Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995–2019: a multi-country surveillance study of verbal autopsy data

Yue  Chu; Milly Marston; Albert Dube; Charles Festo; Eveline Geubbels; Simon Gregson; Kobus  Herbst; Chodziwadziwa Kabudula; Kathleen Kahn; Tom  Lutalo; Louisa  Moorhouse; Robert  Newton; Constance Nyamukapa; Ronald Makanga; Emma Slaymaker; Mark Urassa; Abdhalah Ziraba; Clara Calvert; Samuel J. Clark

doi:10.1016/S2214-109X(24)00171-2

Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995–2019: a multi-country surveillance study of verbal autopsy data

Yue Chu^*, Milly Marston, Albert Dube, Charles Festo, Eveline Geubbels, Simon Gregson, Kobus Herbst, Chodziwadziwa Kabudula, Kathleen Kahn, Tom Lutalo, Louisa Moorhouse, Robert Newton, Constance Nyamukapa, Ronald Makanga, Emma Slaymaker, Mark Urassa, Abdhalah Ziraba, Clara Calvert^*, Samuel J. Clark

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

Background

The absence of high-quality comprehensive civil registration and vital statistics systems across many settings in Africa has led to limited empirical data on causes of death in the region.

Methods

We harmonized verbal autopsy (VA) and residency data from nine health and demographic surveillance system (HDSS) sites across Eastern and Southern Africa, each with variable coverage across the period 1995-2019. InSilicoVA, a probabilistic model, was used to assign cause of death based on the signs and symptoms reported in the VA. Levels and trends in all-cause and cause-specific mortality rates and cause-specific mortality fractions were calculated, stratified by HDSS site, sex, age, and calendar periods.

Findings

All-cause mortality has generally decreased across the HDSS sites, particularly for adults aged 20-59. In many of the HDSS sites, these decreases were driven by reductions in HIV/TB-related deaths. For 2010-2014, the top causes of death were: road traffic accidents, HIV/TB and meningitis/sepsis for adolescents (12-19 years), HIV/TB for adults (20-59 years), and neoplasms and cardiovascular disease for older adults (>59 years). There was greater between-HDSS and between-sex variation in causes of death for adolescents compared to adults.

Interpretation

This study shows that there has been progress in reducing mortality across Eastern and Southern Africa but also points to age, sex and between-HDSS differences in causes of adolescent and adult deaths. This highlights the importance of detailed local-level data to inform health needs to ensure continued improvements in survival.

Funding

National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health, USA.

Original language	English
Journal	The Lancet Global Health
Volume	12
Issue number	8
DOIs	https://doi.org/10.1016/S2214-109X(24)00171-2
Publication status	Published - 1 Aug 2024

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Cite this

Chu, Y., Marston, M., Dube, A., Festo, C., Geubbels, E., Gregson, S., Herbst, K., Kabudula, C., Kahn, K., Lutalo, T., Moorhouse, L., Newton, R., Nyamukapa, C., Makanga, R., Slaymaker, E., Urassa, M., Ziraba, A., Calvert, C., & Clark, S. J. (2024). Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995–2019: a multi-country surveillance study of verbal autopsy data. The Lancet Global Health, 12(8). https://doi.org/10.1016/S2214-109X(24)00171-2

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title = "Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995–2019: a multi-country surveillance study of verbal autopsy data",

abstract = "Background The absence of high-quality comprehensive civil registration and vital statistics systems across many settings in Africa has led to limited empirical data on causes of death in the region. Methods We harmonized verbal autopsy (VA) and residency data from nine health and demographic surveillance system (HDSS) sites across Eastern and Southern Africa, each with variable coverage across the period 1995-2019. InSilicoVA, a probabilistic model, was used to assign cause of death based on the signs and symptoms reported in the VA. Levels and trends in all-cause and cause-specific mortality rates and cause-specific mortality fractions were calculated, stratified by HDSS site, sex, age, and calendar periods. Findings All-cause mortality has generally decreased across the HDSS sites, particularly for adults aged 20-59. In many of the HDSS sites, these decreases were driven by reductions in HIV/TB-related deaths. For 2010-2014, the top causes of death were: road traffic accidents, HIV/TB and meningitis/sepsis for adolescents (12-19 years), HIV/TB for adults (20-59 years), and neoplasms and cardiovascular disease for older adults (>59 years). There was greater between-HDSS and between-sex variation in causes of death for adolescents compared to adults. Interpretation This study shows that there has been progress in reducing mortality across Eastern and Southern Africa but also points to age, sex and between-HDSS differences in causes of adolescent and adult deaths. This highlights the importance of detailed local-level data to inform health needs to ensure continued improvements in survival. Funding National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health, USA.",

author = "Yue Chu and Milly Marston and Albert Dube and Charles Festo and Eveline Geubbels and Simon Gregson and Kobus Herbst and Chodziwadziwa Kabudula and Kathleen Kahn and Tom Lutalo and Louisa Moorhouse and Robert Newton and Constance Nyamukapa and Ronald Makanga and Emma Slaymaker and Mark Urassa and Abdhalah Ziraba and Clara Calvert and Clark, {Samuel J.}",

