Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.

BACKGROUND: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. OBJECTIVE: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. DESIGN: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992-2012, but two-thirds of the observations related to 2006-2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. RESULTS: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. CONCLUSIONS: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites.

BACKGROUND: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15-64 years) and older (65+ years) NCD mortality. DESIGN: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15-64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. CONCLUSIONS: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work

HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

BACKGROUND: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. OBJECTIVE: To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. DESIGN: Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. RESULTS: The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. CONCLUSIONS: Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS

Individual, community, and social network influences on beliefs concerning the acceptability of intimate partner violence in rural Senegal

Intimate partner violence (IPV) is a pressing international public health and human rights concern. Recent scholarship concerning causes of IPV has focused on the potentially critical influence of social learning and influence in interpersonal interaction through social norms. Using sociocentric network data from all individuals aged 16 years and above in a rural Senegalese village surveyed as part of the Niakhar Social Networks and Health Project (n =1,274), we estimate a series of nested linear probability models to test the association between characteristics of respondents' social networks and residential compounds (including educational attainment, health ideation, socioeconomic status, and religion) and whether respondents are classified as finding IPV acceptable, controlling for individual characteristics. We also test for direct social learning effects, estimating the association between IPV acceptability among network members and co-residents and respondents' own, net of these factors. We find individual, social network, and residential compound factors are all associated with IPV acceptability. On the individual level, these include gender, traditional health ideation, and household agricultural investment. Residential compound-level associations are largely explained in the presence of the individual and network characteristics, except for that concerning educational attainment. We find that network alters' IPV acceptability is strongly positively associated with respondents'own, net of individual and compound-level characteristics. A 10% point higher probability of IPV acceptability in respondents' networks is estimated in to be associated with a 4.5% point higher likelihood of respondents being classified as finding IPV acceptable. This research provides compelling evidence that social interaction through networks exerts an important, potentially normative, influence on whether individuals in this population perceive IPV as acceptable or not. It also suggests that interventions targeting individuals most likely to perceive IPV as acceptable may have a multiplier effect, influencing the normative context of others they interact with through their social networks

Improving age measurement in low- and middle-income countries through computer vision: A test in Senegal

International audienc

Estimating mortality rom external causes using data from retrospective surveys : a validation study in Niakhar (Senegal)

Background: In low- and middle-income countries (LMICs), data on causes of death is often inaccurate or incomplete. In this paper, we test whether adding a few questions about injuries and accidents to mortality questionnaires used in representative household surveys would yield accurate estimates of the extent of mortality due to external causes (accidents, homicides, or suicides). Methods: We conduct a validation study in Niakhar (Senegal), during which we compare reported survey data to high-quality prospective records of deaths collected by a health and demographic surveillance system (HDSS). Results: Survey respondents more frequently list the deaths of their adult siblings who die of external causes than the deaths of those who die from other causes. The specificity of survey data is high, but sensitivity is low. Among reported deaths, less than 60% of the deaths classified as due to external causes by the HDSS are also classified as such by survey respondents. Survey respondents better report deaths due to road-traffic accidents than deaths from suicides and homicides. Conclusions: Asking questions about deaths resulting from injuries and accidents during surveys might help measure mortality from external causes in LMICs, but the resulting data displays systematic bias in a rural population of Senegal. Future studies should 1) investigate whether similar biases also apply in other settings and 2) test new methods to further improve the accuracy of survey data on mortality from external causes

Health and demographic surveillance system profile : Bandafassi Health and Demographic Surveillance System (Bandafassi HDSS), Senegal

The Bandafassi Health and Demographic Surveillance System (Bandafassi HDSS) is located in south-eastern Senegal, near the borders with Mali and Guinea. The area is 700 km from the national capital, Dakar. The population under surveillance is rural and in 2012 comprised 13 378 inhabitants living in 42 villages. Established in 1970, originally for genetic studies, and initially covering only villages inhabited by one subgroup of the population of the area (the Mandinka), the project was transformed a few years later into a HDSS and then extended to the two other subgroups living in the area: Fula villages in 1975, and Bedik villages in 1980. Data have been collected through annual rounds since the project first began. On each visit, investigators review the composition of all the households, checking the lists of people who were present in each household the previous year and gathering information about births, marriages, migrations and deaths (including their causes) since then. One specific feature of the Bandafassi HDSS is the availability of genealogies