Disease-specific mortality burdens in a rural Gambian population using verbal autopsy, 1998–2007

Figures & data

Fig. 1 Location of the urban and contiguous rural areas east and west of Farafenni Town, which collectively constitute the Farafenni Health and Demographic Surveillance area.

Table 1 Number of deaths, proportion of deaths with verbal autopsy and death rates by period and population

	All			1998–2001			2002–2004			2005–2007
	No. of deaths	Number of VAs conducted (% of deaths)	Death rate (per 1,000 PY)	No. of deaths	Number of VAs conducted (% of deaths)	Death rate (per 1,000 PY)	No. of deaths	Number of VAs conducted (% of deaths)	Death rate (per 1,000 PY)	No. of deaths	Number of VAs conducted (% of deaths)	Death rate (per 1,000 PY)
Age group
<1 year	536	224 (42)	47	201	20 (10)	78	162	122 (75)	42	173	82 (47)	35
1–4 years	559	295 (53)	13	246	24 (10)	27	188	163 (87)	12	125	108 (86)	7
5–14 years	204	137 (67)	2	81	38 (47)	4	67	59 (88)	2	56	40 (71)	2
15–59 years	891	715 (80)	6	187	180 (96)	6	368	303 (82)	6	336	232 (69)	5
60+ years	1,013	904 (89)	58	287	280 (98)	63	359	331 (92)	59	367	293 (80)	54
Sex
Male	1,727	1,217 (70)	12	531	287 (54)	17	609	522 (86)	11	587	408 (70)	9
Female	1,476	1,058 (72)	9	471	255 (54)	14	535	456 (85)	9	470	347 (74)	7
Ethnic group
Wollof	1,192	825 (69)	10	349	172 (49)	15	418	355 (85)	9	425	298 (70)	8
Mandinka	1,262	950 (75)	11	453	272 (60)	16	428	386 (90)	11	381	292 (77)	9
Fula	629	416 (66)	9	194	95 (49)	14	239	195 (82)	10	196	126 (64)	7
Other	120	84 (70)	7	6	3 (50)	9	59	42 (71)	8	55	39 (71)	6
Area of residence
Rural	2,145	1,491 (70)	13	1,002	542 (54)	15	635	572 (90)	12	508	377 (74)	10
Urban^a	1,058	784 (74)	7				509	406 (80)	8	549	378 (69)	7
All	3,203	2,275 (71)	10	1,002	542 (54)	15	1,144	978 (85)	10	1,057	755 (71)	8

^aSurveillance in this area started in October 2002.

Table 2 Cause-specific mortality fractions (CSMFs) derived using recommended InterVA-4 settings by age group, period, sex, residence and ethnicity

