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Causes of Death in Rural Africa: Insights from Nanoro HDSS System

Explore causes of death in rural Africa using the Nanoro Health and Demographic Surveillance System in Burkina Faso. This study sheds light on mortality statistics and the significance of reliable data in public health planning. Discover the healthcare challenges and solutions.

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Causes of Death in Rural Africa: Insights from Nanoro HDSS System

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  1. 7th Annual Symposium, April 15th - 17th · Bellevue, WA www.crun.bf Causes of death in rural Africa: evidence the from Nanoro Health and Demographic Surveillance System (HDSS) in Central Burkina Faso Karim Derra, Innocent Valea, Halidou Tinto Contact:kderra@crun.bf

  2. Background • Reliable and timely data are needed in any society to guide policy deliberations • Mortality statistics are the foundation of public health planning, monitoring and evaluation of health interventions/policies • Mortality is still high… • CoD in sub-Saharan Africa  critical knowledge gap • Countries are not producing useable CoD data nationally • Mortality Information Paradox : • Civil Registration and Vital Statistics (CRVS) system is weak • Health Information and Management System (HIMS) data are highly selective  most (2/3) of all deaths occur outside health facilities • Population-based surveys (e.g. DHS) and national censuses do not collect CoD data

  3. Background: HDSS, an alternative to fill the gap… • The HDSS platform offers a medium term solution to the lack of reliable mortality data in LMICs  direct estimates of mortality • HDSS site are valuable source of data on long-term trends in mortality by age and sex, as well as population dynamic • Verbal autopsy are also conducted, which provide insights into all-cause and cause-specific mortality trends INDEPTH Cause of Death Data Vol. 1 (2014), Global Health

  4. Clinical Research Unit of Nanoro (CRUN) Study area Burkina Faso • CRUN established (officially) in 2009 • Research studies at high international standards • Training e.g. GCP,L • Departments : CLINIC, PHARMACY, LABORATORY, DM-IT… • CRUN set-up a HDSS in 2009 • Located at Center Western BF, 85 km from Ouagadougou • ≈ 600 Km² in rural area • Rainy season: July–November (Mean rain fall : 700mm/yr) • Malaria transmission is holoendemic, occurring between July-December • Mossi community (>90%) • Economical activities: Agriculture NIGER MALI N 600 mm Nanoro OUAGADOUGOU BENIN 900 mm TOGO GHANA BOBO-DIOULASSO LEGENDE Zone sahélienne Zone Nord soudanienne Zone Sud soudanienne Province du Houet COTE D'IVOIRE Province du Kénédougou 0 50 100 Echelle: Limite d’état Kilomètres

  5. Health and Demographic Surveillance System Concept MappingAll locations Out-migrate Verbal Autopsy on all deaths Exit Dynamic Cohort Initial Census (Unique ID given) (Rural/Urban/ Peri-Urban) Ideal cycles of enumeration 2-4/year Entry In-migrate Follow up of pregnancies and their outcomes

  6. Derra et al., 2012 • 65,500 inhabitants recorded in 9,000 households • Regular 4-monthly household updated visits • Events : • Marriages • Pregnancies • Births • In/out migrations • Deaths + Verbal autopsies • … • Staff (45) : • Demographer, Geographer • Data Managers • FWs, Supervisors • Key Informants • DATA : longitudinal format • Event history analysis file • Quality checks • Demographic rates by the same file The Nanoro HDSS profile • 24 Villages • 10 peripheral HF • 1 Referral hospital

  7. Verbal Auptosy (VA) • VA have limitations • International standards tools • WHO 2007, 2012, 2014 & 2016 • Computers based coding VA (CCVA) • InterVA • Tarriff or SmartVA • InSilicoVA • ICD-10 codes • CoD ascertained tool • community-based approach  home visits • post-mortem interview capturing the circumstances, signs and symptoms leading to the death • by non medical staff • Physicians review the data to assign the CoD (PCVA) • Validation studies • Evaluation of the performance of tools

  8. VA procedure in the field • Death notification  by Fieldworkers • Structured questionnaire to relative or friends who assisted the deceased  VA interviewers • Assess CoD based on report of Interview • 2 independents Physicians, 3th or more ? • Software  Statistician • fast, cheap, internally consistent… • ICD 10  Physician or Statistician

  9. VA data collected in Nanoro HDSS • Paper based: 3 different questionnaires by group age • Neonate < 4 weeks age old • Children 4 weeks to 11 years old • Adult >= 12 years

  10. Results : 2,300/ 2,423 VA deaths, from 2011 to 2016

  11. Results : CoD in 3 major groups All Male Female

  12. Results : CoD by 3 major groups trend All Female Male

  13. Results : CoD fraction by age groups Title of presentation

  14. Conclusions • Predomiance of CDs  LMICs • Malaria leads the causes of death among children < 5 • VA CoD can be performed • Combining PCVA + CCVA  easyVA • Combining data from hospitals

  15. Thanks !

  16. We should save our system

  17. Population Pyramid • Typical of rural low and middle-income countries: • High birth rate (Total Fertility Rate ~ 5); • Population is growing rapidly; • Out-migration is especially high in adult men

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