umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Mortality in transitional Vietnam
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Understanding mortality patterns is an essential pre-requisite for guiding public health action and for supporting development of evidence-based policy. However, such information is not sufficiently available in Vietnam. Mortality statistics and causes of death are solely collected from health facilities while most deaths occur at home without the presence of health professionals. Facility-based data cannot represent what happened in the wider community. This thesis studies the patterns and burdens of mortality as well as their relationships with socio-economic status in rural Vietnam. The overall aim is to contribute to the improvement of the current system of mortality data collection in the country for the purposes of public health planning and priority setting.

The study was carried out within the framework of an ongoing Demographic Surveillance System (DSS) in Bavi district, Hatay province, northern rural Vietnam. This study used a verbal autopsy (VA) approach to identify cause of death in a cohort of approximately 250,000 person- years over a five-year period from 1999 to 2003.

During the five year study, a total of 1,240 deaths were recorded and VA was successfully completed for 1,220 cases. Results revealed that VA was an appropriate and useful method for ascertaining cause of death in this rural Vietnamese community where specific data were otherwise scarce. The mortality pattern reflected a transitional pattern of disease in which the leading cause of death was cardiovascular diseases (CVD), followed by neoplasms, infectious and parasitic diseases, and external causes, accounting for 28.9%, 14.5%, 11.2%, and 9.8%, respectively. In terms of premature mortality, there were 85 and 55 Years of Life Lost (YLL) per 1,000 population for males and females respectively. The largest contributions to YLL were CVDs, malignant neoplasms, unintentional injuries, and perinatal and neonatal causes. In general, men had higher mortality rates than women for all mortality categories. In adults of 20 years and above, mortality rates increased substantially with age, and showed similar age effects for all mortality categories with the strongest association for non-communicable diseases (NCD). Education was an important factor for survival in general, and high economic status seemed to benefit men more than women. Compared with cancer and other NCD causes, higher CVD rates were observed among males, the elderly, and those without formal education, using a Cox proportional hazards model.

This study is an initial effort to provide information on mortality patterns in a community using longitudinal follow-up of a dynamic cohort. Continuing the study using the VA approach as part of routine data collection in the setting will help to show trends in mortality patterns for the community over time, which may be useful for priority setting and health planning purposes, not only locally but also at the national level. Further analyses are needed to understand mortality inequality across all ages to have a comprehensive picture of mortality burdens in the setting. Validation studies and further standardization of VA methods should be carried out whenever possible to improve the performance and extension of the technique.

Place, publisher, year, edition, pages
2006. , 67 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1036
Keyword [en]
cause of death, verbal autopsy, mortality, rural Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-878ISBN: 91-7264-126-6 (print)OAI: oai:DiVA.org:umu-878DiVA: diva2:144855
Public defence
2006-10-19, Sal D, 1D, Tandläkarhögskolan, NUS, 13:00 (English)
Opponent
Supervisors
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2009-10-20Bibliographically approved
List of papers
1. Applying verbal autopsy to determine cause of death in rural Vietnam
Open this publication in new window or tab >>Applying verbal autopsy to determine cause of death in rural Vietnam
2003 (Swedish)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no Suppl. 62, 19-25 p.Article in journal (Refereed) Published
Abstract [sv]

Aims: Verbal autopsy (VA) is an attractive method for ascertaining causes of death in settings where the proportion of

people who die under medical care is low. VA has been widely used to determine causes of childhood and maternal deaths,

but has had limited use in assessing causes in adults and across all age groups. The objective was to test the feasibility of

using VA to determine causes of death for all ages in Bavi District, Vietnam, in 1999, leading to an initial analysis of the

mortality pattern in this area. Methods: Trained lay field workers interviewed a close caretaker of the deceased using a

combination closed/open-ended questionnaire. Results: A total of 189 deaths were studied. Diagnoses were made by two

physicians separately, with good agreement (k~0.84) and then combined to reach one single underlying cause of death for

each case. The leading causes of death were cardiovascular and infectious diseases (accounting for 20.6% and 17.9% of the

total respectively). Drowning was very prevalent in children under 15 (seven out of nine cases of drowning were in this age

group). Discussion: One month seemed an acceptable minimum recall period to ensure mourning procedures were over. A

combination VA questionnaire was an appropriate instrument provided it was supported by adequate training of

interviewers. Two physicians were appropriate for making the diagnoses but predefined diagnostic methods for common

causes should be developed to ensure more replicable results and comparisons, as well as to observe trends of mortality over

time. The causes of death in this study area reflect a typical pattern for developing countries that are in epidemiological

transition. No maternal deaths and a low infant mortality rate may be the result of improvements in maternal and child

health in this study area. Using the VA gave more precise causes of death than those reported at death registration.

Although the validity of the VA method used has not been fully assessed, it appeared to be an appropriate method for

ascertaining causes of death in the study area.

Key words: cause of death, community data, field survey, mortality, verbal autopsy, Vietnam.

