Mortality of neurological disorders in Tanzania: analysis of baseline data from sample vital registration with verbal autopsy (SAVVY)

Abstract

Background: Neurological disorders (ND) have a profound consequence on human productivity, quality of life and survival. There are limited data on the burden of ND in Tanzania due to insufficient coverage of civil and vital registration systems. Objectives: This study was conducted to estimate mortality of ND in all ages in Tanzania using data from the Sample Vital Registration with Verbal Autopsy (SAVVY) study. Methods: Multistage random sampling was employed to select 23 districts, 1397 census enumeration areas and 154,603 households. During the baseline survey conducted between 2011 and 2014, deaths which occurred 12 months prior to the baseline survey were documented followed by verbal autopsy interviews. Causes of death were certified using International Classification of Diseases. Results: The baseline survey enrolled a total of 650,864 residents. A total of 6645 deaths were reported to have occurred 12 months before the date of survey. Death certification was available for 5225 (79%) deaths. The leading causes of death were cerebrovascular diseases with a cause-specific mortality fraction (CSMF) of 1.64% (95% CI: 1.30-1.99) and 3.82% (95% CI: 2.92-4.72) in all ages and adults older than 50 years, respectively. Stroke accounted for 92% of all cerebrovascular deaths. Mortality of epilepsy was estimated with a CSMF of 0.94% (95% CI: 0.68-1.20); meningitis with a CSMF of 0.80% (95% CI: 0.56-1.04); cerebral palsy and other paralytic syndromes with a CSMF of 0.46% (95% CI: 0.27-0.65); and intrauterine hypoxia in neonates with a CSMF of 2.06% (95% CI: 1.12-3.01). Overall, mortality of ND was estimated with a CSMF of 4.99% (95% CI: 4.40-5.58). Conclusions: The SAVVY survey provides estimates of mortality burden of ND in Tanzania. The study provides a basis for monitoring trends of ND and contributes to advancing knowledge of the burden of diseases. Integrating morbidities measures into the SAVVY design will provide comprehensive measures of burden of ND taking into account lifetime disabilities created by ND.

Availability of population-level data sources for tracking the incidence of deaths and injuries from road traffic crashes in low-income and middle-income countries

“…We were unable to acquire the SAVVY dataset but extracted estimates from a published study. 22 We excluded the National Panel Survey from further analysis because of the small sample (3357 households; 5 traffic deaths). These data sources have not been used for GBD or GSRSS estimates of road traffic deaths in Tanzania.…”

Estimates of road traffic deaths in Tanzania

“…The literature review yielded 25 publications with potentially relevant road injury data (online supplemental table A1). Based on a review of the title, abstract and full text, we only identified one study, Levira et al ,24 that provided a nationally representative data estimate of causes of death in Tanzania using verbal autopsy.…”

“…Causes of death were determined based on verbal autopsy interviews with next of kin or other caregivers. Microdata from the study were not available to us but estimates of road traffic deaths from SAVVY were reported by Levira et al 24 who estimated that 2.43% (95% CI: 2.01 to 2.84) of all-cause deaths were due to road traffic injuries in 2016. We applied these proportions to GBD estimate of all-cause deaths.…”

Mortality implications and factors associated with nonengagement in a public epilepsy care initiative in a transient population

“…Sixty percent of the deaths were related to epilepsy. Population-based studies of mortality from the LMICs are few but it can be inferred from a meta-analysis of these studies, that the proportionate mortality due to status epilepticus (5-57%) and SUDEP (1-20%) is high 21 . In comparison, studies from HICs have shown that the risk of dying due to status epilepticus and SUDEP are as low as 0.2/1000 and <1.5/1000 people respectively 27 .…”

“…Lastly, we visited the homes of those who had died since the initial screening. During these visits, a neurologist (GS), experienced in verbal autopsy protocols, used the WHO verbal autopsy tool to ascertain the cause/s of death in those who died 20,21 . A family member or someone in the household, who was aware of circumstances surrounding the death provided the information.…”