CHAPTER 4: CAUSES OF MORTALITY
4.4 Causes of Death by Age-Group
This section presents the causes of death in different age groups. Five age groups were used: under5 year old age group (0 to 4 years old), children (5 to 14 years old), young adults (15 to 49 years old), adults aged between 50 and 64 years old and those aged 65 yearsold and above.
4.4.1 Causes of Childhood Death (<1 year, 1-4 years and 5-14 years)
There were few deaths (n=22) that occurred in the community among children in the under 5 year age group (Table 3). The causes of death in the hospital for children
births, low birth weight and birth asphyxia, while in the community of the 3 deaths in this age group 1 was due to infectious diseases and the other two deaths were undetermined.
Amongst children in the 1 to 4 year age group, hospital deaths were dominated by infectious diseases (32%), non-natural causes (16%) and malnutrition (11%), while in the community (42%) were attributed to ill-defined conditions,while infectious diseases caused (26%) of the deaths.
Table 3:Causes of death among children aged <1 and 1-4 years
<1 year 1-4 years Total
Hospital deaths
n(%)
Community deaths n(%)
Hospital deaths
n(%)
Community deathsn(%)
Hospital deaths
n(%)
Community deathsn(%)
Congenital anomalies 36(5) - - - 36(4) -
Cardiovascular disease 17(2) - 2(1) - 19(2) -
Digestive disease 28(4) - 6(4) - 34(4) -
Genito-urinary 10(1) - 7(4) - 17(2) -
Infectious/parasitic 88(11) - 29(17) 5(26) 117(12) 5(23)
Injury 21(3) - 27(16) 1(5) 48(5) 1(5)
Cancer 6(1) - 8(5) - 14(1) -
Neuropsychiatry 4(1) - 4(2) - 8(1) -
Malnutrition 18(2) - 18(11) 3(16) 36(4) 3(14)
Perinatal conditions 369(46) - 11(7) - 380(39) -
Respiratory disease 30(4) - 2(1) - 32(3) -
Respiratory infections 95(12) 1(33) 25(15) 2(11) 120(12) 2(14)
Other NCD 7(1) - 3(2) - 10(1)
Undermined 69(9) 2(67) 24(14) 8(42) 93(10) 10(45)
Total 798(100) 3 166(100) 19 964(100) 22
Other NCD: Skin diseases, Musculoskeletal and Endocrine disorders
With regard to stillbirths, from 11473 deliveries, 334 stillbirths were recorded in the hospital during the 2-year period of the study, giving a stillbirth rate of 29.1 per 1000 deliveries (data not shown). In the community, no stillbirths were reported.
A large proportion (59.6%) of the stillbirths was macerated. Of these, half (50%)
hypertensive diseases and (14%) were as a result of placenta abruption. Among the fresh stillbirths group, (31%) were due to maternal hypertensive disease, (23%) placenta abruption and (5.8%) were due to foetal distress (Table 4).
Table 4:Causes ofstillbirth in Pietersburg/Mankweng Hospital Complex
Fresh stillbirth Macerate stillbirth Total
No % No % No %
Maternal
Hypertensive disease 42 31.1 36 18.2 78 23.4
Diabetes mellitus 3 1.9 8 4.0 11 3.2
Cephalo-pelvic disproportion 4 2.9 2 1.0 6 1.8
Unspecified 7 4.9 6 3.0 13 3.8
Foetal
Congenital anomalies 3 1.9 2 1.0 5 1.4
Foetal distress 8 5.8 - - 8 2.4
Breaches 7 4.9 - - 7 2.0
Infection 3 1.9 2 1.0 5 1.4
Placenta
Placental abruption 31 23.3 28 14.1 60 17.8
Placenta praevia - - 2 1.0 2 0.6
Cord accidents 7 4.9 12 6.1 19 5.6
Unexplained IUFD 22 16.5 101 50.5 123 36.8
Amongst children in the 5 to 14 year old age group, infectious diseases(50%) and injuries (20%) were the most common causes of death in the community (n=10), while in the hospital (n=164)infectious diseases (23%), malignant neoplasms(21%) and injuries (13%) were the leading causes of death (data not shown). HIV/AIDS and tuberculosis were the most common causes of death from infectious diseases followed by gastroenteritis and meningitis.
