The trend and pattern of adult mortality in South-Central Ethiopia: analysis using the 2008-2019 data from Butajira Health and Demographic Surveillance System

ABSTRACT

Background

Understanding context-specific temporal trends in mortality is essential for setting health policy priorities.

Objective

To investigate the trends and distribution of deaths due to communicable and non-communicable diseases and external causes in South-Central Ethiopia.

Method

All adult deaths captured by the Butajira Health and Demographic Surveillance System between January 2008 and December 2019 were included. A verbal autopsy method of collecting cause of death data was used. Physician review and a computerised algorithm, InterVA, were used to determine the cause of death. Coding was undertaken using the World Health Organization's International Classification of Diseases. Trends in adult mortality rate and proportional mortality were estimated by major cause of death categories. Significant trends were analysed using the Mann–Kendall statistical test with a significance set at P < 0.05. Deaths were also disaggregated by age, sex, and residence.

Results

There were 1,612 deaths in 279,681 person-years; 811 (50.3%) were females. The median age at death was 65 years. The proportional adult mortality and adult mortality rates (per 1000 person-years) attributed to communicable diseases, non-communicable diseases, and external causes were 31.1%, 58.9%, and 6.0%, and 1.9, 3.4, and 0.4, respectively. Adult mortality due to communicable diseases showed a declining trend (tau, the measure of the strength and direction of association, = −0.52; P < 0.05), whereas the trend increased for non-communicable diseases (tau = 0.67, P < 0.05) and external causes (tau = 0.29, P > 0.05). Moreover, death rates were pronounced in the 65+ age group and rural areas but comparable among males and females.

Conclusion

The trend in deaths due to communicable diseases declined but increased for non-communicable diseases and external causes with significant public health burdens. These findings will provide essential input in formulating health policy reforms to reduce premature mortality.

KEYWORDS:

• Adult mortality
• burden
• HDSS
• pattern
• trend

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgments

We would like to acknowledge Addis Ababa University, College of Health Sciences, School of Public Health for permission to use the data from Butajira-HDSS for this study. We are grateful to Butajira HDSS coordinators, VA field team leaders, and database managers for their unreserved support in completing this bit of research work. The authors would also like to acknowledge Dr Jennifer Wisdom’s contribution to the English language edition.

Author contributions

HAY had taken a principal role in the conception of ideas, writing the full proposal, analyses, write-up, and drafting of this manuscript. WMA contributed to the proposal writing, analyses, write-up, and critically revising of the manuscript. AWY contributed to the proposal writing, analyses, write-up, and editing of the manuscript. All the authors read and approved the final manuscript.

Disclosure statement

All authors declared that they have no competing interests.

Ethics and consent

We used secondary data from the Butajira HDSS, and the study was done after getting written permission from the Research Ethics Committee at the School of Public Health and Institutional Review Board at the College of Health Sciences, Addis Ababa University. Consent was also obtained from the Butajira HDSS management committee.

Paper context

The paucity of information on deaths and their causes critically impedes the complete understanding of the problem. A verbal autopsy is a well-established method that provides information on the level, trend, and pattern of deaths, especially in low-income settings. In Ethiopia, deaths from non-communicable diseases and external causes are rising but declining for communicable diseases. The epidemiological transition in poorer countries is escalating health care system stress. Context-specific health system reforms are urgently needed.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2022.2118180

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.