Classification and causes of death	Total	<1 year	1–4 years	5–14 years	15–59 years	60+ years	1998–2001	2002–2004	2005–2007	Male	Female	Rural	Urban	Wollof	Mandinka	Fula	Other
Number of deaths	2,275	224	295	137	715	904	542	978	755	1,217	1,058	1,491	784	825	950	416	84
Infectious diseases
Malaria	12.9	15.8	38.3	28.3	7.5	5.9	10.7	14	12.9	12.3	13.5	13	12.6	15.4	10.3	13.5	13.9
ARI, including pneumonia	13.7	28.1	15.2	11.7	9.9	12.9	13.5	13.8	13.6	15	12.2	14	13	14.5	13.1	13.8	11.3
Pulmonary tuberculosis	10.2		0.4	1	14	14.3	10.2	9.7	10.8	12.6	7.4	9.6	11.3	7.4	12.5	8.8	17.5
HIV/AIDS-related	5.8	5.9	15	8.7	6.6	1.9	3.3	6.2	7.2	4.3	7.6	4.8	7.8	6.5	4.5	7.3	8
Diarrhoeal diseases	3.9	10.2	8.3	0.9	3.7	1.7	4.2	3.8	3.9	4	3.8	4.3	3.3	3.4	4.2	4.7	2.1
Meningitis and encephalitis	2.2	1.5	1.3	6.5	2.7	1.5	3	1.8	2	2.1	2.2	2.1	2.2	2.5	1.4	2.8	4.2
Other infectious diseases	1.2	0.1	0.1	2.8	1.6	1.2	1.1	1.4	1	1.7	0.6	1.2	1.2	0.9	1.2	1.6	0.7
Cancers
Digestive neoplasms	3.1				5.3	3.5	3	3	3.3	3.6	2.5	2.8	3.6	3.1	3.1	3.4	1.1
Respiratory neoplasms	1.6				1.6	2.7	2.3	1.5	1.3	2.4	0.7	1.8	1.3	0.8	2.2	1.5	3.3
Reproductive neoplasms	1.3				1.6	2.1	1.8	1.3	1	1	1.7	1.4	1.1	1.3	1.4	1.2	0.9
Other neoplasms	0.9				3.2	3.8	3	2.4	2.3	2.7	2.3	2.5	2.5	2.4	2.9	1.9	2.3
Other NCDs
Stroke	6.4				4.2	12.8	5.6	6.8	6.5	5.4	7.6	5.9	7.5	5.9	6.4	7.6	6.3
Acute abdomen	4.8	0.4	0.2	9.7	5.6	6	6.5	3.9	4.8	4.5	5.1	5	4.5	4.2	6.2	3.2	3.4
Severe malnutrition	1.6	3.4	6	1.5	0.2	0.8	0.8	1.7	2.1	1.6	1.5	1.5	1.9	2.1	1.4	1.3	0.9
Acute cardiac diseases	0.9				0.8	1.5	1	0.6	1	0.8	0.9	0.9	0.8	1.3	0.7	0.5
Other cardiac diseases	1.3	0.5	0.8	2.2	1.1	1.7	1	1.5	1.4	1.3	1.3	1	2	1.6	1.2	1.1	1
Other unspecified NCDs	2.5	0.1	0.8	1.2	3	3.5	2.5	2.2	3	2.2	2.9	2.6	2.3	2.4	3.1	2
Liver cirrhosis	2.5			1.8	0.8	1.3	0.5	0.9	1.1	1.1	0.7	1.1	0.6	1	0.5	1.6	1.2
Neonatal	2	20.6					1.4	3.2	0.9	1.5	2.6	2.9	0.4	2.1	2.1	1.6	2.4
External	2.5	0.7	1.2	5.9	3.8	1.7	2.9	2.1	2.6	2.7	2.2	2.4	2.5	2.2	2.9	2.2	1.8
Maternal	2.1				6.8		2.6	2.3	1.5		4.6	2	2.4	2.7	1.5	2.4	2.9
Indeterminate	16.6	12.8	12.4	17.8	16.2	19.1	19.1	15.9	15.8	17.1	16	17.3	15.3	16.5	17.2	16	14.7
Total	100	100	100	100	100	100	100	100	100	100	100	100	100	100	100	100	100

Fig. 2 Comparison of the distribution of causes of death among children under 5 years of age by InterVA-4 for Farafenni HDSS, 1998–2007 and CHERG estimates for The Gambia, 2008 (27).

