OBJECTIVE: To measure HIV-associated adult mortality in a rural population in Tanzania. To record the signs and symptoms associated with deaths of HIV-positive adults. DESIGN: Prospective cohort study conducted in the context of a randomized controlled trial to evaluate the impact of a sexually transmitted disease treatment programme. METHODS: A cohort consisting of a random sample of 12501 adults aged 15-54 years was recruited from 12 rural communities in Mwanza region, Tanzania in 1991/1992. Baseline HIV prevalence was 4.0%. The cohort was followed up after 2 years to record mortality according to baseline HIV status. A verbal autopsy questionnaire was administered for each of the deaths reported. RESULTS: A total of 196 deaths were recorded, of which 73 (37%) occurred in HIV-positive individuals. Mortality rates per 1000 person-years were 6.0 in HIV-negatives and 93.5 in HIV-positives. The age-adjusted mortality rate ratio was 15.68 (95% confidence interval, 11.18-21.03). The proportion of adult deaths attributed to HIV infection was 35% overall and 53% in those aged 20-29 years. Verbal autopsies showed that HIV-positive deaths were significantly associated with fever, rash, weight loss, anaemia, cough, chest pain, abdominal pain and headache, but the specificity of individual symptoms was low. The World Health Organization clinical case definition of AIDS was satisfied for only 13 deaths, of which seven were HIV-positive at baseline. Only seven respondents reported that the death was associated with HIV or AIDS. CONCLUSIONS: This study confirms the strong association of HIV infection and mortality in rural Africa, with an annual death rate in adult seropositives of over 9%. In this rural population with a relatively low HIV prevalence of 4%, HIV has increased overall adult mortality by more than 50%. Signs and symptoms associated with HIV deaths were non-specific, and the population seemed largely unaware of the contribution of HIV to mortality, an important obstacle to prevention efforts.
OBJECTIVE: To measure HIV-associated adult mortality in a rural population in Tanzania. To record the signs and symptoms associated with deaths of HIV-positive adults. DESIGN: Prospective cohort study conducted in the context of a randomized controlled trial to evaluate the impact of a sexually transmitted disease treatment programme. METHODS: A cohort consisting of a random sample of 12501 adults aged 15-54 years was recruited from 12 rural communities in Mwanza region, Tanzania in 1991/1992. Baseline HIV prevalence was 4.0%. The cohort was followed up after 2 years to record mortality according to baseline HIV status. A verbal autopsy questionnaire was administered for each of the deaths reported. RESULTS: A total of 196 deaths were recorded, of which 73 (37%) occurred in HIV-positive individuals. Mortality rates per 1000 person-years were 6.0 in HIV-negatives and 93.5 in HIV-positives. The age-adjusted mortality rate ratio was 15.68 (95% confidence interval, 11.18-21.03). The proportion of adult deaths attributed to HIV infection was 35% overall and 53% in those aged 20-29 years. Verbal autopsies showed that HIV-positive deaths were significantly associated with fever, rash, weight loss, anaemia, cough, chest pain, abdominal pain and headache, but the specificity of individual symptoms was low. The World Health Organization clinical case definition of AIDS was satisfied for only 13 deaths, of which seven were HIV-positive at baseline. Only seven respondents reported that the death was associated with HIV or AIDS. CONCLUSIONS: This study confirms the strong association of HIV infection and mortality in rural Africa, with an annual death rate in adult seropositives of over 9%. In this rural population with a relatively low HIV prevalence of 4%, HIV has increased overall adult mortality by more than 50%. Signs and symptoms associated with HIV deaths were non-specific, and the population seemed largely unaware of the contribution of HIV to mortality, an important obstacle to prevention efforts.
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Keywords:
Acquired Immunodeficiency Syndrome; Africa; Africa South Of The Sahara; Causes Of Death; Demographic Factors; Developing Countries; Diseases; Eastern Africa; English Speaking Africa; Excess Mortality; Hiv Infections; Mortality; Population; Population Characteristics; Population Dynamics; Research Report; Rural Population; Tanzania; Viral Diseases
Authors: T Messele; M Abdulkadir; A L Fontanet; B Petros; D Hamann; M Koot; M T Roos; P T Schellekens; F Miedema; T F Rinke de Wit Journal: Clin Exp Immunol Date: 1999-03 Impact factor: 4.330
Authors: Fredrick E Makumbi; Gertrude Nakigozi; Joseph Sekasanvu; Ivan Lukabwe; Joseph Kagaayi; Tom Lutalo; Maria Wawer; Ronald Gray Journal: Trop Med Int Health Date: 2012-06-21 Impact factor: 2.622
Authors: Carla van Tienen; Maarten Schim van der Loeff; Ingrid Peterson; Matthew Cotten; Sören Andersson; Birgitta Holmgren; Tim Vincent; Thushan de Silva; Sarah Rowland-Jones; Peter Aaby; Hilton Whittle Journal: PLoS One Date: 2011-12-14 Impact factor: 3.240
Authors: Elia J Mmbaga; Akhtar Hussain; Germana H Leyna; Kagoma S Mnyika; Noel E Sam; Knut-Inge Klepp Journal: BMC Public Health Date: 2007-04-19 Impact factor: 3.295