Central Statistical Office, Government of the Republic of Zambia, Lusaka, Zambia.
Global AIDS Program, Centers for Disease Control and Prevention, Government of the United States of America, Lusaka, Zambia.
Popul Health Metr. 2011 Aug 5;9:40. doi: 10.1186/1478-7954-9-40.
Verbal autopsy (VA) can be used to describe leading causes of death in countries like Zambia where vital events registration does not produce usable data. The objectives of this study were to assess the feasibility of using verbal autopsy to determine age-, sex-, and cause-specific mortality in a community-based setting in Zambia and to estimate overall age-, sex-, and cause-specific mortality in the four provinces sampled.
A dedicated census was conducted in regions of four provinces chosen by cluster-sampling methods in January 2010. Deaths in the 12-month period prior to the census were identified during the census. Subsequently, trained field staff conducted verbal autopsy interviews with caregivers or close relatives of the deceased using structured and unstructured questionnaires. Additional deaths were identified and respondents were interviewed during 12 months of fieldwork. After the interviews, two physicians independently reviewed each VA questionnaire to determine a probable cause of death.
Among the four provinces (1,056 total deaths) assessed, all-cause mortality rate was 17.2 per 1,000 person-years (95% confidence interval [CI]: 12.4, 22). The seven leading causes of death were HIV/AIDS (287, 27%), malaria (111, 10%), injuries and accidents (81, 8%), diseases of the circulatory system (75, 7%), malnutrition (58, 6%), pneumonia (56, 5%), and tuberculosis (50, 5%). Those who died were more likely to be male, have less than or equal to a primary education, and be unmarried, widowed, or divorced compared to the baseline population. Nearly half (49%) of all reported deaths occurred at home.
The 17.2 per 1,000 all-cause mortality rate is somewhat similar to modeled country estimates. The leading causes of death -- HIV/AIDS, malaria, injuries, circulatory diseases, and malnutrition -- reflected causes similar to those reported for the African region and by other countries in the region. Results can enable the targeting of interventions by region, disease, and population to reduce preventable death. Collecting vital statistics using standardized Sample Vital Registration with Verbal Autopsy (SAVVY) methods appears feasible in Zambia. If conducted regularly, these data can be used to evaluate trends in estimated causes of death over time.
在像赞比亚这样的国家，由于生命事件登记没有产生可用数据，因此可以使用死因推断（VA）来描述主要死因。本研究的目的是评估在赞比亚社区环境中使用死因推断来确定年龄、性别和病因特异性死亡率的可行性，并估计抽样的四个省份的总年龄、性别和病因特异性死亡率。
2010 年 1 月，采用聚类抽样方法在四个省份的地区进行了专门的普查。在普查期间，确定了普查前 12 个月内的死亡人数。随后，经过培训的现场工作人员使用结构化和非结构化问卷，对死者的照顾者或近亲进行死因推断访谈。在 12 个月的实地工作期间，还确定了其他死亡人数并对受访者进行了访谈。访谈结束后，两名医生独立审查了每个 VA 问卷，以确定可能的死因。
在所评估的四个省份（共 1056 例死亡）中，全因死亡率为 17.2/1000 人年（95%置信区间：12.4，22）。前 7 位死因是：艾滋病毒/艾滋病（287 例，27%）、疟疾（111 例，10%）、损伤和意外（81 例，8%）、循环系统疾病（75 例，7%）、营养不良（58 例，6%）、肺炎（56 例，5%）和肺结核（50 例，5%）。与基线人群相比，死亡者更有可能是男性、接受过小学或以下教育、未婚、丧偶或离婚。近一半（49%）的报告死亡发生在家中。
17.2/1000 的全因死亡率与模型估计的国家数据有些相似。主要死因——艾滋病毒/艾滋病、疟疾、损伤、循环系统疾病和营养不良——反映了与非洲地区和该地区其他国家报告的类似原因。研究结果可以使各地区、疾病和人群能够有针对性地采取干预措施，以减少可预防的死亡。使用标准化的抽样生命登记与死因推断（SAVVY）方法收集生命统计数据似乎是可行的。如果定期进行，这些数据可用于评估随时间推移估计死因的趋势。