4.4.2 Causes of Death in AdultsAged 15 to 49 Years Old
Amongst adults in the 15 to 49 year old age group, infectious and parasitic diseases were the most common cause of death in both the (43%) hospital and in the (57%) community (Table 5).
Table 5:Causes of Death AmongstAdults 15 years Old and Older
15-49yrs 50-64yrs 65yrs
Hospital deaths
n (%)
Community deaths
n(%)
Hospital deaths
n (%)
Community deaths
n(%)
Hospital deaths
n (%)
Community deaths
n(%) Infectious/parasitic
diseases 929(43) 108(57) 240(24) 41(39) 98(9) 41(21)
Respiratory infections 122(6) 13(7) 56(6) 7(7) 94(9) 30(15)
Maternal conditions 53(2) 2(01) - - - -
Nutritional deficiencies 29(1) 1(0.5) 18(2) - 15(1) 4(2)
Malignant neoplasms 177(8) 6(3) 187(18) 4(4) 196(18) 11(6)
Cardiovascular diseases 98(5) 10(5) 117(12) 21(22) 225(21) 59(30)
Digestive diseases 82(4) - 73(7) - 67(6) -
Genito-urinary diseases 59(3) - 27(3) 2(2) 16(1) 4(2)
Diabetes mellitus 18(1) 4(2) 46(5) 8(8) 63(6) 20(10)
Respiratory diseases 40(2) 2(1) 37(4) 1(1) 28(3) 1(1)
Endocrine disorder 19(1) - 16(2) - 24(2) -
Neuropsychiatric disorder 40(2) - 11(1) - 7(1) -
Other NCD 11(1) - 6(1) - 3(0) 1(1)
Trauma 327(15) 30(16) 71(7) 3(3) 72(7) 11(6)
Undetermined/Unknown 178(8) 14(7) 116(11) 10(10) 163(15) 14(6)
All causes 2182 190 1021 97 1071 196
Trauma was one of the main causes of death in both the (15%) hospital and in the (16%) community. There were 2 maternal deaths reported in the community, while in the hospital 53 deaths were reported. Causes of death in the hospital which were not found in the community included: digestive diseases, genitor-urinary disease, endocrine disorders and neuropsychiatry conditions.
4.4.3 Causes of Death in AdultsAged between 50 and 64 Years of Age
Amongst adults aged between 50 and 64 years old, common causes of death in both the hospital and in the community included infectious and parasitic diseasesas well as cardiovascular diseases.
The incidence of infectious and parasitic diseaseswas (39%) in the community deaths and (24%) in the hospital deaths.Deaths due to cardiovascular diseases were
cancers were greater cause of death in the hospital (18%) than in the community (4%).
There were (11%) undetermined causes of death in the hospital deaths, while in the community deaths (10%) were recorded as undetermined causes. Causes of death recorded in the hospital which was absent from the community include: digestive diseases, endocrine disorders and neuropsychiatric conditions.
4.4.4 Causes of Death in Adults 65 Years of Age and Older:
Amongst adults aged 65 years old and older, cardiovascular diseases were by far the most common causes of death in both the (30%) hospital and in the (21%) community. The cause of death due to infectious and parasitic disease was (21%) in the community deaths and (9%) in the hospital deaths and respiratory infections was (15%) in the community deaths and (9%) in the hospital deaths.
In this age category undetermined causes of death were more common in the (15%) hospital deaths than in the (6%) community deaths. The proportion of deaths due to diabetes mellitus was (10%) in the community deaths and (6%) in the hospital deaths.However, malignant neoplasms caused more deaths in the (18%) hospital than in the (6%) community.
4.5 Summary
Chapter 4summarised the age and gender of the deceased and the leading causes of death that occurred in the hospital and in the nearby community. The mortality
rates in the Dikgale Health and Demographic SurveillanceCentre are presented in Chapter 5.