Child, maternal, and adult mortality in rural Ethiopia in 2019: a cross-sectional mortality survey using electronic verbal autopsies

Wubegzier Mekonnen; Damen Haile Mariam; Catherine Meh; Biratu Yigezu; Anteneh T Assalif; Ashley Aimone; Solomon Atnafu; Hayat Ahmed; Wubetsh Asnake; Prabhat Jha

doi:10.1016/j.eclinm.2024.102573

Child, maternal, and adult mortality in rural Ethiopia in 2019: a cross-sectional mortality survey using electronic verbal autopsies

EClinicalMedicine. 2024 Apr 6:71:102573. doi: 10.1016/j.eclinm.2024.102573. eCollection 2024 May.

Authors

Affiliations

¹ School of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia.
² Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
³ Central Statistical Agency, Addis Ababa, Ethiopia.
⁴ Department of Computer Science, College of Natural and Computational Sciences, Addis Ababa University, Ethiopia.
⁵ School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia.
⁶ Ethiopian Public Health Association, Addis Ababa, Ethiopia.

Abstract

Background: Ethiopia, with about 10% of Africa's population, has little direct information on causes of death, particularly in rural areas where 80% of Ethiopians live. In 2019-2020, we conducted electronic verbal autopsies (e-VA) to examine causes of death and quantify cause-specific mortality rates in rural Ethiopia.

Methods: We examined deaths under 70 years in the three years prior to the survey dates (November 25, 2019-February 29, 2020) among 2% of East Gojjam Zone (Amhara Region) using registered deaths and adding random sampling in this cross-sectional study. Trained surveyors interviewed relatives of the deceased with central dual-physician assignment of causes as the main outcome. We documented details on age, sex and location of death, and derived overall rural death rates using 2007 Census data and the United Nations national estimates for 2019. To these, we applied our sample-weighted causes to derive cause-specific mortality rates. We calculated death risks for the leading causes for major age groups.

Findings: We studied 3516 deaths: 55% male, 97% rural, and 68% occurring at home. At ages 5 and older, injuries were notable, accounting for over a third of deaths at 5-14 years, half of the deaths at ages 15-29 years, and a quarter of deaths at ages 30-69 years. Neonatal mortality was high, mostly from prematurity/low birthweight and infections. Among children under 5 (excluding neonates), infections caused nearly two-thirds of deaths. Most maternal deaths (84%) arose from direct causes. After injuries, especially suicide, assaults, and road traffic accidents, vascular disease (15%) and cancer (13%) were the leading causes among adults at 30-69 years. HIV/AIDS and tuberculosis deaths were also important causes among adults.

Interpretation: Rural Ethiopia has a high burden of avoidable mortality, particularly injury, including suicide, assaults, and road traffic accidents.

Funding: International Development Research Centre, and the Canadian Institutes of Health Research.

Keywords: Causes of death; Electronic verbal autopsies; Ethiopia; Mortality; Rural.