Thesis (Ph. D. (Science)) -- University of Limpopo, 2015 / The objectives of the study were to examine the demographic profile and causes of
death of people dying in a hospital and community; and to determine mortality rates,
specifically age- and gender-specific mortality rates in a community. The study also
compared causes of death assigned to hospital records with causes of death
obtained from verbal autopsy reports.
Methodology
The data used in this thesis were collected in two phases. The first phase involved a
retrospective review of all deaths that occurred in the Pietersburg/Mankweng
Hospital Complex from 1st January, 2011 to 31st December, 2012. The second phase
involved a community-based study using a verbal autopsyto determine cause of
death in Dikgale HDSS for the same period.
Results
A total of 5402 deaths were reported in the hospital and 625 in the community. The
majority of deaths in the hospital involved adults in the 15 to 49 year old age group,
while in the community more deaths were recorded amongst adults aged 15 to 49
years of age and those in the 65+ year old age group. There were more male deaths
in the hospital, while in the community a higher proportion of deaths occurred
amongst females.
v
In children less than1 year old, the cause of death in the hospital was predominantly
due to perinatal conditions, particularly preterm birth, low birth weight and birth
asphyxia; while in the community, of the 5 deaths in this age group, infectious
diseases were recorded as the main cause of death. Amongst children in the 1 to 4
year old age groups causes of hospital deaths were dominated by infectious
diseases, injuries and malnutrition; while in the community infectious diseases were
the main cause of death.
Stillbirths were noted in the hospital with a stillbirth rate of 29.1/1000 deliveries. In
the community no stillbirths were reported. More than half of the stillbirths were
caused by unexplained intrauterine foetal causes followed by maternal hypertension
in pregnancy and placenta abruption.
For adults in the 15 to 49 year old age groups infectious diseases, such as HIV/AIDS
and tuberculosis, were the leading causes of death in both the hospital and in the
community. The proportion of deaths due to HIV/AIDS and tuberculosis was
significantly greater in the community than in the hospital.
Amongst adults in the 50+year old age group non-communicable diseases,
particularly cardiovascular diseases and cancers were the most common causes of
death. In this age group, the hospital recorded more cancer deaths than did the
community; while the community recorded more cardiovascular deaths than did the
hospital.
vi
The overall mortality rate in the community was 8.4 deaths per 1000 person-year,
with more deaths occurring amongst males (8.9 deaths per 1000 person-year). The
mortality rate was high amongst adults in the 65+ year old age group (48.9 deaths
per 1000 person-year).
When comparing cause-specific mortality between hospital cause of death
notification forms and cause of death determined by verbal autopsy reviews, the
same top five underlying causes of death were observed, namely: cardiovascular
diseases, infectious diseases, diabetes mellitus, malignant neoplasms and
respiratory infections. The agreement between causes of death reported on cause of
death notification forms and cause of death as a result of a verbal autopsywas 48%.
For individual causes, agreement of more than 80% was achieved between cause of
death recorded on cause of death notification forms and from verbal autopsy reviews
for respiratory infections, diabetes, malignancies and injuries. Infectious diseases
(68.5%) and cardiovascular diseases (74.1%) achieved the lowest agreement. In
other words, in only 68.5% and 74.1% respectively was the cause of death as
recorded on the “cause of death notification” forms the same as the cause of death
when reviewed verbally.
Furthermore, 13 deaths were recorded as being due to cardiovascular diseases on
the “cause of death notification” forms, however, in only 5 of these cases was the
cause of death recorded as the same in the verbal autopsy report. In 21 cases cause
of death was attributed to infectious diseases on the cause of death notification form,
vii
while in only 13 of these cases was the cause of death similarly ascribed after verbal
autopsy review.
Conclusion
This study showed that the verbal autopsy instrument has the potential to identify
causes of death in a population where deaths occur outside of health facilities.
Procedures for death certification and coding of underlying causes of death need to
be streamlined in order to improve the reliability of registration data. This will be
achieved if medical students and trainee specialists are trained in the completion of
cause of death notification forms.
Foetal autopsies should be introduced at tertiary hospitals to determine the causes
of stillbirths.Antenatal care education for pregnant women should be encouraged
because the level of antenatal care has an influence on the health of mothers and
their newborns.
The government should continue to focus on improving the socio-economic status of
the population, while adequate foetal monitoring by health workers may reduce
neonatal deaths resulting from preterm births, low birth weight and birth asphyxia.
Innovative injury prevention strategies, interventions to control infectious diseases,
cancer screening and lifestyle program may reduce adult mortality.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ul/oai:ulspace.ul.ac.za:10386/1658 |
| Date | January 2015 |
| Creators | Ntuli, Sam Thembelihle |
| Contributors | Alberts, M., Byass, P. |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | xiii, 153 leaves |
| Relation | Adobe Acrobat Reader, version 7 |
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