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Chu, Y, Marston, M, Dube, A, Festo, C, Geubbels, E, Gregson, S, Herbst, K, Kabudula, C, Kahn, K, Lutalo, T, Moorhouse, L, Newton, R, Nyamukapa, C, Makanga, R, Slaymaker, E, Urassa, M, Ziraba, A, Calvert, C & Clark, SJ 2024, 'Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995–2019: a multi-country surveillance study of verbal autopsy data', The Lancet Global Health, vol. 12, no. 8. https://doi.org/10.1016/S2214-109X(24)00171-2

TY - JOUR

T1 - Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995–2019

T2 - a multi-country surveillance study of verbal autopsy data

AU - Chu, Yue

AU - Marston, Milly

AU - Dube, Albert

AU - Festo, Charles

AU - Geubbels, Eveline

AU - Gregson, Simon

AU - Herbst, Kobus

AU - Kabudula, Chodziwadziwa

AU - Kahn, Kathleen

AU - Lutalo, Tom

AU - Moorhouse, Louisa

AU - Newton, Robert

AU - Nyamukapa, Constance

AU - Makanga, Ronald

AU - Slaymaker, Emma

AU - Urassa, Mark

AU - Ziraba, Abdhalah

AU - Calvert, Clara

AU - Clark, Samuel J.

PY - 2024/8/1

Y1 - 2024/8/1

N2 - Background The absence of high-quality comprehensive civil registration and vital statistics systems across many settings in Africa has led to limited empirical data on causes of death in the region. Methods We harmonized verbal autopsy (VA) and residency data from nine health and demographic surveillance system (HDSS) sites across Eastern and Southern Africa, each with variable coverage across the period 1995-2019. InSilicoVA, a probabilistic model, was used to assign cause of death based on the signs and symptoms reported in the VA. Levels and trends in all-cause and cause-specific mortality rates and cause-specific mortality fractions were calculated, stratified by HDSS site, sex, age, and calendar periods. Findings All-cause mortality has generally decreased across the HDSS sites, particularly for adults aged 20-59. In many of the HDSS sites, these decreases were driven by reductions in HIV/TB-related deaths. For 2010-2014, the top causes of death were: road traffic accidents, HIV/TB and meningitis/sepsis for adolescents (12-19 years), HIV/TB for adults (20-59 years), and neoplasms and cardiovascular disease for older adults (>59 years). There was greater between-HDSS and between-sex variation in causes of death for adolescents compared to adults. Interpretation This study shows that there has been progress in reducing mortality across Eastern and Southern Africa but also points to age, sex and between-HDSS differences in causes of adolescent and adult deaths. This highlights the importance of detailed local-level data to inform health needs to ensure continued improvements in survival. Funding National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health, USA.

AB - Background The absence of high-quality comprehensive civil registration and vital statistics systems across many settings in Africa has led to limited empirical data on causes of death in the region. Methods We harmonized verbal autopsy (VA) and residency data from nine health and demographic surveillance system (HDSS) sites across Eastern and Southern Africa, each with variable coverage across the period 1995-2019. InSilicoVA, a probabilistic model, was used to assign cause of death based on the signs and symptoms reported in the VA. Levels and trends in all-cause and cause-specific mortality rates and cause-specific mortality fractions were calculated, stratified by HDSS site, sex, age, and calendar periods. Findings All-cause mortality has generally decreased across the HDSS sites, particularly for adults aged 20-59. In many of the HDSS sites, these decreases were driven by reductions in HIV/TB-related deaths. For 2010-2014, the top causes of death were: road traffic accidents, HIV/TB and meningitis/sepsis for adolescents (12-19 years), HIV/TB for adults (20-59 years), and neoplasms and cardiovascular disease for older adults (>59 years). There was greater between-HDSS and between-sex variation in causes of death for adolescents compared to adults. Interpretation This study shows that there has been progress in reducing mortality across Eastern and Southern Africa but also points to age, sex and between-HDSS differences in causes of adolescent and adult deaths. This highlights the importance of detailed local-level data to inform health needs to ensure continued improvements in survival. Funding National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health, USA.

U2 - 10.1016/S2214-109X(24)00171-2

DO - 10.1016/S2214-109X(24)00171-2

M3 - Article

SN - 2214-109X

VL - 12

JO - The Lancet Global Health

JF - The Lancet Global Health

IS - 8

ER -

Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995–2019: a multi-country surveillance study of verbal autopsy data

Abstract / Description of output

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