Mortality Decreases among Young Adults in Southern Central Ethiopia

ABSTRACT

Background: Despite the anticipated high impact of HIV and AIDS among young people; AIDS related mortality is not well documented because of the lack of death registration systems in Ethiopia. The objective of this analysis was to investigate the trends in mortality among young adults (aged 10-24 years) in the era of the AIDS epidemic. Methods: We analyzed data for young adults aged between 10-24 years using the Butajira Rural Health Programme (BRHP) open cohort database. The study covers 1 urban and 9 rural communities; which were initially randomly selected from the Butajira district. The BHRP database covers the period 1987-2004; recording vital events and migration at the household level after an initial baseline census in 1987; using village-based data collectors. The data included 34;150 young people who contributed a total of 248;154 person years. Results: In the 18-year follow-up period; 1;030 young adults died; giving an age-specific crude mortality rate of 4.2 per 1;000 person-years. The trends of mortality in this population declined from 6 per 1;000 person-years in 1987- 1989 to less than 2 per 1;000 person-years in 2002-2004. Deaths due to HIV were recorded at a rate of only 0.02 per 1;000 person-years; according to causes of death reported by family care givers. A multivariate regression model showed that young adults from the rural highlands and lowlands had a higher risk of death (adjusted rate ratios 1.99 [1.40-2.83] and 2.58 [1.82-3.66] respectively) than young urban adults; even after adjusting for water source; literacy and housing type. The earlier cohorts (1987-1989 and 1990-1994) had higher risks of mortality than the latest cohort (1999-2004) - (adjusted rate ratios 1.91 [1.59-2.29] 2.03 [1.75-2.35] respectively). Conclusion: A remarkable decline in mortality was observed in this population with little sign of excessive HIV/AIDS-related mortality appearing during this 18-year period. However; the occurrence of AIDS-related deaths in the latter part of the study period suggests appropriate interventions to counter the developing HIV epidemic are justified