lastname: Bellis
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.forename: Kevin
authors.initials: K
authors.lastname: deCock
authors.forename: Robert
authors.initials: R
authors.lastname: Breiman
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D003141:Communicable Diseases / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012424:Rural Population; D012737:Sex Factors; D055815:Young Adult