Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal

Background: In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources. Little is known about population mobility at the end of life. Objective: To document the magnitude, motivations and associated factors of short-term mobility before death among adults over 15 years of age in Burkina Faso and Senegal. Methods: The study was based on deaths of adult residents reported in three Health and Demographic Surveillance System (HDSS) sites in urban (Ouagadougou) and semi-rural areas (Kaya) of Burkina Faso, and rural areas of Senegal (Mlomp). After excluding deaths from external causes, the analysis covered, respectively, 536 and 695 deaths recorded during the period 2012–2015 in Ouagadougou and Kaya. The period was extended to 2000–2015 in Mlomp, with a sample of 708 deaths. Binary logistic regressions were used to examine the effects of socio-demographic characteristics on place of death (health facility or not) and location of death (within or outside the HDSS). Results: In Mlomp, Kaya and Ouagadougou, respectively 20.6%, 5.3% and 5.9% of adults died outside the HDSS site. In Mlomp and Kaya, these deaths were more likely to occur in a health facility than deaths that occurred within the site. The reverse situation was found in Ouagadougou. Age is the strongest determinant of mobility before death in Mlomp and Kaya. In Mlomp, young adults (15–39) were 10 times more likely to die outside the site than adults in the 60–79 age group. In Ouagadougou, non-natives were three times more likely to die outside the city than natives. Conclusions: At the end of life, some rural residents move to urban areas for medical treatment while some urban dwellers return to their village for supportive care. These movements of dying individuals may affect the estimation of urban/rural mortality differentials

Estimating Mortality from Census Data: an record linkage study in the Nouna Demographic and Health Surveillance System in Burkina Faso

Using data collected in the Nouna HDSS in Burkina Faso, we evaluate the reliability of mortality estimates based on the 2006 national census. We extracted from the census database all records referring to the population under surveillance in the HDSS. Life tables were estimated from recent household deaths reported in the census and compared to those obtained from the prospective mortality data. We linked census and HDSS records at the individual level and evaluated the reported ages of household members and those who died in the 12 months preceding the census against those in the HDSS. Life expectancies derived from recent deaths reported in households pointed to lower mortality than monitored in the HDSS, with a difference of 3.2 years for men and 6.8 years for women. Age errors were limited for the surviving population, but larger for the deceased. Underreporting of deaths plays a larger role than age errors

Estimating mortality from census data: A record-linkage study of the Nouna Health and Demographic Surveillance System in Burkina Faso

Background: In low- and middle-income countries, mortality levels are commonly derived from retrospective reports on deceased relatives collected in sample surveys and censuses. These data sources are potentially affected by recall errors. Objective: Using high-quality data collected by the Nouna Health and Demographic Surveillance System (HDSS) in Burkina Faso, we evaluate the reliability of mortality estimates based on the 2006 national census. Methods: We extracted from the census database all records referring to the population under surveillance in the HDSS. Life tables were estimated from recent household deaths reported in the census and compared to those obtained from the prospective mortality data. To evaluate age errors and assess their impact on mortality, we linked census and HDSS records at the individual level for the surviving population and the deceased. Indirect estimates of mortality were also calculated based on the reported survival of children and parents. Results: Life expectancies at birth derived from recent household deaths pointed to a lower mortality than monitored in the HDSS, with a difference of 4 years for men and 8 years for women. Underreporting of deaths among the population aged 60 and above accounted for more than half of these differences. Age errors were small for the surviving population and larger for the deceased, but their effects on mortality estimates were modest. Indirect estimates of child mortality were consistent with the HDSS data, but orphanhood-based estimates were implausibly low. Conclusions: Additional elicitation questions should be asked during the census interviews to improve the collection of data on recent household deaths. Contribution: Mortality rates derived from recent household deaths can seriously underestimate mortality. In Burkina Faso the downward bias in the 2006 census was larger among females and was mostly attributable to underreporting of deaths

Estimating mortality from census data: A record-linkage study of the Nouna Health and Demographic Surveillance System in Burkina Faso

BACKGROUND In low- and middle-income countries, mortality levels are commonly derived from retrospective reports on deceased relatives collected in sample surveys and censuses. These data sources are potentially affected by recall errors. OBJECTIVE Using high-quality data collected by the Nouna Health and Demographic Surveillance System (HDSS) in Burkina Faso, we evaluate the reliability of mortality estimates based on the 2006 national census. METHODS We extracted from the census database all records referring to the population under surveillance in the HDSS. Life tables were estimated from recent household deaths reported in the census and compared to those obtained from the prospective mortality data. To evaluate age errors and assess their impact on mortality, we linked census and HDSS records at the individual level for the surviving population and the deceased. Indirect estimates of mortality were also calculated based on the reported survival of children and parents. RESULTS Life expectancies at birth derived from recent household deaths pointed to a lower mortality than monitored in the HDSS, with a difference of 4 years for men and 8 years for women. Underreporting of deaths among the population aged 60 and above accounted for more than half of these differences. Age errors were small for the surviving population and larger for the deceased, but their effects on mortality estimates were modest. Indirect estimates of child mortality were consistent with the HDSS data, but orphanhood-based estimates were implausibly low. CONCLUSION Additional elicitation questions should be asked during the census interviews to improve the collection of data on recent household deaths. CONTRIBUTION Mortality rates derived from recent household deaths can seriously underestimate mortality. In Burkina Faso the downward bias in the 2006 census was larger among females and was mostly attributable to underreporting of deaths

Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites.

BACKGROUND: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. OBJECTIVE: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. DESIGN: All 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 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. CONCLUSIONS: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs

Cause-specific childhood mortality in Africa and Asia : evidence from INDEPTH health and demographic surveillance system sites

Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from 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.; To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia.; All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (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 provided person-time denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1-4 year and 5-14 year age groups.; A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported.; Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes under-documented, rates. External causes of death are a significant childhood problem in some settings

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

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.; 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.; 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.; 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.; These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian setting 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