Mortality rate and cause of death pattern in Thai Nguyen and Quang Ninh provinces

JOURNAL OF MEDICAL RESEARCH<br /> <br /> MORTALITY RATE AND CAUSE OF DEATH PATTERN IN<br /> THAI NGUYEN AND QUANG NINH PROVINCES<br /> Pham Ngan Giang, Nguyen Phuong Hoa,<br /> Thanh Ngoc Tien, Nguyen Thi Tuyet Nhung<br /> Department of Family Medicine, Hanoi Medical University<br /> Cause of deaths reflects the burden of diseases in the community and is important information for<br /> evidence-based health policy. Objectives of the study were to determine mortality rates and cause of<br /> death pattern in Thai Nguyen and Quang Ninh. A cross - sectional study was conducted. One thousand<br /> four hundred and seventy seven deaths were recorded at 26 communes in 2014. The survey was used<br /> WHO standard verbal autopsy questionnaire. The results showed that overall mortality rate was 4.94‰,<br /> mortality rate among males was higher than among females (6.09‰ versus 4.91‰, p < 0.05), urban<br /> population had lower rate of death than the rural population (4.73‰ versus 5.56‰, p < 0,05). The results<br /> showed that most of the deaths occurred at home (88%), only 4.8% of deaths in health facilities. There<br /> was a transition in the cause of death pattern while the leading causes were cardiovascular diseases,<br /> cancer and injury. In particular, death from stroke was 20.6%, lung cancer 8.3% and traffic accident<br /> 3.7%. In conclusion, it is necessary to collect information about the deaths, which are outside health facilities (at home) and an intervention programs need to prioritize for some of the leading causes of death.<br /> <br /> Keywords: mortality rate, cause of death, burden of diseases<br /> <br /> I. INTRODUCTION<br /> Mortality statistics and causes of death<br /> (COD) information are important to measure<br /> population health status, identify key public<br /> health issues, set priorities, and improve<br /> health outcomes through effective resource<br /> allocation [1 - 3]. However, an estimated 2/3<br /> of all deaths were not reported globally. Millions of people in Africa and Asia die without<br /> leaving any trace in legal records or official<br /> Corresponding author: Nguyen Phuong Hoa, Department of Family Medicine,, Hanoi Medical University<br /> Email: nguyenphuonghoa@hmu.edu.vn<br /> Received: 05 June 2017<br /> Accepted: 16 November 2017<br /> <br /> JMR 111 E2 (2) - 2018<br /> <br /> statistics [4].<br /> Mortality data on causes of death for<br /> Vietnam have not been reported to the<br /> World Health Organization (WHO) to date<br /> [5; 6]. With a population of over 91 million<br /> [6], there is a critical need for such data for<br /> the above stated purposes. At the national<br /> level, due to limitations in the availability of<br /> data, cause of death patterns in Vietnam<br /> has been estimated based on mortality data<br /> from Chinese, Thai and Indian populations<br /> [7].<br /> The absence of complete and valid national mortality data limits the evidence<br /> base to estimate the burden of disease in<br /> 85<br /> <br /> JOURNAL OF MEDICAL RESEARCH<br /> Vietnam. At the national level, three organizations within the Government of Vietnam<br /> collect national mortality data: the Ministry<br /> of Health (MOH), the Ministry of Justice<br /> (MOJ), and the General Statistics Office<br /> (GSO). GSO data provide important indicators such as life expectancy and crude<br /> death rates [8]. However, this source does<br /> not collect detailed information about COD,<br /> which is urgently required by the health sector for developing health interventions, priority setting, and policy formulation. The MOJ<br /> has legal responsibility over the national<br /> civil registration and vital statistics system.<br /> For deaths, this system only collects information about the numbers of deaths by sex<br /> and age. However, the registration of deaths<br /> recorded in this system is low for different<br /> areas. Also, the MOJ system does not have<br /> any procedures for formal reporting of the<br /> causes of death (COD).<br /> In order to meet the information needs<br /> of the health sector, the MOH operates a<br /> routine death register system at commune<br /> health stations (CHS). Local commune<br /> health staffs identify deaths in the community and record basic demographic data and<br /> information on the cause of death for each<br /> death in an official MOH log-book named<br /> the “A6 register”. Frankly, data from the A6<br /> registers are not used effectively at different<br /> levels in the health sector because there is<br /> no consistent process for compiling data<br /> from A6 registers at district, province, and<br /> national levels; therefore the MOH mortality<br /> database now in the Statistical Handbook<br /> of Vietnam MoH was based on mortality<br /> data from hospitals only. However, currently<br /> in Vietnam, the majority of deaths occur at<br /> 86<br /> <br /> home.