Leading causes of death and high mortality rates in an HIV endemic setting (Kisumu county, Kenya, 2019)

• Published in: PloS one Vol. 17; no. 1; p. e0261162
• Main Authors: Waruru, Anthony, Onyango, Dickens, Nyagah, Lilly, Sila, Alex, Waruiru, Wanjiru, Sava, Solomon, Oele, Elizabeth, Nyakeriga, Emmanuel, Muuo, Sheru W, Kiboye, Jacqueline, Musingila, Paul K, van der Sande, Marianne A B, Massawa, Thaddeus, Rogena, Emily A, DeCock, Kevin M, Young, Peter W
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20.01.2022; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Aged; AIDS; Biology and Life Sciences; Cardiovascular diseases; Cause of Death; Charts; Chi-square test; Child; Child, Preschool; Death; Endemic Diseases; Epidemiology; Fatalities; Female; Forecasts and trends; Global Burden of Disease; HIV; HIV infection; HIV Infections - epidemiology; HIV Infections - mortality; Human immunodeficiency virus; Humans; Infant; Infectious diseases; Kenya; Kenya - epidemiology; Male; Medical diagnosis; Medicine and Health Sciences; Men; Middle Aged; Mortality; Mortuaries; Patient outcomes; People and Places; Public health; Statistical tests; Statistics; Tuberculosis; Young Adult; Kenya; Nairobi Kenya; Netherlands; Belgium; United States > US; Kisumu Kenya
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0261162

In resource-limited settings, underlying causes of death (UCOD) often are not ascertained systematically, leading to unreliable mortality statistics. We reviewed medical charts to establish UCOD for decedents at two high volume mortuaries in Kisumu County, Kenya, and compared ascertained UCOD to those notified to the civil registry. Medical experts trained in COD certification examined medical charts and ascertained causes of death for 456 decedents admitted to the mortuaries from April 16 through July 12, 2019. Decedents with unknown HIV status or who had tested HIV-negative >90 days before the date of death were tested for HIV. We calculated annualized all-cause and cause-specific mortality rates grouped according to global burden of disease (GBD) categories and separately for deaths due to HIV/AIDS and expressed estimated deaths per 100,000 population. We compared notified to ascertained UCOD using Cohen's Kappa (κ) and assessed for the independence of proportions using Pearson's chi-squared test. The four leading UCOD were HIV/AIDS (102/442 [23.1%]), hypertensive disease (41/442 [9.3%]), other cardiovascular diseases (23/442 [5.2%]), and cancer (20/442 [4.5%]). The all-cause mortality rate was 1,086/100,000 population. The highest cause-specific mortality was in GBD category II (noncommunicable diseases; 516/100,000), followed by GBD I (communicable, perinatal, maternal, and nutritional; 513/100,000), and III (injuries; 56/100,000). The HIV/AIDS mortality rate was 251/100,000 population. The proportion of deaths due to GBD II causes was higher among females (51.9%) than male decedents (42.1%; p = 0.039). Conversely, more men/boys (8.6%) than women/girls (2.1%) died of GBD III causes (p = 0.002). Most of the records with available recorded and ascertained UCOD (n = 236), 167 (70.8%) had incorrectly recorded UCOD, and agreement between notified and ascertained UCOD was poor (29.2%; κ = 0.26). Mortality from infectious diseases, especially HIV/AIDS, is high in Kisumu County, but there is a shift toward higher mortality from noncommunicable diseases, possibly reflecting an epidemiologic transition and improving HIV outcomes. The epidemiologic transition suggests the need for increased focus on controlling noncommunicable conditions despite the high communicable disease burden. The weak agreement between notified and ascertained UCOD could lead to substantial inaccuracies in mortality statistics, which wholly depend on death notifications.