Mortality in women of reproductive age in rural South Africa
Identifieur interne : 002612 ( Ncbi/Merge ); précédent : 002611; suivant : 002613Mortality in women of reproductive age in rural South Africa
Auteurs : Dorean Nabukalu [Afrique du Sud, Ouganda] ; Kerstin Klipstein-Grobusch [Afrique du Sud, Pays-Bas] ; Kobus Herbst [Afrique du Sud] ; Marie-Louise Newell [Afrique du Sud, Royaume-Uni]Source :
- Global Health Action [ 1654-9716 ] ; 2013.
Abstract
To determine causes of death and associated risk factors in women of reproductive age in rural South Africa.
Deaths and person-years of observation (pyo) were determined for females (aged 15–49 years) resident in 15,526 households in a rural South African Demographic and Health Surveillance site from 2000 to 2009. Cause of death was ascertained by verbal autopsy and ICD-10 coded; causes were categorized as HIV/TB, non-communicable, communicable/maternal/perinatal/nutrition, injuries, and undetermined (unknown). Characteristics of women were obtained from regularly updated household visits, while HIV and self-reported health status was obtained from the annual HIV surveillance. Overall and cause-specific mortality rates (MRs) with 95% confidence intervals (CI) were calculated. The Weibull regression model (HR, 95% CI) was used to determine risk factors associated with mortality.
A total of 42,703 eligible women were included; 3,098 deaths were reported for 212,607 pyo. Overall MRwas 14.6 deaths/1,000 pyo (95% CI: 14.1–15.1), peaking in 2003 (MR 18.2/1,000 pyo, 95% CI: 16.4–20.1) and declining thereafter (2009: MR 9.6/1,000 pyo, 95% CI: 8.4–10.9). Mortality was highest for HIV/TB (MR 10.6/1,000 pyo, 95% CI: 10.2–11.1), accounting for 73.1% of all deaths, ranging from 61.2% in 2009 to 82.7% in 2002. Adjusting for education level, marital status, age, employment status, area of residence, and migration, all-cause mortality was associated with external migration (adjusted hazard ratio, or aHR), 1.70, 95% CI: 1.41–2.05), self-reported poor health status (aHR 8.26, 95% CI: 2.94–23.15), and HIV-infection (aHR 7.84, 95% CI: 6.26–9.82); external migration and HIV infection were also associated with causes of mortality other than HIV/TB (aHR 1.62, 95% CI: 1.12–2.34 and aHR 2.59, 95% CI: 1.79–3.75).
HIV/TB was the leading cause of death among women of reproductive age, although rates declined with the rollout of HIV treatment in the area from 2004. Women's age, external migration status and HIV-positive status were significantly associated with all-cause and cause-specific mortality.
Url:
DOI: 10.3402/gha.v6i0.22834
PubMed: 24360403
PubMed Central: 3869952
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<series><title level="j">Global Health Action</title>
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<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Objective</title>
<p>To determine causes of death and associated risk factors in women of reproductive age in rural South Africa.</p>
</sec>
<sec id="st2"><title>Methods</title>
<p>Deaths and person-years of observation (pyo) were determined for females (aged 15–49 years) resident in 15,526 households in a rural South African Demographic and Health Surveillance site from 2000 to 2009. Cause of death was ascertained by verbal autopsy and ICD-10 coded; causes were categorized as HIV/TB, non-communicable, communicable/maternal/perinatal/nutrition, injuries, and undetermined (unknown). Characteristics of women were obtained from regularly updated household visits, while HIV and self-reported health status was obtained from the annual HIV surveillance. Overall and cause-specific mortality rates (MRs) with 95% confidence intervals (CI) were calculated. The Weibull regression model (HR, 95% CI) was used to determine risk factors associated with mortality.</p>
</sec>
<sec id="st3"><title>Results</title>
