Seasonal and temporal trends in all-cause and malaria mortality in rural Burkina Faso, 1998–2007

Abstract

BackgroundHigh mortality levels in sub-Saharan Africa are still a major public health problem. Children are the most affected group with malaria as one of the major causes of death in this region. To plan health interventions, reliable empirical information on cause-specific mortality patterns is essential, yet such data are often not available in developing countries. Health and Demographic Surveillance Systems (HDSS) implementing the verbal autopsy (VA) method provide such data on a longitudinal basis. Physician Coded VA is usually used to determine cause of death, but recently a computerized method, Interpreting VA (InterVA) was alternatively introduced. This study investigates the effect of season on all-cause and malaria mortality analysing cause of death data from 1998 to 2007 obtained by the Nouna HDSS in rural Burkina Faso and derived by InterVA.MethodsMonthly mortality rates were calculated for different age groups (infants, children, adolescents, adults, elderly). Seasonal and temporal trends were modelled with parametric Poisson regression adjusted for sex, area of residence and year of death.ResultsOverall, 7,378 deaths occurred corresponding to a mortality rate of 11.9/1,000 with highest rates in infants (56.8/1,000) and children (22.0/1,000). Young children were most affected by malaria. Malaria mortality patterns in children showed significantly higher rates during the rainy season and a stagnant long-term trend. The seasonal trend is well described parametrically with a sinusoidal function. InterVA assigned about half as many deaths to malaria than physicians.ConclusionsMalaria mortality remains highly seasonal in rural Burkina Faso. The InterVA method appears to determine reasonably well seasonal mortality patterns, which should be considered for the planning of health resources and activities.

The changing epidemiology of hepatitis B and C infections in Nanoro, rural Burkina Faso: a random sampling survey

“…Despite the introduction of hepatitis B vaccine into Burkina Faso's national expanded program on immunization (EPI) for children in 2006, related death has increased and cost 2600 lives in 2015 [10]. The picture could even be worse given that accurate identification of death causes in sub-Saharan Africa is still a challenge [11]. In African regions, transmission is reported to be mainly perinatal through mother to child transmission or horizontal transmission through exposure to infected body fluids [12,13].…”

A systematic review and synthesis of the strengths and limitations of measuring malaria mortality through verbal autopsy

“…The malaria epidemiological context also influences misclassification bias, resulting in either an under or over estimation of the malaria mortality burden [ 14 , 16 , 26 , 31 , 43 , 48 , 49 , 54 , 55 ]. In high transmission areas, it was suggested that malaria mortality is overestimated due to the practice of assigning malaria as the COD for cases of acute febrile illness where no other cause is evident [ 14 ].…”

“…In high transmission areas, it was suggested that malaria mortality is overestimated due to the practice of assigning malaria as the COD for cases of acute febrile illness where no other cause is evident [ 14 ]. Many studies have attributed this as bias introduced by the experience and knowledge of the physicians coding the deaths [ 7 , 39 , 45 , 47 – 49 , 52 , 56 – 58 ]. However, a few studies note the reverse finding, that the malaria mortality burden is actually underestimated in high transmission areas and overestimated in medium to low malaria prevalence areas [ 26 , 37 ].…”

“…Other general limitations of VA studies that were noted include the small sample sizes of studies that limit the precision of estimates [ 16 , 19 ], recall bias among respondents that can result in misclassification bias [ 35 ], and the fact that many deaths in VA studies cannot be determined and are either excluded from the study (due to incomplete information) or are classified as an ‘unknown’ cause of death [ 39 , 49 , 72 , 73 ].…”

Antibiotic Prescription Patterns among Children Younger than 5 Years in Nouna District, Burkina Faso

“…Data collection for the study took place in July 2017, corresponding with the malaria season in this region of Burkina Faso. 11 The data collection period for antibiotic prescriptions covered March through June, before the malaria season. The Institutional Review Boards at the University of California, San Francisco, and the Centre de Recherche en Santé de Nouna reviewed and approved all study procedures.…”