Who died of what in rural KwaZulu-Natal, South Africa: a cause of death analysis using InterVA-4.
BACKGROUND
For public health purposes, it is important to see whether men and women in different age groups die of the same causes in South Africa.


OBJECTIVE
We explored sex- and age-specific patterns of causes of deaths in a rural demographic surveillance site in northern KwaZulu-Natal in South Africa over the period 2000-2011.


METHODS
Deaths reported through the demographic surveillance were followed up by a verbal autopsy (VA) interview using a standardised questionnaire. Causes of death were assigned likelihoods using the publicly available tool InterVA-4. Cause-specific mortality fractions were determined by age and sex.


RESULTS
Over the study period, a total of 5,416 (47%) and 6,081 (53%) deaths were recorded in men and women, respectively. Major causes of death proportionally affecting more women than men were (all p<0.0001): human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (20.1% vs. 13.6%), other and unspecified cardiac disease (5.9% vs. 3.2%), stroke (4.5% vs. 2.7%), reproductive neoplasms (1.7% vs. 0.4%), diabetes (2.4% vs. 1.2%), and breast neoplasms (0.4% vs. 0%). Major causes of deaths proportionally affecting more men than women were (all p<0.0001) assault (6.1% vs. 1.7%), pulmonary tuberculosis (34.5% vs. 30.2%), road traffic accidents (3.0% vs. 1.0%), intentional self-harm (1.3% vs. 0.3%), and respiratory neoplasms (2.5% vs. 1.5%). Causes of death due to communicable diseases predominated in all age groups except in older persons.


CONCLUSIONS
While mortality during the 2000s was dominated by tuberculosis and HIV/AIDS, we found substantial sex-specific differences both for communicable and non-communicable causes of death, some which can be explained by a differing sex-specific age structure. InterVA-4 is likely to be a valuable tool for investigating causes of death patterns in other similar Southern African settings.
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa; National Health Laboratory, Surveillance & Epidemiology of Infectious Diseases, Dudelange, Luxembourg; joel.mossong@lns.etat.lu.
Joël
J
Mossong
Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
Peter
P
Byass
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa.
Kobus
K
Herbst
D000293:Adolescent; D000328:Adult; D000368:Aged; D001344:Autopsy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011159:Population Surveillance; D012307:Risk Factors; D012984:Software; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires
HIV/AIDS; South Africa; cause of death; demographic surveillance; mortality; tuberculosis; verbal autopsy