Vesper Hichilombwe Chisumpa

Adult mortality in sub-saharan Africa, Zambia: Where do adults die?

Place of death remains an issue of growing interest and debate among scholars as an indicator of quality of end-of-life care in developed countries. In sub-Saharan Africa, however, variations in place of death may suggest inequalities in access to and the utilization of health care services that should be addressed by public health interventions. Limited research exists on factors associated with place of death in sub-Saharan Africa. The study examines factors associated with the place of death among Zambian adults aged 15–59 years using the 2010–2012 sample vital registration with verbal autopsy survey (SAVVY) data, descriptive statistics and multivariate logistic regression analysis. Results show that more than half of the adult deaths occurred in a health facility and two-fifths died at home. Higher educational attainment, urban versus rural residence, and being of female gender were significant predictors of the place of death. Improvement in educational attainment and investment in rural health facilities and the health care system as a whole may improve access and utilization of health services among adults.

Decomposition of age- and cause-specific adult mortality contributions to the gender gap in life expectancy from census and survey data in Zambia

In the context of high adult mortality and an immense impact on the health burden of Zambia, a decomposition analysis of age- and cause-specific mortality in age group 15–59 was performed to determine the contributions to the gap in life expectancy at birth between males and females. Previous studies on decomposition have examined income groups, ethnicity, and regional differences’ contributions to gaps in life expectancy, but not the adult mortality age group 15–59. These studies focus on developed countries and few on developing countries. Arriaga’s decomposition method was applied to 2010 census and 2010–2012 sample vital registration with verbal autopsy survey (SAVVY) data to decompose contributions of age- and cause-specific adult mortality to the gap in life expectancy at birth between males and females. The decomposition analysis revealed that mortality was higher among males than females and concentrated in age groups 20–49. Age- and cause-specific adult mortality contributed positively, 50% of the years to the gap in life expectancy at birth between males and females. Major cause-specific mortality contributors to the gap in life expectancy were infectious and parasitic diseases (1.17 years, 26.3%), accidents and injuries (0.54 years, 12.2%), suicide and violence (0.30 years, 6.8%). Female HIV mortality offset male mortality. Neoplasms deaths among females contributed negatively to the gap in life expectancy (-0.22 years, -5.4%). Accidents, injuries, suicide, and violence are emerging major causes of death in age group 20–49 in Zambia which health policy and programmes should target.

Adult mortality in sub-Saharan Africa using 2001—2009 census data: does estimation method matter?

Adult mortality is an important development and public health issue that continues to attract the attention of demographers and public health researchers. Controversies exist about the accurate level of adult mortality in sub-Saharan Africa (SSA), due to different data sources and errors in data collection. To address this shortcoming, methods have been developed to accurately estimate levels of adult mortality. Using three different methods (orphanhood, widowhood, and siblinghood) of indirect estimation and the direct siblinghood method of adult mortality, we examined the levels of adult mortality in 10 countries in SSA using 2001–2009 census and survey data. Results from the different methods vary. Estimates from the orphanhood data show that adult mortality rates for males are in decline in South Africa and West African countries, whilst there is an increase in adult mortality in the East African countries, for the period examined. The widowhood estimates were the lowest and reveal a marked increase in female adult mortality rates compared to male. A notable difference was observed in adult mortality estimates derived from the direct and indirect siblinghood methods. The method of estimation, therefore, matters in establishing the level of adult mortality in SSA.

The influence of internal migration on mental health status in South Africa

Abstract Mental health status is fundamental to overall health and well-being but most studies on the relationship between migration and mental health status deal with international migration and neglects internal migration. Therefore, this study compares the mental health status of internal migrants with that of non-migrants; and also appraises the socio-demographic factors associated with mental health status in South Africa. Data were from the National Income Dynamics Study (NIDS), waves 3 (2012), and 4 (2014) of South Africa. Univariate analysis was used to describe the study population, bivariate analysis was use to explain the mental health status of the population, and binary logistic regression was used analyze the socio-demographic factors associated with mental health status. The study found significant differences in the mental health status of migrants and non-migrants across the waves of NIDS used for this study. While, the migrants had better mental health status in 2012, the non-migrants had better mental health status in 2014. In addition, factors significantly associated with mental health status in 2012, were marital status, income, and province of residence. On the other hand, only race, and province of residence were significantly associated with mental health status in 2014.

Estimating regional variations in adult mortality in Zambia

Background: A dearth of regional level adult mortality estimates exists in Zambia. Regional adult mortality rates reflect inequalities in socioeconomic conditions and health service provision. Adult mortality rates are useful indicators for monitoring effectiveness and impact of health interventions (HIV/AIDS antiretroviral therapy (ART), tuberculosis (TB) and malaria) at regional level. Previous studies have not produced adult mortality rates at regional level. Data Source and Methods: Using data from the 2010 census, this study estimated adult mortality rates at regional level for age group 15-59 years. Age-specific mortality rates (ASMRs), cause-specific mortality rates (CSMRs), standardised mortality rates (SMRS) and probabilities of dying between age 15 and 60 years ( 45 q 15 ) were computed. Correlations with HIV prevalence and literacy rates, and mortality rates were also computed. Findings: Adult mortality rates varied across all provinces. The 45 q 15 was highest for males in Western province, 59 % and lowest in North-western province, 36.7 %. For females, 45 q 15 was highest in Copperbelt province, 47.9 % and lowest in North-western province, 34.8 %. Conclusion: HIV prevalence and literacy rates were positively correlated with regional adult mortality rates. Health policies and programmes aimed at reducing adult mortality should, therefore, be tailored to recognise the regional variations in mortality rates