Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.
BACKGROUND
Because most deaths in Africa and Asia are not well documented, estimates of mortality are often made using scanty data. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering all deaths over time and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.


OBJECTIVE
To build a large standardised mortality database from African and Asian sites, detailing the relevant methods, and use it to describe cause-specific mortality patterns.


METHODS
Individual demographic and verbal autopsy (VA) data from 22 INDEPTH sites were collated into a standardised database. The INDEPTH 2013 population was used for standardisation. The WHO 2012 VA standard and the InterVA-4 model were used for assigning cause of death.


RESULTS
A total of 111,910 deaths occurring over 12,204,043 person-years (accumulated between 1992 and 2012) were registered across the 22 sites, and for 98,429 of these deaths (88.0%) verbal autopsies were successfully completed. There was considerable variation in all-cause mortality between sites, with most of the differences being accounted for by variations in infectious causes as a proportion of all deaths.


CONCLUSIONS
This dataset documents individual deaths across Africa and Asia in a standardised way, and on an unprecedented scale. While INDEPTH sites are not constructed to constitute a representative sample, and VA may not be the ideal method of determining cause of death, nevertheless these findings represent detailed mortality patterns for parts of the world that are severely under-served in terms of measuring mortality. Further papers explore details of mortality patterns among children and specifically for NCDs, external causes, pregnancy-related mortality, malaria, and HIV/AIDS. Comparisons will also be made where possible with other findings on mortality in the same regions. Findings presented here and in accompanying papers support the need for continued work towards much wider implementation of universal civil registration of deaths by cause on a worldwide basis.
Matlab HDSS, Bangladesh; International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana.
P Kim
PK
Streatfield
International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana; Bandarban HDSS, Bangladesh.
Wasif A
WA
Khan
INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh.
Abbas
A
Bhuiya
INDEPTH Network, Accra, Ghana; AMK HDSS, Bangladesh; Centre for Population, Urbanisation and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh.
Nurul
N
Alam
INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso.
Ali
A
Sié
INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso.
Abdramane B
AB
Soura
INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
Bassirou
B
Bonfoh
INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; Université Félix Houphoët-Boigny, Abidjan, Côte d'Ivoire.
Eliezer K
EK
Ngoran
INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Berhe
B
Weldearegawi
INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia.
Momodou
M
Jasseh
INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana.
Abraham
A
Oduro
INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana.
Margaret
M
Gyapong
INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India.
Shashi
S
Kant
INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India.
Sanjay
S
Juvekar
INDEPTH Network, Accra, Ghana; Purworejo HDSS, Indonesia; Department of Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Siswanto
S
Wilopo
INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Medicine, Imperial College, St. Mary's Hospital, London.
Thomas N
TN
Williams
INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya.
Frank O
FO
Odhiambo
INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya.
Donatien
D
Beguy
INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya.
Alex
A
Ezeh
INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya.
Catherine
C
Kyobutungi
INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; Karonga Prevention Study, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom.
Amelia
A
Crampin
INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal.
Valérie
V
Delaunay
INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
Stephen M
SM
Tollman
INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa.
Kobus
K
Herbst
INDEPTH Network, Accra, Ghana; FilaBavi HDSS, Vietnam; Health System Research, Hanoi Medical University, Hanoi, Vietnam.
Nguyen T K
NT
Chuc
INDEPTH Network, Accra, Ghana; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hanoi Medical University, Hanoi, Vietnam; osman.sankoh@indepth-network.org.
Osman A
OA
Sankoh
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Marcel
M
Tanner
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
Peter
P
Byass
D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D001344:Autopsy; D002423:Cause of Death; D003625:Data Collection / Q000592:standards*; D016208:Databases, Factual; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D011159:Population Surveillance
Africa; Asia; INDEPTH Network; cause of death; mortality; verbal autopsy