<p>A total of 42,703 eligible women were included; 3,098 deaths were reported for 212,607 pyo. Overall MRwas 14.6 deaths/1,000 pyo (95% CI: 14.1–15.1), peaking in 2003 (MR 18.2/1,000 pyo, 95% CI: 16.4–20.1) and declining thereafter (2009: MR 9.6/1,000 pyo, 95% CI: 8.4–10.9). Mortality was highest for HIV/TB (MR 10.6/1,000 pyo, 95% CI: 10.2–11.1), accounting for 73.1% of all deaths, ranging from 61.2% in 2009 to 82.7% in 2002. Adjusting for education level, marital status, age, employment status, area of residence, and migration, all-cause mortality was associated with external migration (adjusted hazard ratio, or aHR), 1.70, 95% CI: 1.41–2.05), self-reported poor health status (aHR 8.26, 95% CI: 2.94–23.15), and HIV-infection (aHR 7.84, 95% CI: 6.26–9.82); external migration and HIV infection were also associated with causes of mortality other than HIV/TB (aHR 1.62, 95% CI: 1.12–2.34 and aHR 2.59, 95% CI: 1.79–3.75).</p>
</sec>
<sec id="st4"><title>Conclusion</title>
<p>HIV/TB was the leading cause of death among women of reproductive age, although rates declined with the rollout of HIV treatment in the area from 2004. Women's age, external migration status and HIV-positive status were significantly associated with all-cause and cause-specific mortality.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Glob Health Action</journal-id>
<journal-id journal-id-type="iso-abbrev">Glob Health Action</journal-id>
<journal-id journal-id-type="publisher-id">GHA</journal-id>
<journal-title-group><journal-title>Global Health Action</journal-title>
</journal-title-group>
<issn pub-type="ppub">1654-9716</issn>
<issn pub-type="epub">1654-9880</issn>
<publisher><publisher-name>Co-Action Publishing</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">24360403</article-id>
<article-id pub-id-type="pmc">3869952</article-id>
<article-id pub-id-type="publisher-id">22834</article-id>
<article-id pub-id-type="doi">10.3402/gha.v6i0.22834</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Mortality in women of reproductive age in rural South Africa</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Nabukalu</surname>
<given-names>Dorean</given-names>
</name>
<xref ref-type="aff" rid="AF0001">1</xref>
<xref ref-type="aff" rid="AF0002">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Klipstein-Grobusch</surname>
<given-names>Kerstin</given-names>
</name>
<xref ref-type="aff" rid="AF0001">1</xref>
<xref ref-type="aff" rid="AF0003">3</xref>
<xref ref-type="corresp" rid="cor1">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Herbst</surname>
<given-names>Kobus</given-names>
</name>
<xref ref-type="aff" rid="AF0004">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Newell</surname>
<given-names>Marie-Louise</given-names>
</name>
<xref ref-type="aff" rid="AF0004">4</xref>
<xref ref-type="aff" rid="AF0005">5</xref>
</contrib>
</contrib-group>
<aff id="AF0001"><label>1</label>
Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</aff>
<aff id="AF0002"><label>2</label>
Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda</aff>
<aff id="AF0003"><label>3</label>
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands</aff>
<aff id="AF0004"><label>4</label>
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa</aff>
<aff id="AF0005"><label>5</label>
Faculty of Medicine and Faculty of Social and Human Sciences, University of Southampton, Southampton, UK</aff>
<author-notes><corresp id="cor1"><label>*</label>
Correspondence to: Kerstin Klipstein-Grobusch, Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands, Tel:+31 88 75 684 42, Fax +31 88 75 554 85, Email: <email xlink:href="k.klipstein-grobusch@umcutrecht.nl">k.klipstein-grobusch@umcutrecht.nl</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>19</day>
<month>12</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="collection"><year>2013</year>
</pub-date>
<volume>6</volume>
<elocation-id content-type="doi">10.3402/gha.v6i0.22834</elocation-id>
<history><date date-type="received"><day>14</day>
<month>9</month>
<year>2013</year>
</date>
<date date-type="rev-recd"><day>24</day>
<month>11</month>
<year>2013</year>
</date>
<date date-type="accepted"><day>25</day>
<month>11</month>
<year>2013</year>
</date>
</history>
<permissions><copyright-statement>© 2013 Dorean Nabukalu et al.</copyright-statement>
<copyright-year>2013</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec id="st1"><title>Objective</title>