<br /> Therefore, by using verbal autopsy (VA),<br /> this study was conducted to determine mortality rates and cause of death pattern in<br /> Thai Nguyen and Quang Ninh in 2014.<br /> <br /> II. SUBJECTS AND METHODS<br /> 1. Study sites and sample<br /> The study was implemented in two provinces, Quang Ninh and Thai Nguyen, which<br /> are located in the Northern region of Vietnam. In each province, one urban district<br /> and one rural district were chosen to assess likely differences between those two<br /> areas. Within each selected district, 6-7<br /> communes were chosen as study sites by<br /> simple random method.<br /> The study sample comprised all deaths<br /> that occurred between 01/01/2014 and<br /> 31/12/2014 among residents of the 26 selected communes. There were 1477 deaths<br /> in total, which were listed by combining the<br /> A6 registers, the Justice Clerks’ books and<br /> some other resources. All deaths in each<br /> selected commune were re-investigated to<br /> ascertain the causes of death, using Verbal Autopsy (VA) surveys. There were 1365<br /> Verbal Autopsy (VA) interviews conducted.<br /> The other 112 cases could not undertake VA<br /> mainly due to the movement of population.<br /> 2. Methods<br /> This assessment was based on a<br /> cross-sectional study design.<br /> Data collection<br /> - Making the combined death list<br /> All deaths recorded in A6 registers, the<br /> Justice Clerk books and some other sources during the defined one-year period beJMR 111 E2 (2) - 2018<br /> <br /> JOURNAL OF MEDICAL RESEARCH<br /> tween 01 January 2014 and 31 December<br /> 2014 were extracted onto a separate form.<br /> Information collected included reported<br /> name, age and sex, date of death, address<br /> of the deceased. Then, a process of matching death cases from these sources was<br /> carried out by commune health staffs, who<br /> were responsible for mortality recording.<br /> Variables used for the matching process<br /> were name, sex, age, date of death, and<br /> address of the deceased.<br /> - Implementing Verbal Autopsy surveys<br /> All deaths identified in the above combined list were followed up to conduct the<br /> household verbal autopsy (VA) interview<br /> using a standardized questionnaire that<br /> elicits information on signs, symptoms,<br /> medical history, and circumstances preceding death. The VA questionnaire used for<br /> this assessment is the updated version of<br /> the Vietnamese verbal autopsy questionnaire, accompanied by a manual and guide<br /> for fieldworkers. The original English version of the VA questionnaires, which was<br /> recommended by WHO, were translated<br /> into Vietnamese and revised.<br /> Interviewers were local health workers<br /> from commune health stations who have<br /> medical related backgrounds (e.g., medical<br /> assistants, nurses) working at the commune<br /> or village level where the deaths occurred,<br /> and who have the responsibility for collecting data and recording it in the A6 registers<br /> at commune health stations. The training of<br /> interviewers emphasized techniques and<br /> communication skills to motivate the principal caretaker of the deceased to participate<br /> in the survey and encourage them to give<br /> accurate and honest answers.<br /> JMR 111 E2 (2) - 2018<br /> <br /> The interviewees were persons who<br /> were mainly responsible for taking care of<br /> the decedent before he/she died, and who<br /> were able to provide information about the<br /> symptoms and diseases experienced by the<br /> deceased prior to death.<br /> The supervisors were the principal investigators and staff in the Provincial/ District Health Centre. Supervisors provided<br /> assistance and monitored the interviewers’<br /> activities to ensure the quality of the VA interviews. On completion of all VA interviews<br /> were diagnosed and coded of the Underlying cause of death (UCOD), by trained doctors The UCOD then was coded using International Classification of Diseases version<br /> 10 (ICD-10) by application of the mortality<br /> coding rules and guidelines[9].<br /> Data analysis and management<br /> Epidata software and SPSS18 were employed to analyse data.<br /> The proportions were calculated by<br /> communes, district, provincial levels, urban/<br /> rural areas, sex, broad age groups (0 - 4<br /> years, 5 - 14 years, 15 - 59 years, and 60+),<br /> place of death, type of health facility, and<br /> the last treatment method. Each proportion<br /> was computed for 95% confidence intervals<br /> [10].<br /> 3. Ethics<br /> Respondents of this study were clearly<br /> explained all information regarding the objectives of this assessment, the detail of<br /> collecting information. Respondents have<br /> had complete autonomy in regard to participation, as well as freedom to withdraw at<br /> any stage during the interview. Access to<br /> completed questionnaires and data were<br /> 87<br /> <br /> JOURNAL OF MEDICAL RESEARCH<br /> restricted to authorized personnel to ensure<br /> the confidentiality of each respondent. The<br /> collected data was only used for the purpose of research.<br /> <br /> ber of deaths. VA interview could not be carried out in 112 cases (7.4% of total deaths).<br /> Table 1 describes the death amount and<br /> the crude death rate in general according<br /> to gender and location identified during<br /> the study. The mortality rate of general<br /> population was calculated 4.94 per 1000.<br /> In comparison to female group, the death<br /> proportion in male was higher with statistically significance (p < 0.001). In regards to<br /> location, the urban population had the lower<br /> mortality rate than the rural population (p <<br /> 0.001)<br /> <br /> III. RESULTS<br /> A total of 1477 deaths were recorded in<br /> the reference year, which comprised 746<br /> cases in Quang Ninh province and 731 cases in Thai Nguyen province. Out of these<br /> 1477 deaths, the COD were re-investigated<br /> in 1365 cases using VA household interviews, equivalent to 92.6% of the total num-<br /> <br /> Table 1. Crude death rate by sex and area in 2014<br /> Characteristic<br /> General population<br /> <br /> Total<br /> <br /> Number of deaths<br /> <br /> Rate<br /> (‰)<br /> <br /> 299,237<br /> <br /> 1477<br /> <br /> 4.94<br /> <br /> Male<br /> <br /> 152,357<br /> <br /> 928<br /> <br /> 6.09<br /> <br /> Female<br /> <br /> 146,880<br /> <br /> 549<br /> <br /> 4.91<br /> <br /> Urban<br /> <br /> 226,325<br /> <br /> 1071<br /> <br /> 4.73<br /> <br /> Rural<br /> <br /> 72,912<br /> <br /> 406<br /> <br /> 5.56<br /> <br /> p value<br /> <br /> Sex<br /> < 0.001<br /> <br /> Area<br /> <br /> Table 2 describes the distribution of<br /> deaths by age group and some factors relating to death, all the statistics were ascertained by VA. In regard to age, over two<br /> thirds of the deaths were among the elderly.<br /> The proportions of deaths recorded in two<br /> groups under the age of 5 years and 5 - 14<br /> years old are very low (1.8% and 1.2% respectively). As can be seen, more than 70%<br /> of people attended a health facility for the<br /> 88<br /> <br /> < 0.001<br /> <br /> last treatment prior to death. Most of them<br /> had visited central/ provincial hospitals<br /> (80%) and in about 29% of cases, a visit to<br /> a district hospital was reported. Only 4.7%<br /> went to a commune health station, 2.1%<br /> saw healers and very few people visited private doctors. As shown in table 2, although<br /> only 6% of VA respondents kept the last<br /> treatment documents provided by hospitals, which would be useful for reporting for<br /> JMR 111 E2 (2) - 2018<br /> <br /> JOURNAL OF MEDICAL RESEARCH<br /> the mortality register at CHS. This aspect will be given attention in the recommendations to<br /> strengthen the COD reporting system.<br /> Table 2. Distribution of deaths by age and information before death<br /> Characteristic<br /> <br /> Number of deaths<br /> <br /> Percent (%)<br /> <br /> Age group (n = 1365)*<br /> 0-4<br /> <br /> 24<br /> <br /> 1.8<br /> <br /> 5 - 14<br /> <br /> 17<br /> <br /> 1.2<br /> <br /> 15 - 59<br /> <br /> 455<br /> <br /> 33.3<br /> <br /> 60+<br /> <br /> 869<br /> <br /> 63.7<br /> <br /> Treatment at health facility in the last sickness leading to the death? (n = 1365)<br /> Yes<br /> <br /> 959<br /> <br /> 70.3<br /> <br /> No<br /> <br /> 354<br /> <br /> 26.0<br /> <br /> Unsure/Don’t know<br /> <br /> 35<br /> <br /> 2.6<br /> <br /> Central/Provincial Hospitals<br /> <br /> 770<br /> <br /> 80.3<br /> <br /> District hospitals<br /> <br /> 276<br /> <br /> 28.8<br /> <br /> Commune Health Station<br /> <br /> 45<br /> <br /> 4.7<br /> <br /> Healers (traditional medicine)<br /> <br /> 20<br /> <br /> 2.1<br /> <br /> Private Doctor<br /> <br /> 6<br /> <br /> 0.6<br /> <br /> Others<br /> <br /> 4<br /> <br /> 0.4<br /> <br /> Recall information about the diagnosis after<br /> discharge from hospital (n = 959)<br /> <br /> 885<br /> <br /> 92.3<br /> <br /> Kept the documents from hospital about the<br /> last treatment (n = 959)<br /> <br /> 55<br /> <br /> 5.7<br /> <br /> Type of health facility in the last treatment (n = 959)<br /> <br /> *1365 cases were interviewed by VA questionnaire<br /> Figure 1 illustrates the places of deaths. Approximately 88.1% of the people died at home<br /> and only 5.0% died at a health facility (includes hospitals, commune health station, clinic,<br /> etc.). However, as mentioned above, a large number of the decedents who died at home had<br /> visited health facilities during their final illness.<br /> <br /> JMR 111 E2 (2) - 2018<br /> <br /> 89<br /> <br />