OBJECTIVE: To compare alternative methods to vital registration systems for estimating adult mortality, and describe patterns of mortality in Manicaland, Zimbabwe, which has been severely affected by HIV. METHODS: We compared estimates of adult mortality from (1) a single question on household mortality, (2) repeated household censuses, and (3) an adult cohort study with linked HIV testing from Manicaland, with a mathematical model fitted to local age-specific HIV prevalence (1998 -2000). FINDINGS: The crude death rate from the single question (29 per 1000 person-years) was roughly consistent with that from the mathematical model (22 -25 per 1000 person-years), but much higher than that from the household censuses (12 per 1000 person-years). Adult mortality in the household censuses (males 0.65; females 0.51) was lower than in the cohort study (males 0.77; females 0.57), while mathematical models gave a much higher estimate, especially for females (males 0.80 -0.83; females 0.75 -0.80). The population attributable fraction of adult deaths due to HIV was 0.61 for men and 0.70 for women, with life expectancy estimated to be 34.3 years for males and 38.2 years for females. CONCLUSION: Each method for estimating adult mortality had limitations in terms of loss to follow-up (cohort study), under-ascertainment (household censuses), transparency of underlying processes (single question), and sensitivity to parameterization (mathematical model). However, these analyses make clear the advantages of longitudinal cohort data, which provide more complete ascertainment than household censuses, highlight possible inaccuracies in model assumptions, and allow direct quantification of the impact of HIV.
OBJECTIVE: To compare alternative methods to vital registration systems for estimating adult mortality, and describe patterns of mortality in Manicaland, Zimbabwe, which has been severely affected by HIV. METHODS: We compared estimates of adult mortality from (1) a single question on household mortality, (2) repeated household censuses, and (3) an adult cohort study with linked HIV testing from Manicaland, with a mathematical model fitted to local age-specific HIV prevalence (1998 -2000). FINDINGS: The crude death rate from the single question (29 per 1000 person-years) was roughly consistent with that from the mathematical model (22 -25 per 1000 person-years), but much higher than that from the household censuses (12 per 1000 person-years). Adult mortality in the household censuses (males 0.65; females 0.51) was lower than in the cohort study (males 0.77; females 0.57), while mathematical models gave a much higher estimate, especially for females (males 0.80 -0.83; females 0.75 -0.80). The population attributable fraction of adult deaths due to HIV was 0.61 for men and 0.70 for women, with life expectancy estimated to be 34.3 years for males and 38.2 years for females. CONCLUSION: Each method for estimating adult mortality had limitations in terms of loss to follow-up (cohort study), under-ascertainment (household censuses), transparency of underlying processes (single question), and sensitivity to parameterization (mathematical model). However, these analyses make clear the advantages of longitudinal cohort data, which provide more complete ascertainment than household censuses, highlight possible inaccuracies in model assumptions, and allow direct quantification of the impact of HIV.
Authors: Geoffrey H Rosen; Tara M Randis; Purnahamsi V Desai; Katherine J Sapra; Bing Ma; Pawel Gajer; Michael S Humphrys; Jacques Ravel; Shari E Gelber; Adam J Ratner Journal: J Infect Dis Date: 2017-09-15 Impact factor: 5.226
Authors: B Lopman; A Cook; J Smith; G Chawira; M Urassa; Y Kumogola; R Isingo; C Ihekweazu; J Ruwende; M Ndege; S Gregson; B Zaba; T Boerma Journal: J Epidemiol Community Health Date: 2009-10-23 Impact factor: 3.710
Authors: Ben Lopman; James Lewis; Constance Nyamukapa; Phyllis Mushati; Steven Chandiwana; Simon Gregson Journal: AIDS Date: 2007-11 Impact factor: 4.177
Authors: Riitta A Dlodlo; Paula I Fujiwara; Zanele E Hwalima; Stanley Mungofa; Anthony D Harries Journal: J Int AIDS Soc Date: 2011-07-06 Impact factor: 5.396
Authors: Ben A Lopman; Ruanne V Barnabas; J Ties Boerma; Godwin Chawira; Kezia Gaitskell; Tara Harrop; Peter Mason; Christl A Donnelly; Geoff P Garnett; Constance Nyamukapa; Simon Gregson Journal: PLoS Med Date: 2006-08 Impact factor: 11.069
Authors: Simon Gregson; Constance Nyamukapa; Ben Lopman; Phyllis Mushati; Geoffrey P Garnett; Stephen K Chandiwana; Roy M Anderson Journal: Proc Natl Acad Sci U S A Date: 2007-08-30 Impact factor: 11.205