<p>To determine causes of death and associated risk factors in women of reproductive age in rural South Africa.</p>
</sec>
<sec id="st2"><title>Methods</title>
<p>Deaths and person-years of observation (pyo) were determined for females (aged 15–49 years) resident in 15,526 households in a rural South African Demographic and Health Surveillance site from 2000 to 2009. Cause of death was ascertained by verbal autopsy and ICD-10 coded; causes were categorized as HIV/TB, non-communicable, communicable/maternal/perinatal/nutrition, injuries, and undetermined (unknown). Characteristics of women were obtained from regularly updated household visits, while HIV and self-reported health status was obtained from the annual HIV surveillance. Overall and cause-specific mortality rates (MRs) with 95% confidence intervals (CI) were calculated. The Weibull regression model (HR, 95% CI) was used to determine risk factors associated with mortality.</p>
</sec>
<sec id="st3"><title>Results</title>
<p>A total of 42,703 eligible women were included; 3,098 deaths were reported for 212,607 pyo. Overall MRwas 14.6 deaths/1,000 pyo (95% CI: 14.1–15.1), peaking in 2003 (MR 18.2/1,000 pyo, 95% CI: 16.4–20.1) and declining thereafter (2009: MR 9.6/1,000 pyo, 95% CI: 8.4–10.9). Mortality was highest for HIV/TB (MR 10.6/1,000 pyo, 95% CI: 10.2–11.1), accounting for 73.1% of all deaths, ranging from 61.2% in 2009 to 82.7% in 2002. Adjusting for education level, marital status, age, employment status, area of residence, and migration, all-cause mortality was associated with external migration (adjusted hazard ratio, or aHR), 1.70, 95% CI: 1.41–2.05), self-reported poor health status (aHR 8.26, 95% CI: 2.94–23.15), and HIV-infection (aHR 7.84, 95% CI: 6.26–9.82); external migration and HIV infection were also associated with causes of mortality other than HIV/TB (aHR 1.62, 95% CI: 1.12–2.34 and aHR 2.59, 95% CI: 1.79–3.75).</p>
</sec>
<sec id="st4"><title>Conclusion</title>
<p>HIV/TB was the leading cause of death among women of reproductive age, although rates declined with the rollout of HIV treatment in the area from 2004. Women's age, external migration status and HIV-positive status were significantly associated with all-cause and cause-specific mortality.</p>
</sec>
</abstract>
<kwd-group><kwd>reproductive age</kwd>
<kwd>women</kwd>
<kwd>mortality</kwd>
<kwd>rural South Africa</kwd>
<kwd>risk factors</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Afrique du Sud</li>
<li>Ouganda</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
</country>
<region><li>Gauteng</li>
<li>Utrecht (province)</li>
</region>
<settlement><li>Johannesbourg</li>
<li>Utrecht</li>
</settlement>
<orgName><li>Université du Witwatersrand</li>
</orgName>
</list>
<tree><country name="Afrique du Sud"><region name="Gauteng"><name sortKey="Nabukalu, Dorean" sort="Nabukalu, Dorean" uniqKey="Nabukalu D" first="Dorean" last="Nabukalu">Dorean Nabukalu</name>
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<name sortKey="Herbst, Kobus" sort="Herbst, Kobus" uniqKey="Herbst K" first="Kobus" last="Herbst">Kobus Herbst</name>
<name sortKey="Klipstein Grobusch, Kerstin" sort="Klipstein Grobusch, Kerstin" uniqKey="Klipstein Grobusch K" first="Kerstin" last="Klipstein-Grobusch">Kerstin Klipstein-Grobusch</name>
<name sortKey="Newell, Marie Louise" sort="Newell, Marie Louise" uniqKey="Newell M" first="Marie-Louise" last="Newell">Marie-Louise Newell</name>
</country>
<country name="Ouganda"><noRegion><name sortKey="Nabukalu, Dorean" sort="Nabukalu, Dorean" uniqKey="Nabukalu D" first="Dorean" last="Nabukalu">Dorean Nabukalu</name>
</noRegion>
</country>
<country name="Pays-Bas"><region name="Utrecht (province)"><name sortKey="Klipstein Grobusch, Kerstin" sort="Klipstein Grobusch, Kerstin" uniqKey="Klipstein Grobusch K" first="Kerstin" last="Klipstein-Grobusch">Kerstin Klipstein-Grobusch</name>
</region>
</country>
<country name="Royaume-Uni"><noRegion><name sortKey="Newell, Marie Louise" sort="Newell, Marie Louise" uniqKey="Newell M" first="Marie-Louise" last="Newell">Marie-Louise Newell</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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