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Young adult and middle age mortality in Butajira demographic surveillance site, Ethiopia: lifestyle, gender and household economy
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
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2008 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 8, Article nr 268- p.Article in journal (Refereed) Published
Abstract [en]

Background Public health research characterising the course of life through the middle age in developing societies is scarce. The aim of this study is to explore patterns of adult (15–64 years) mortality in an Ethiopian population over time, by gender, urban or rural lifestyle, causes of death and in relation to household economic status and decision-making.

Methods The study was conducted in Butajira Demographic Surveillance Site (DSS) in south-central Ethiopia among adults 15–64 years old. Cohort analysis of surveillance data was conducted for the years 1987–2004 complemented by a prospective case-referent (case control) study over two years.

Rate ratios were computed to assess the relationships between mortality and background variables using a Poisson regression model. In the case-referent component, odds ratios (95% confidence intervals) were used to assess the effect of certain risk factors that were not included in the surveillance system.

Results A total of 367 940 person years were observed in a period of 18 years, in which 2 860 deaths occurred. One hundred sixty two cases and 486 matched for age, sex and place of residence controls were included in the case referent (case control) study. Only a modest downward trend in adult mortality was seen over the 18 year period. Rural lifestyle carried a significant survival disadvantage [mortality rate ratio 1.62 (95% CI 1.44 to 1.82), adjusted for gender, period and age group], while the overall effects of gender were negligible. Communicable disease mortality was appreciably higher in rural areas [rate ratio 2.05 (95% CI 1.73 to 2.44), adjusted for gender, age group and period]. Higher mortality was associated with a lack of literacy in a household, poor economic status and lack of women's decision making.

Conclusion A complex pattern of adult mortality prevails, still influenced by war, famine and communicable diseases. Individual factors such as a lack of education, low economic status and social disadvantage all contribute to increased risks of mortality.

Place, publisher, year, edition, pages
BioMed Central, 2008. Vol. 8, Article nr 268- p.
Keyword [en]
Adolescent, Adult, Case-Control Studies, Cause of Death, Cohort Studies, Decision Making, Ethiopia/epidemiology, Female, Humans, Male, Middle Aged, Mortality/*trends, Poisson Distribution, Population Surveillance, Risk Factors, Rural Population/statistics & numerical data, Sex Distribution, Urban Population/statistics & numerical data
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-11199DOI: 10.1186/1471-2458-8-268ISI: 000258795600002PubMedID: 18671854OAI: oai:DiVA.org:umu-11199DiVA: diva2:150870
Note

This study was financially supported by SAREC (Swedish Agency for Research Co-operation with Developing Countries).

Available from: 2008-11-25 Created: 2008-11-25 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Mortality and survival from childhood to old age in rural Ethiopia
Open this publication in new window or tab >>Mortality and survival from childhood to old age in rural Ethiopia
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis examines ways of establishing cause of death, assessing trends in mortality, and identifying factors that affect mortality and survival among the different population groups in rural and semi-urban Ethiopia. These data are important for health care planning; however, such vital data are unavailable in many developing countries. The study was conducted in Butajira Rural Health Program Demographic Surveillance Site, Ethiopia, where data collection on vital events and related research has been conducted for the last 20 years. This thesis used a cohort and a case referent study preceded by Focus Group Discussion. It also employed a verbal autopsy procedure to identify causes of death. The cohort component used 18 years of surveillance data (1987-2004). The prospective case referent study, carried out in the years 2003-2005, was used to complement the mortality analysis and focused particularly on issues related to household decision making, social capital, and economic status. The main subgroups included were children under-five years old, adults 15-64, and the elderly 65 years and above. Cause of death was ascertained using the Physicians’ Review and InterVA methods.

Food shortage and epidemics affected the modest downward trend of mortality. There was a general similarity between the Physicians’ Review and InterVA methods in identifying the major causes of death. About 60% of the deaths were due to pneumonia/sepsis, pulmonary tuberculosis, malaria, and diarrhoea disease/malnutrition. The InterVA method was cheaper and more consistent. Higher rates of HIV/AIDS (11%), tuberculosis (18%), and cardiovascular (9%) mortality were noted in urban areas compared to rural areas. Consistent higher mortality was found in rural areas. Women were disadvantaged by residence and advanced age. Place of residence, illiteracy, widowhood, and not owning a house affected men and women differently, indicating a possible need for gender-specific interventions. Children and women survival is affected by household decision-making; this means efforts to improve women’s involvement in household decision-making (women empowerment) might improve child and women survival in poor settings. Many factors that significantly affect mortality can only be controlled by concerted efforts to improve health and overall development.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin, 2008. 62 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1153
Keyword
Mortality, survival, children, adults, elderly, cause of death, determinants, Ethiopia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-1559 (URN)978-91-7264-490-8 (ISBN)
Public defence
2008-03-14, Sal D, 9tr, Tandläkarhögskolan, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2008-02-25 Created: 2008-02-25 Last updated: 2010-01-21Bibliographically approved

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