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Karim Derra , Innocent Valea, Halidou Tinto

7 th Annual Symposium, April 15 th - 17 th · 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. Background.

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Karim Derra , Innocent Valea, Halidou Tinto

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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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