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  • Title: Contribution of AIDS to the general mortality in Central Africa: evidence from a morgue-based study in Brazzaville, Congo.
    Author: Pictet G, Le Coeur S, M'Pelé P, Brouard N, Lallemant M.
    Journal: AIDS; 1998 Nov 12; 12(16):2217-23. PubMed ID: 9833864.
    Abstract:
    OBJECTIVE: To accurately measure AIDS-related mortality relative to other causes and its impact on life expectancy in Brazzaville, Congo. DESIGN: Investigation of all deaths during a 1-month period in Brazzaville. METHODS: From 10 July to 9 August 1996, all bodies handled by Brazzaville's three morgues were examined by a physician. Relatives were interviewed on the circumstances of death, while additional clinical data were gathered from hospital files. Blood samples were systematically drawn from the bodies in two of the three morgues and tested for HIV antibodies. RESULTS: Amongst the 756 bodies examined at the three morgues, 149 (19.7%) AIDS cases were identified. HIV-1 prevalence was 26.2% (38 out of 145) amongst the subjects in the two morgues where HIV serology was systematically performed. AIDS was the leading cause of death in adults (age > or = 15 years), with 25.1% (122 out of 487) of the adults diagnosed with AIDS. The proportion of adult female AIDS cases was significantly higher than the proportion of male cases (30.2 versus 21.0%; P < 0.05). Moreover, female AIDS cases were significantly younger than male cases (median age, 32 versus 42 years; P < 0.00001). Overall AIDS mortality rate amongst adults was 2.8 per 1000 for men and 3.2 per 1000 for women. The impact of AIDS on life expectancy at birth is 4.3 years for women and 3.3 years for men. CONCLUSION: Our study provides a direct measure of AIDS contribution to mortality relative to other causes, using a rapid, low cost, reliable and replicable method. Clearly, the impact of AIDS is strongest on female life expectancy. As of December 1997, UNAIDS estimated that 20.8 million people were infected with HIV in sub-Saharan Africa. Brazzaville, Congo, has an estimated population of 850,000, according to the 1996 national census, and an estimated HIV-1 prevalence rate of approximately 5% in the general reproductive-age population. Findings are presented from a study conducted to accurately measure AIDS-related mortality relative to other causes and its impact upon life expectancy in Brazzaville, Congo. From July 10 to August 9, 1996, all bodies handled by Brazzaville's 3 morgues were examined by a physician. Relatives were interviewed on the circumstances of death and additional clinical data were collected from hospital files. Blood samples were systematically drawn from the bodies in 2 of the 3 morgues and tested for HIV antibodies. 149 of the 756 bodies (19.7%) examined at the morgues had AIDS. 38 of the 145 (26.2%) subjects in the 2 morgues in which HIV serology was systematically performed were infected with HIV-1. AIDS was the leading cause of death among people aged 15 years and older, with 122 of the 487 (25.1%) adults diagnosed with AIDS. 30.2% of the adult female deaths were due to AIDS, compared to only 21.0% of the male cases. The median age of female AIDS cases was 32 years, compared to 42 years for male cases, a highly significant difference. The overall AIDS mortality rate among adults was 2.8/1000 for men and 3.2/1000 for women. The impact of AIDS upon life expectancy at birth is 4.3 years for women and 3.3 years for men.
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