Mortality Reduction Associated with HIV/AIDS Care and Antiretroviral Treatment in Rural Malawi: Evidence from Registers, Coffin Sales and Funerals

BACKGROUND: To report on the trend in all-cause mortality in a rural district of Malawi that has successfully scaled-up HIV/AIDS care including antiretroviral treatment (ART) to its population, through corroborative evidence from a) registered deaths at traditional authorities (TAs), b) coffin sales and c) church funerals. METHODS AND FINDINGS: Retrospective study in 5 of 12 TAs (covering approximately 50% of the population) during the period 2000-2007. A total of 210 villages, 24 coffin workshops and 23 churches were included. There were a total of 18,473 registered deaths at TAs, 15781 coffins sold, and 2762 church funerals. Between 2000 and 2007, there was a highly significant linear downward trend in death rates, sale of coffins and church funerals (X(2) for linear trend: 338.4 P<0.0001, 989 P<0.0001 and 197, P<0.0001 respectively). Using data from TAs as the most reliable source of data on deaths, overall death rate reduction was 37% (95% CI:33-40) for the period. The mean annual incremental death rate reduction was 0.52/1000/year. Death rates decreased over time as the percentage of people living with HIV/AIDS enrolled into care and ART increased. Extrapolating these data to the entire district population, an estimated 10,156 (95% CI: 9786-10259) deaths would have been averted during the 8-year period. CONCLUSIONS: Registered deaths at traditional authorities, the sale of coffins and church funerals showed a significant downward trend over a 8-year period which we believe was associated with the scaling up HIV/AIDS care and ART

Trends in registered deaths, coffin sales and church funerals.

<p><b>1a</b>) Trends in registered deaths at traditional authorities, (2000–2007) Thyolo, District, Malawi. <b>1b</b>) Trend in coffin sales (2000–2007), Thyolo, District, Malawi. <b>1c</b>). Trend in registered church funerals (2000–2007), Thyolo, Malawi.</p

Registered church funerals in the 5 traditional authorities (2000–2007), Thyolo district, Malawi.

<p>a. X² for linear trend  = 196.8, <i>P</i><0.0001.</p><p>b. 95% Confidence Intervals.</p

Death rates from 5 traditional authorities projected to estimate averted deaths in the entire Thyolo district, Malawi.

<p>TAs, Traditional authorities; CI, Confidence Interval.</p><p>a. Death rate from registered deaths at traditional authorities in 5 TAs.</p><p>b. Number of deaths extrapolated by year for the entire Thyolo District assuming the same rates of death per year as in the 5 TAs.</p><p>c. Number of projected deaths assuming a death rate of 10,9 (95% CI:10.4–11.2)/1000/year that was observed in 2000 in the 5 TAs.</p