Following two decades of research showing a decline in death rates over time among different age groups in parts of Africa, scientists from North America, Europe, and Africa have underscored the need for a localized strategic approach to further improve survival rates in the region.

The study, published on The Lancet Global Health journal, utilized verbal autopsy data to estimate the causes of death among adolescents and adults in eastern and southern Africa between 1995 and 2019, providing an in-depth analysis of mortality trends and their underlying causes.

By analyzing nearly 25 years of data from six countries – Kenya, Malawi, Tanzania, South Africa, Uganda, and Zimbabwe – the scientists observed notable declines in mortality rates across all age groups, particularly among adults aged 20-59 from the period 2005–09.

Lack of vital statistics drives need for study
In many parts of Africa, the absence of high-quality civil registration and vital statistics systems has left health officials and policymakers with limited empirical data on the causes of death. This study, funded by the National Institute of Child Health and Human Development of the US National Institutes of Health, sought to address this gap by using verbal autopsy data to estimate specific causes of death.

Verbal autopsies involve interviewing relatives or witnesses about the signs and symptoms observed before death, which are then analyzed to determine the likely cause of death.

The research team, led by scientists from Ohio State University and the London School of Hygiene & Tropical Medicine (LSHTM), along with two members from Ifakara Health Institute and other partner institutions, analyzed 52,000 deaths and more than five million years of data, making it one of the most comprehensive studies in the region.

Key causes of death revealed
The study identified varying causes of death across different age groups and locations. For adolescents (12-19 years), the leading causes of death between 2010 and 2014 were road traffic accidents, HIV, tuberculosis, and infections such as meningitis. 

Among adults (20-59 years), HIV and tuberculosis were the leading causes, while older adults (60 years and above) mostly died from non-communicable diseases (NCDs) like cancer and heart disease.

The study also identified significant variations in causes of death between different sites and sexes, particularly among adolescents, underscoring the importance of localized data for addressing specific health needs of different populations.

Implications on health policy and interventions
According to scientists, these findings are crucial for informing health policies and interventions in eastern and southern Africa. The data obtained not only highlight the progress made in reducing mortality, particularly from HIV and tuberculosis but also point to ongoing challenges, such as the high rates of deaths from road traffic accidents among adolescents and NCD-related deaths among older adults.

“Reductions in the number of HIV and tuberculosis deaths have contributed to improvement in survival across the region,” observed the scientists further stating, “Ongoing commitment will be required to ensure widespread access to testing and treatment and to ensure treatment retention by those with HIV and tuberculosis, to further improve survival of adults in these areas.”

A call for improved data collection
Moreover, the study underscores the importance of health and demographic surveillance, particularly where verbal autopsy methods are used to determine the causes of death. Despite the challenges such as misclassification of causes of death due to overlapping symptoms, the study confirms that verbal autopsies are a valuable tool for understanding mortality patterns in resource-limited settings.

“This study shows the value of health and demographic surveillance – specifically where there is comprehensive coverage of verbal autopsy – in providing essential information on the cause of death,” noted the scientists.

“It provides some of the most extensive cause of death comparisons by sex, age, setting, and time across eastern and southern Africa and highlights the need for a strategic focus at the local level to continue to improve survival among adolescents and adults in the region.”

Overall, this study highlights the progress made in reducing deaths among adolescents and adults in eastern and southern Africa and calls for continued focus on local health challenges to further improve survival rates in the region.

Ifakara scientists involved in the study
Several Ifakara Health Institute scientists, including Charles Festo and Eveline Geubbels, contributed to this study, with special recognition to Jensen Charles, Jumanne Kisweka, Sigilbert Mrema, and Francis Levira for their participation in the surveillance. 

Other contributors are from Ohio State University (USA), the London School of Hygiene & Tropical Medicine (UK), Malawi Epidemiology and Intervention Research Unit (Malawi), Imperial College London (UK), Biomedical Research and Training Institute (Zimbabwe), Africa Health Research Institute, University of Witwatersrand (South Arica), Rakai Health Sciences Program (Uganda), University of York (USA), National Institute for Medical Research (Tanzania), African Population and Health Research Center (Kenya) and University of Edinburgh (UK).

Read the publication here.