Identifiers
urn:nbn:se:umu:diva-12510 (URN)doi:10.1080/14034950310015068 (DOI)14649633 (PubMedID)
Available from: 2006-04-26 Created: 2006-04-26 Last updated: 2017-12-14Bibliographically approved
2. Burden of premature mortality in rural Vietnam from 1999 - 2003: analyses from a Demographic Surveillance Site
Open this publication in new window or tab >>Burden of premature mortality in rural Vietnam from 1999 - 2003: analyses from a Demographic Surveillance Site
Show others...
2006 (English)In: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 4, Article nr 9- p.Article in journal (Refereed) Published
Abstract [en]

Background: Assessing the burden of disease contributes towards evidence-based allocation of limited health resources. However, such measures are not yet commonly available in Vietnam. Taking advantage of the FilaBavi Demographic Surveillance Site (FilaBavi DSS) in Vietnam, this study aimed to establish the feasibility of applying the Years of Life Lost (YLL) technique in the context of a defined DSS, and to estimate the importance of the principal causes of premature mortality in a rural area of Vietnam between 1999 and 2003.

Methods: Global Burden of Disease methods were applied. Causes of death were ascertained by verbal autopsy.

Results: In five years, 1,240 deaths occurred and for 1,220 cases cause of death information from verbal autopsy was available. Life expectancy at birth was 71.0 (95% confidence interval 69.9–72.1) in males and 80.9 (79.9–81.9) in females. The discounted, but not age weighted YLL per 1,000 population was 85 and 55 for males and females, respectively. The leading causes of YLL and death counts were cardiovascular diseases, malignant neoplasms, unintentional injuries, and neonatal causes. Males contributed 54% of total deaths and 59% of YLL. Males experienced higher YLL than women across all causes. Filabavi mortality estimates are considerably lower than 2002 WHO country estimates for Vietnam. Also the FilaBavi cause distribution varies considerably from the WHO result.

Conclusion: The combination of localised demographic surveillance, verbal autopsy and the application of YLL methods enable new insights into the magnitude and importance of significant public health issues in settings where evidence for planning is otherwise scarce. Local mortality data vary considerably from the WHO model-based estimates.

Place, publisher, year, edition, pages
BioMed Central, 2006
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-14139 (URN)10.1186/1478-7954-4-9 (DOI)16893472 (PubMedID)
Available from: 2007-05-23 Created: 2007-05-23 Last updated: 2017-12-14Bibliographically approved
3. Socio-economic status inequality and major causes of death in adults: a 5-year follow-up study in rural Vietnam.
Open this publication in new window or tab >>Socio-economic status inequality and major causes of death in adults: a 5-year follow-up study in rural Vietnam.
Show others...
2006 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, no 6, 497-504 p.Article in journal (Refereed) Published
Keyword
Adult, Age Factors, Aged, Aged; 80 and over, Cause of Death/*trends, Female, Follow-Up Studies, Humans, Male, Middle Aged, Population Surveillance, Risk Assessment, Risk Factors, Rural Health/*statistics & numerical data, Sex Distribution, Social Class, Social Justice, Socioeconomic Factors, Vietnam/epidemiology
Identifiers
urn:nbn:se:umu:diva-14140 (URN)10.1016/j.puhe.2006.03.003 (DOI)16707143 (PubMedID)
Available from: 2007-05-23 Created: 2007-05-23 Last updated: 2017-12-14Bibliographically approved
4. Cardiovascular disease mortality and its association with socioeconomic status: findings from a population-based cohort study in rural Vietnam, 1999-2003.
Open this publication in new window or tab >>Cardiovascular disease mortality and its association with socioeconomic status: findings from a population-based cohort study in rural Vietnam, 1999-2003.
Show others...
2006 (English)In: Preventing Chronic Disease, ISSN 1545-1151, E-ISSN 1545-1151, Vol. 3, no 3, A89- p.Article in journal (Refereed) Published
Keyword
Adult, Aged, Cardiovascular Diseases/*economics/*mortality, Cohort Studies, Female, Humans, Male, Middle Aged, Rural Population/*statistics & numerical data, Socioeconomic Factors, Vietnam/epidemiology
Identifiers
urn:nbn:se:umu:diva-14138 (URN)16776890 (PubMedID)
Available from: 2007-08-28 Created: 2007-08-28 Last updated: 2017-12-14Bibliographically approved

Open Access in DiVA

fulltext(655 kB)2479 downloads
File information
File name FULLTEXT01.pdfFile size 655 kBChecksum SHA-1
c8260abfe394f8ea6a272e9895b394156c9db7e4fede89d28b1414bd67dce918503f1ab1
Type fulltextMimetype application/pdf

By organisation
Epidemiology and Public Health Sciences
Public Health, Global Health, Social Medicine and Epidemiology

Search outside of DiVA

GoogleGoogle Scholar
Total: 2479 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 964 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf