ABSTRACT
BACKGROUND: Reliable information on causes of death to understand health priorities is rare from rural underdeveloped regions of India but is needed to direct health care response. This prompted us to study causes of death in a rural region of Gadchiroli, one of the most underdeveloped districts of India. METHODS: Data on causes of death were collected from 86 villages between April 2011 and March 2013 using verbal autopsies. Two physicians independently assigned cause of death using the tenth revision of the International Classification of Disease and disagreement was resolved by a third physician. RESULTS: There were 1599 deaths over 188,308 person years of observation. The crude death rate was 8.5 (95% confidence interval (CI)=8.1-8.9). The five leading causes of death were diseases of the circulatory system (20.8%), with stroke being the leading cause (14.3%), infections and parasitic disorders (18.4%), injuries and other external causes of mortality (10%), peri-natal diseases (6.5%) and diseases of the respiratory system (6.4%). Non-communicable diseases (NCDs) accounted for 38.5%, infections and perinatal diseases for 28.3% and external causes including injuries for 10% of all deaths. CONCLUSIONS: Epidemiological transition with a shift in causes of deaths from communicable to NCDs has occurred even in a rural underdeveloped district like Gadchiroli. Public health system in rural India which focuses on infections and maternal and child health will now need to be strengthened urgently to face the triple challenge of communicable and non-communicable diseases as well as injuries.
ABSTRACT
BACKGROUND AND PURPOSE: Stroke is an important cause of death and disability worldwide. However, information on stroke deaths in rural India is scarce. To measure the mortality burden of stroke, we conducted a community-based study in a rural area of Gadchiroli, one of the most backward districts of India. METHODS: We prospectively collected information on all deaths from April 2011 to March 2013 and assigned causes of death using a well-validated verbal autopsy tool in a rural population of 94 154 individuals residing in 86 villages. Two trained physicians independently assigned the cause of death, and the disagreements were resolved by a third physician. RESULTS: Of 1599 deaths during the study period, 229 (14.3%) deaths were caused by stroke. Stroke was the most frequent cause of death. For those who died because of stroke, the mean age was 67.47±11.8 years and 48.47% were women. Crude stroke mortality rate was 121.6 (95% confidence interval, 106.4-138.4), and age-standardized stroke mortality rate was 191.9 (95% confidence interval, 165.8-221.1) per 100,000 population. Of total stroke deaths, 87.3% stroke deaths occurred at home and 46.3% occurred within the first month from the onset of symptoms. CONCLUSIONS: Stroke is the leading cause of death and accounted for 1 in 7 deaths in this rural community in Gadchiroli. There was high early mortality, and the mortality rate because of stroke was higher than that reported from previous studies from India. Stroke is emerging as a public health priority in rural India.
