Cause-specific mortality patterns among hospital deaths in Tanzania, 2006-2015

Abstract

Background: Understanding the causes of inpatient mortality in hospitals is important for monitoring the population health and evidence-based planning for curative and public health care. Dearth of information on causes and trends of hospital mortality in most countries of Sub-Saharan Africa has resulted to wide use of model-based estimation methods which are characterized by estimation errors. This retrospective analysis used primary data to determine the cause-specific mortality patterns among inpatient hospital deaths in Tanzania from 2006-2015.

Materials and methods: The analysis was carried out from July to December 2016 and involved 39 hospitals in Tanzania. A review of hospital in-patient death registers and report forms was done to cover a period of 10 years. Information collected included demographic characteristics of the deceased and immediate underlying cause of death. Causes of death were coded using international classification of diseases (ICD)-10. Data were analysed to provide information on cause-specific, trends and distribution of death by demographic and geographical characteristics.

Principal findings: A total of 247,976 deaths were captured over a 10-year period. The median age at death was 30 years, interquartile range (IQR) 1, 50. The five leading causes of death were malaria (12.75%), respiratory diseases (10.08%), HIV/AIDS (8.04%), anaemia (7.78%) and cardio-circulatory diseases (6.31%). From 2006 to 2015, there was a noted decline in the number of deaths due to malaria (by 47%), HIV/AIDS (28%) and tuberculosis (26%). However, there was an increase in number of deaths due to neonatal disorders by 128%. Malaria and anaemia killed more infants and children under 5 years while HIV/AIDS and Tuberculosis accounted for most of the deaths among adults.

Conclusion: The leading causes of inpatient hospital death were malaria, respiratory diseases, HIV/AIDS, anaemia and cardio-circulatory diseases. Death among children under 5 years has shown an increasing trend. The observed trends in mortality indicates that the country is lagging behind towards attaining the global and national goals for sustainable development. The increasing pattern of respiratory diseases, cancers and septicaemia requires immediate attention of the health system.

Fig 1. Distribution of death by sex and regions in Tanzania, 2006–2015.

Fig 2. Age and sex distribution of hospital deaths, 2006–2015.

Fig 3. Age-sex mortality rate per 100,000 population, 2006–2015.

Fig 4

The annual pattern of causes of death by (A) sex; and (B) children and adults. The equation is for a trend-line indicating the slope and intercept over years.

Fig 5. Distribution of death by the three Global Burden of diseases categories, 2006–2015.

The overall contribution from young adults to old age for the entire study period is GI = 46.67; GII = 46.06 and GIII = 7.3. The annual pattern for the same age range is demonstrated on the right side of the plot, the black dotted line indicates the margin on 50% (GI: Group I; GII: Group II; GIII: Group III).

Fig 6. Cumulative proportion of death by cause of death groups for all ages.

Fig 7. Cumulative proportion of death by cause of death groups among children < 5 years old.

Fig 8. Cumulative proportion of death by cause of deaths groups among ≥ 5 years old.

Fig 9. Comparing pattern of cause of death between 2006–2010 and 2011–2015 periods for all age groups.

The blue bars indicate the causes with decreasing trend. Red bars indicate those with increasing trend. The actual percentage increase or decrease is shown as data label for each cause.

Fig 10. Leading causes of death in regions comparing periods of 2006–2010 and 2011–2015.

Maps are shown with inclusion or exclusion of special hospitals.