title: Mortality in women of reproductive age in rural South Africa.
abstract: OBJECTIVE
  To determine causes of death and associated risk factors in women of reproductive age in rural South Africa.
  
  
  METHODS
  Deaths and person-years of observation (pyo) were determined for females (aged 15-49 years) resident in 15,526 households in a rural South African Demographic and Health Surveillance site from 2000 to 2009. Cause of death was ascertained by verbal autopsy and ICD-10 coded; causes were categorized as HIV/TB, non-communicable, communicable/maternal/perinatal/nutrition, injuries, and undetermined (unknown). Characteristics of women were obtained from regularly updated household visits, while HIV and self-reported health status was obtained from the annual HIV surveillance. Overall and cause-specific mortality rates (MRs) with 95% confidence intervals (CI) were calculated. The Weibull regression model (HR, 95%CI) was used to determine risk factors associated with mortality.
  
  
  RESULTS
  A total of 42,703 eligible women were included; 3,098 deaths were reported for 212,607 pyo. Overall MRwas 14.6 deaths/1,000 pyo (95% CI: 14.1-15.1), peaking in 2003 (MR 18.2/1,000 pyo, 95% CI: 16.4-20.1) and declining thereafter (2009: MR 9.6/1,000 pyo, 95% CI: 8.410.9). Mortality was highest for HIV/TB (MR 10.6/1,000 pyo, 95% CI: 10.211.1), accounting for 73.1% of all deaths, ranging from 61.2% in 2009 to 82.7% in 2002. Adjusting for education level, marital status, age, employment status, area of residence, and migration, all-cause mortality was associated with external migration (adjusted hazard ratio, or aHR), 1.70, 95% CI: 1.41-2.05), self-reported poor health status (aHR 8.26, 95% CI: 2.94-23.15), and HIV-infection (aHR 7.84, 95% CI: 6.26-9.82); external migration and HIV infection were also associated with causes of mortality other than HIV/TB (aHR 1.62 CI: 1.12-2.34 and aHR 2.59, CI: 1.79-3.75).
  
  
  CONCLUSIONS
  HIV/TB was the leading cause of death among women of reproductive age, although rates declined with the rollout of HIV treatment in the area from 2004. Women's age, external migration status, and HIV-positive status were significantly associated with all-cause and cause-specific mortality.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Dorean
authors.initials: D
authors.lastname: Nabukalu
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; k.klipstein-grobusch@umcutrecht.nl.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Klipstein-Grobusch
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.
authors.forename: Kobus
authors.initials: K
authors.lastname: Herbst
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa; Faculty of Medicine and Faculty of Social and Human Sciences, University of Southampton, Southampton, UK.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002423:Cause of Death; D003141:Communicable Diseases / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000401:mortality; D016387:Women's Health / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: mortality; reproductive age; risk factors; rural South Africa; women