Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019

Dorean Nabukalu*, Julia Calazans, Milly Marston, Clara Calvert, Hadijja Nakawooya, Brendah Nansereko, Gertrude Nakigozi, David Serwadda, Nelson K Sewankambo, Godfrey Kigozi, Ronald H Gray, Fred Nalugoda, Fredrick E. Makumbi, Tom Lutalo, Jim Todd

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background
There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status.

Objectives
To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda.

Methodology
Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood.

Results
Between 1999 and 2019, 63082 adults (15–60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33–5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61–12.28) to 3.27 (95% CI: 2.89–3.68) per 1000 pyo between 1999–2004 and 2015–2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively.

Conclusion
There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.
Original languageEnglish
Article number2338635
Number of pages10
JournalGlobal Health Action
Volume17
DOIs
Publication statusPublished - 8 May 2024

Keywords / Materials (for Non-textual outputs)

  • Verbal autopsy
  • adult mortality
  • Uganda
  • ealth and demographic surveillance sites
  • cause of death

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