Table 3 Top five causes of death by age group and period

	1998–2007			1998–2001			2002–2004			2005–2007
Age group and rank	Cause	No. of deaths	Cause-specific mortality rate per 1,000 PY (95% CI)	Cause	No. of deaths	Cause-specific mortality rate per 1,000 PY (95% CI)	Cause	No. of deaths	Cause-specific mortality rate per 1,000 PY (95% CI)	Cause	No. of deaths	Cause-specific mortality rate per 1,000 PY (95% CI)
<1 year
1	ARI, including pneumonia	64	5.59 (4.38–7.15)	Neonatal sepsis	4	1.54 (0.58–4.11)	ARI, including pneumonia	36	9.34 (6.74–13.00)	ARI, including pneumonia	25	5.01 (3.38–7.41)
2	Malaria	47	4.11 (3.09–5.47)	Malaria	4	1.54 (0.58–4.11)	Malaria	21	5.45 (3.55–8.36)	Malaria	22	4.41 (2.90–6.69)
3	Neonatal sepsis	31	2.71 (1.91–3.85)	ARI, including pneumonia	3	1.16 (0.37–3.59)	Neonatal Sepsis	21	5.45 (3.55–8.36)	Diarrhoeal diseases	10	2.00 (1.08–3.72)
4	Diarrhoeal diseases	24	2.10 (1.41–3.13)	Neonatal pneumonia	2	0.77 (0.19–3.08)	Diarrhoeal diseases	12	3.11 (1.77–5.48)	Neonatal sepsis	6	1.20 (0.54–2.68)
5	HIV/AIDS-related	14	1.22 (0.72–2.07)	Other neonatal causes	2	0.77 (0.19–3.08)	Neonatal pneumonia	9	2.33 (1.21–4.49)	HIV/AIDS-related	6	1.20 (0.54–2.68)
	Indeterminate	11		Indeterminate	0		Indeterminate	7		Indeterminate	4
1–4 years
1	Malaria	131	3.06 (2.58–3.63)	Malaria	16	1.78 (1.09–2.91)	Malaria	78	4.92 (3.94–6.14)	Malaria	37	2.06 (1.49–2.84)
2	HIV/AIDS-related	50	1.17 (0.89–1.54)	Diarrhoeal diseases	2	0.22 (0.06–0.89)	HIV/AIDS-related	27	1.70 (1.17–2.48)	HIV/AIDS-related	23	1.28 (0.85–1.93)
3	ARI, including pneumonia	45	1.05 (0.79–1.41)	ARI, including pneumonia	1	0.11 (0.02–0.79)	ARI, including pneumonia	25	1.58 (1.06–2.33)	ARI, including pneumonia	19	1.06 (0.67–1.66)
4	Diarrhoeal diseases	26	0.61 (0.41–0.89)	Severe malnutrition	1	0.11 (0.02–0.79)	Diarrhoeal diseases	13	0.82 (0.48–1.41)	Diarrhoeal diseases	11	0.61 (0.34–1.11)
5	Severe malnutrition	18	0.42 (0.26–0.67)	Meningitis and encephalitis	1	0.11 (0.02–0.79)	Severe malnutrition	7	0.44 (0.21–0.93)	Severe malnutrition	10	0.56 (0.30–1.03)
	Indeterminate	9		Indeterminate	2		Indeterminate	4		Indeterminate	3
5–14 years
1	Malaria	47	0.53 (0.40–0.70)	Malaria	11	0.58 (0.32–1.05)	Malaria	25	0.76 (0.51–1.12)	Malaria	11	0.30 (0.17–0.54)
2	ARI, including pneumonia	16	0.18 (0.11–0.29)	Acute abdomen	6	0.32 (0.14–0.71)	HIV/AIDS-related	6	0.18 (0.08–0.41)	ARI, including pneumonia	6	0.16 (0.07–0.36)
3	Acute abdomen	15	0.17 (0.10–0.28)	ARI, including pneumonia	6	0.32 (0.14–0.71)	Acute abdomen	6	0.18 (0.08–0.41)	HIV/AIDS-related	6	0.16 (0.07–0.36)
4	HIV/AIDS-related	14	0.16 (0.09–0.27)	External causes	3	0.16 (0.05–0.49)	ARI, including pneumonia	4	0.12 (0.05–0.32)	Acute abdomen	3	0.08 (0.03–0.25)
5	External causes	9	0.10 (0.05–0.19)	Meningitis and encephalitis	3	0.16 (0.05–0.49)	External causes	3	0.09 (0.03–0.28)	Meningitis and encephalitis	3	0.08 (0.03–0.25)
	Indeterminate	8		Indeterminate	3		Indeterminate	4		Indeterminate	1
15–59 years
1	Pulmonary tuberculosis	107	0.68 (0.57–0.83)	ARI, including pneumonia	23	0.76 (0.50–1.14)	Pulmonary tuberculosis	44	0.75 (0.56–1.01)	Pulmonary tuberculosis	44	0.65 (0.49–0.88)
2	Other infectious diseases	107	0.68 (0.57–0.83)	Pulmonary tuberculosis	19	0.62 (0.40–0.98)	Other infectious diseases	44	0.75 (0.56–1.01)	Other infectious diseases	44	0.65 (0.49–0.88)
3	ARI, including pneumonia	78	0.50 (0.40–0.62)	Other infectious diseases	19	0.62 (0.40–0.98)	ARI, including pneumonia	37	0.63 (0.46–0.87)	Malaria	27	0.40 (0.27–0.58)
4	Malaria	61	0.39 (0.30–0.50)	Maternal causes^a	18	0.59 (0.37–0.94)	Maternal causes^a	25	0.43 (0.29–0.63)	HIV/AIDS-related	19	0.28 (0.18–0.44)
5	Maternal causes^a	56	0.36 (0.28–0.47)	Acute abdomen	15	0.49 (0.30–0.82)	HIV/AIDS-related	24	0.41 (0.28–0.61)	ARI, including pneumonia	18	0.27 (0.17–0.42)
	Indeterminate	47		Indeterminate	9		Indeterminate	21		Indeterminate	17
60+ years
1	Pulmonary tuberculosis	137	7.84 (6.63–9.27)	ARI, including pneumonia	47	10.00 (7.79–14.00)	Stroke	59	9.62 (7.45–12.00)	Stroke	43	6.32 (4.69–8.52)
2	Other infectious diseases	137	7.84 (6.63–9.27)	Pulmonary tuberculosis	43	9.49 (7.04–13.00)	Other infectious diseases	54	8.80 (6.74–11.00)	ARI, including pneumonia	42	6.17 (4.56–8.35)
3	Stroke	134	7.67 (6.48–9.09)	Other infectious diseases	43	9.49 (7.04–13.00)	Pulmonary tuberculosis	54	8.80 (6.74–11.00)	Pulmonary tuberculosis	40	5.88 (4.31–8.02)
4	ARI, including pneumonia	130	7.44 (6.27–8.84)	Stroke	32	7.06 (4.99–9.99)	ARI, including pneumonia	41	6.68 (4.92–9.08)	Other infectious diseases	40	5.88 (4.31–8.02)
5	Malaria	63	3.61 (2.82–4.62)	Malaria	24	5.30 (3.55–7.90)	Acute abdomen	20	3.26 (2.10–5.05)	Acute abdomen	24	3.53 (2.36–5.26)
	Indeterminate	82		Indeterminate	28		Indeterminate	32		Indeterminate	22

