Socio-economic, physical and health-related determinants of causes of death among women in the Kintampo districts of Ghana

Abstract

This study examined the socio-economic, physical and health-related determinants of causes of death among women of reproductive age (WRA) in the Kintampo North Municipality and Kintampo South District of Ghana. Longitudinal data from the Kintampo Health and Demographic Surveillance System (HDSS) was used. Causes of death data from 2005 to 2014 for 846 WRA aged 15–49 were categorized into three broad groups: maternal, infectious and non-communicable diseases. Three hierarchical multinomial logistic regression models were used to examine the determinants of causes of death, with the maternal causes of death as the reference category. Distal, intermediate and proximate factors were entered cumulatively one after the other in Models 1, 2 and 3, respectively, to account for their separate effects on the outcome variable. Across all three models, ever-married (RRR = 0.12; p < 0.001) WRA were significantly less likely to die from infectious or NCD than maternal causes compared to those who were never-married. At the adjusted level (Model 3), infectious causes of deaths differed from the maternal causes of deaths by age at death, marital status, land ownership, district of residence, year of death, season of death, place of death, admission in the last 12 months, surgical operation in the last 24 months and sudden death. Marital status is a key determinant of causes of death among WRA.

Keywords:

• verbal autopsy
• women of reproductive age
• causes of death
• determinants
• Kintampo health and demographic surveillance system

PUBLIC INTEREST STATEMENT

The nexus between socio-economic factors and health has been given less attention in low- and middle-income countries and much less among women. Nonetheless, the burden of ill health disproportionately affects women due to biological, gender and other socio-economic factors. This study examined the socio-economic, physical and health-related determinants of causes of death among women of reproductive age (WRA) in the Kintampo area of Ghana. Causes of death data from 2005 to 2014 for 846 WRA aged 15–49 were categorized into three broad groups: maternal, infectious and non-communicable diseases. Three hierarchical multinomial logistic regression models were used to examine the determinants of causes of death. Across all three models, ever-married (RRR = 0.12; p < 0.001) WRA were significantly less likely to die from infectious or NCD than maternal causes compared to those who were never-married whilst older women were more likely to die of infectious or NCD causes than maternal causes relative to younger women.

Acknowledgements

We are grateful to the Director and the management of KHRC as well as the Ghana Health Service for allowing the use of the KHDSS data. The study team wishes to acknowledge useful comments from KHRC staff, and the Faculty and students of Regional Institute for Population Studies (RIPS), University of Ghana. Our appreciation goes to Prof Delali Margaret Badasu and Professor Samuel N. A. Codjoe of RIPS for their comments on earlier drafts, as well as the community for allowing KHRC to collect data from them.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

There was no funding for this study.

Notes on contributors

Sulemana Watara Abubakari

Sulemana Watara Abubakari is a Principal Research Fellow at the Kintampo Health Research Centre (KHRC), Ghana. He holds a PhD degree in Population Studies and MPhil degree in Geography & Resource Development, University of Ghana, and a Bachelor of Arts degree in Geography and Economics, Kwame Nkrumah University of Science and Technology, Ghana. Sulemana has distinguished himself from primary school where he was awarded best pupil to university where he was also awarded Vice Chancellor’s award for outstanding doctoral dissertation. His poster presentation was adjudged the best, and he was presented with the young scientist award at 2006 INDEPTH Network Conference in Ouagadougou, Burkina Faso. He headed the Kintampo Health and Demographic Surveillance System (Kintampo HDSS), and now heads the Environmental Health Research of KHRC. Currently, he coordinates a study in all regions of Ghana aimed at reducing household air pollution, and activities of malaria vaccine pilot evaluation in three regions of Ghana.