MORTALITY AND CAUSE OF DEATH IN ABUTH, ZARIA: 1999 – 2005

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T. Dahiru¹, K. Sabitu¹, A. Oyemakinde², A.T. Mande¹, and P. Singha¹

1. Department of Community Medicine, ABU, Zaria.
2. Department of Planning, Research & Statistics, Federal Ministry of Health, Abuja, Nigeria.

Abstract

Background: Accurate mortality statistics are needed for policy formulation, implementation and monitoring of health intervention that are aimed at improving the health status of the people. Mortality level is one of the indicators of the quality of life and status of health of a population. However, accurate collection, collation, analysis and interpretation of such data is poorly organised in developing nations, including Nigeria leading to a gap in health policy formulation, implementation and monitoring. Therefore, policies and strategies for disease prevention are based on empirical evidence rather than on data primarily collected to formulate disease specific interventions. Though, hospital data have inherent deficiency in its use to design prevention. However, when accurately generated and adequately managed would provide both qualitative and quantitative information on morbidity and mortality if not for the entire society at least for a segment of the population utilizing it. We implemented a system of death certification to determine causes and pattern of mortality in Ahmadu Bello University Teaching Hospital, Zaria

Methods: From May 1999 to November 2005, all case folders of deceased patients were retrieved from the central library of health information management department of the hospital; case folders of deceased patients are required to have in them a completed IFMCCD (International Form of Medical Certification of Cause of Death). All case folders of deceased patients after relevant information were extracted by the staff of health management information department, were passed on to the staff of department of Community Medicine directly involved in this study. The completed cause of death certificates received in the department of Community Medicine (between May 1999 and November 2005), were examined. Coding rules were employed to select the appropriate code for those certificates that were incorrectly completed. The underlying cause of death as identified from the correctly completed IFMCCDS is coded according to ICD-10.

Results: For the period under study, there were 4019 deaths: 2212 males and 1807 females. Total of 2914 (72.5%) deaths were certified, using the IFMCCD of which 1641 of them were males and 1273 females and formed the basis of this analysis. Coverage rates ranges from 56.2% in 2001 to 85% in 1999. The proportion of garbage codes ranges from 0% to 2.4% while the three leading causes of death are HIV infection, road traffic accident (RTA), and cardiovascular diseases among the ten. The time-trend of the leading causes of death show RTA maintaining steady upward climb while malaria, septicemia, PEM, sepsis in the neonatal period shows unsteady fluctuation.

Conclusion: This study assessed the pattern of mortality and causes of death in ABU Teaching Hospital, Zaria; it also provided information on leading causes of death.

Introduction

Information on causes of death is scanty in many developing countries including Nigeria¹. Though there has been a law in this country establishing a nationwide vital registration system, it has failed to gain enough momentum to ensure a reasonably adequate coverage mainly due to lack of necessary official support, patronage and enforcement of provision of the law².

It is needless to stress the fact that health research is dependent on information collection, analysis and interpretation. Whereas analysis and interpretation is professional expertise, information is generated from a variety of sources. For health information, the principal sources are the official system of civil registration of vital events and all the health care delivery agencies, private and public catering for the needs of the community they serve. Of all these agencies, apart from the civil registration of vital events, the teaching hospital assumes the role of prime mover especially in developing countries as ours where none of the sources is able to provide even a modicum of data of utility. In such despairing state of health information of this country, a research worker or a health service administrator or a health planner rely heavily on hospital data. In a developing country like Nigeria, despite all these limitations, hospital especially university teaching hospital constitutes a very reliable source of data, if not in all accounts, at least in term of diagnostic description of mortality and morbidity. Hospital records accurately generated and adequately managed would provide both qualitative and quantitative information of mortality and morbidity if not for the entire society, at least for a segment of population utilizing it. Analysis of hospital statistics with realistic assumptions and careful circumspection of the conditions that may distort them may bring forth useful inputs to formulating strategies and setting up priorities not only in the internal management and administration of the hospital but also to a greater extent in organizing health care machinery for the community at large.

This study was designed to provide an insight into mortality pattern of a teaching hospital in the heart of Northern Nigeria that initially served the entire former Northern Region of the country and at the same time to shed more light on what is probably the pattern of mortality in the larger community. It is to be noted that similar hospital-based studies were conducted in some teaching hospitals in the 1960s³, 1970s^4,5 and 1980s⁶. This study is the first of its kind in ABUTH, Zaria. Furthermore, the study aims at analyzing the cause-of-death statistics in order to:

1. Determine the pattern of mortality and causes of death in ABUTH, Zaria.
2. Identify the leading causes of death in ABUTH, Zaria.
3. Expose the time trend, if any, of a particular condition.
4. Delineate differential mortality from any specified cause between subgroups of inpatients.