^aRate based on person-time contributed by women aged 15–49 years who constitute the population at risk of maternal causes of death.

Table 4 Comparison of incidence of communicable and non-communicable diseases in the Farafenni demographic surveillance area by period and socio-demographic characteristics

			Non-communicable diseases
	Communicable diseases		All		Cancers		Others
	Rate ratio (95% CI)	p	Rate ratio (95% CI)	p	Rate ratio (95% CI)	p	Rate ratio (95% CI)	p
Period
1998–2001	1		1		1		1
2002–2004	1.09 (0.94–1.25)	0.265	0.91 (0.75–1.10)	0.317	0.85 (0.62–1.16)	0.310	0.94 (0.74–1.19)	0.625
2005–2007	0.75 (0.64–0.87)	<0.0001	0.67 (0.55–0.81)	<0.0001	0.59 (0.43–0.82)	0.002	0.71 (0.55–0.90)	0.006
Age group
< 1 year	1		1				1
1–4 years	0.45 (0.37–0.55)	<0.0001	0.64 (0.31–1.34)	0.238			0.64 (0.31–1.34)	0.238
5–14 years	0.08 (0.06–0.10)	<0.0001	0.34 (0.16–0.69)	0.003			0.30 (0.14–0.62)	0.001
15–60 years	0.17 (0.14–0.21)	<0.0001	1.64 (0.87–3.09)	0.126	1		0.90 (0.47–1.72)	0.750
60+ years	1.68 (1.40–2.03)	<0.0001	26.85 (14.34–50.28)	<0.0001	12.31 (9.53–15.91)	<0.0001	17.75 (9.44–33.36)	<0.0001
Sex
Female	1		1		1		1
Male	1.42 (1.27–1.59)	<0.0001	1.26 (1.09–1.47)	0.002	1.66 (1.29–2.15)	<0.0001	1.09 (0.91–1.31)	0.359
Ethnic group
Wollof	1		1		1		1
Mandinka	1.18 (1.04–1.33)	0.012	1.45 (1.22–1.71)	<0.0001	1.53 (1.15–2.05)	0.004	1.40 (1.14–1.72)	0.001
Fula	0.96 (0.82–1.12)	0.615	0.87 (0.70–1.09)	0.235	1.07 (0.74–1.53)	0.728	0.78 (0.59–1.03)	0.085
Other	0.84 (0.64–1.11)	0.232	0.56 (0.35–0.89)	0.015	0.82 (0.41–1.63)	0.562	0.44 (0.23–0.83)	0.011
Area of residence
Urban	1		1		1		1
Rural	1.59 (1.42–1.79)	<0.0001	1.56 (1.33–1.82)	<0.0001	1.73 (1.33–2.26)	<0.0001	1.47 (1.22–1.78)	<0.0001

Fig. 3 Cause and sex-specific mortality rates among Farafenni adults aged 15–59 years, 1998–2007.

Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, etal. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010; 375: 1969–87.

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