Causes of death in two rural demographic surveillance sites in Bangladesh, 2004-2010: automated coding of verbal autopsies using InterVA-4.
OBJECTIVE
Population-based information on causes of death (CoD) by age, sex, and area is critical for countries with limited resources to identify and address key public health issues. This study analysed the demographic surveillance and verbal autopsy (VA) data to estimate age- and sex-specific mortality rates and cause-specific mortality fractions in two well-defined rural populations within the demographic surveillance system in Abhoynagar and Mirsarai subdistricts, located in different climatic zones.


METHODS
During 2004-2010, the sample demographic surveillance system registered 1,384 deaths in Abhoynagar and 1,847 deaths in Mirsarai. Trained interviewers interviewed the main caretaker of the deceased with standard VA questionnaires to record signs and symptoms of diseases or conditions that led to death and health care experiences before death. The computer-automated InterVA-4 method was used to analyse VAs to determine probable CoD.


RESULTS
Age- and sex-specific death rates revealed a higher neonatal mortality rate in Abhoynagar than Mirsarai, and death rates and sex ratios of male to female death rates were higher in the ages after infancy. Communicable diseases (CDs) accounted for 16.7% of all deaths in Abhoynagar and 21.2% in Mirsarai--the difference was due mostly to more deaths from acute respiratory infections, pneumonia, and tuberculosis in Mirsarai. Non-communicable diseases (NCDs) accounted for 56.2 and 55.3% of deaths in each subdistrict, respectively, with leading causes being stroke (16.5-19.3%), neoplasms (13.2% each), cardiac diseases (8.9-11.6%), chronic obstructive pulmonary diseases (5.1-6.3%), diseases of the digestive system (3.1-4.1%), and diabetes (2.8-3.5%), together accounting for 49.2-51.2% points of the NCD deaths in the two subdistricts. Injury and other external causes accounted for another 7.5-7.7% deaths, with self-harm being higher among females in Abhoynagar.


CONCLUSIONS
The computer-automated coding of VA to determine CoD reconfirmed that NCDs were the leading CoD with some differences between the sites. Incorporating VA into the national sample vital registration system can help policy makers to identify the leading CoDs for public health planning.
Centre for Population, Urbanization and Climate Change, icddr,b, Dhaka, Bangladesh; nalam@icddrb.org.
Nurul
N
Alam
Formerly with Health Information System Knowledge Hub, School of Public Health, University of Queensland, Australia.
Hafizur R
HR
Chowdhury
Centre for Control of Chronic Disease, icddr,b, Dhaka, Bangladesh.
Subhash C
SC
Das
Formerly with Centre for Control of Chronic Disease, icddr,b, Dhaka, Bangladesh.
Ali
A
Ashraf
Centre for Population, Urbanization and Climate Change, icddr,b, Dhaka, Bangladesh.
P Kim
PK
Streatfield
D000293:Adolescent; D000328:Adult; D000368:Aged; D001331:Automation; D001344:Autopsy; D001459:Bangladesh / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011159:Population Surveillance; D012424:Rural Population; D012984:Software
Abhoynagar; Bangladesh; InterVA; Mirsarai; cause of death; verbal autopsy