Estimation of AIDS adult mortality by verbal autopsy in rural Malawi

Objective: To estimate AIDS-related adult mortality using verbal autopsies (VA) in a rural sub-Saharan African setting with high HIV prevalence. Design: VA data were collected from relatives and neighbors that described the circumstances leading to death for 92 adults in three rural areas of Malawi. These adults were initially interviewed in 1998 as part of a longitudinal social survey of a sample of 1554 women and 1126 men, and their deaths occurred between then and a 3-year follow-up interview in 2001. Methods: AIDS-related deaths were identified using a standard World Health Organization (WHO) algorithm and this observed number of deaths was compared with the expected number. The expected number is derived from a comparison of adult mortality in this sample with the pre-AIDS mortality levels measured in the 1987 Malawi census, giving an 'excess mortality factor' that can be considered to be AIDS related. it was calculated that 74.9% of observed deaths in 1998-2001 would be from AIDS. Results: According to the WHO algorithm, 75.5% of the VA deaths could be categorized as AIDS deaths. The gender-specific figures were 75.1% for females and 76.3% for males. Conclusions: Results are consistent with those found in studies conducted in other areas of sub-Saharan Africa at earlier stages in the epidemic. They confirm that VA data can be used to estimate with a reasonable degree of confidence the distribution of AIDS- and non-AIDS-related deaths in the aggregate, even in a rural population with relatively low levels of education. (C) 2003 Lippincott Williams Wilkins.