Causes of deaths using verbal autopsy among adolescents and adults in rural western Kenya

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Abstract
To establish causes and patterns of deaths among adolescents and adults (age >11 years) using verbal autopsy (VA) in a rural area of western Kenya where malaria and HIV are common. Village reporters reported all deaths in Asembo and Gem (population 135 000), an area under routine demographic surveillance. After an interval of >/=1 month, a trained interviewer used a structured questionnaire to ask the caretaker about signs and symptoms that preceded death. Three clinical officers independently reviewed the interviews and assigned two unranked causes of death; a common cause was designated as the cause of death. In 2003, 1816 deaths were reported from residents; 48% were male and 72% were between 20 and 64 years of age. Most residents (97%) were ill before death, with 60% of illnesses lasting more than 2 months; 87% died at home. Care was sought by 96%; a health facility was the most common source, visited by 73%. For 1759 persons (97%), a common cause of death was designated. Overall, 74% of deaths were attributed to infectious causes. HIV (32%) and tuberculosis (TB) (16%) were the most frequent, followed by malaria, respiratory infections, anaemia and diarrhoeal disease (approximately 6% each). Death in a health facility was associated with young age, higher education, higher SES, a non-infectious disease cause and a shorter duration of illness. In this area, the majority of adult and adolescent deaths were attributed to potentially preventable infectious diseases. Deaths in health facilities were not representative of deaths in the community. Programmes to prevent HIV and TB infection and to decrease mortality have started. Their impact can be evaluated against this baseline information.