Zambia 2015/16 SAVVY Report Table of Contents Page ACKNOWLEDGEMENT vii ACRONYMS ix FOREWORD xi EXECUTIVE SUMMARY xiii SUMMARY OF KEY FINDINGS xv Chapter 1: Introduction 1 1.1 Overview of Civil Registration and Vital Statistics Systems 1 1.2 Sample Vital Registration with Verbal Autopsy (SAVVY) 2 1.3 Rationale for SAVVY Implementation in Zambia 2 1.4 Goals and Objectives 2 1.5 Specific Objectives 2 Chapter 2: Methodology 5 2.1 Introduction 5 2.2 Sample Design 5 2.3 Baseline Census 6 2.4 Verbal Autopsy Questionnaires 7 2.5 Verbal Autopsy Fieldwork and Data Collection 7 2.6 Certification, ICD-10 Coding, and Tabulation of Cause of Death 7 2.7 Data Processing 8 2.8 Tabulation of Causes of Death 8 2.9 Data Analysis 9 2.10 Statistical Significance of Results 9 2.11 Response Rates 9 2.12 Study Limitations 10 Chapter 3: Mortality and Causes of Death from Verbal Autopsies 13 3.1 Introduction 13 3.2 Patterns of Mortality by Age 13 3.3 Top 10 Underlying Causes of Death 14 3.4 Leading Causes of Mortality Among Children Aged 0-14 Years 16 3.5 Leading Causes of Death among Adults (15 years and older) 17 3.6 Percent Distribution of Deaths by Province 18 Chapter 4: Deaths from Specific Causes 19 4.1 Introduction 19 4.2 Malaria 19 4.2.1 Malaria Deaths by Region and Sex 19 4.2.2 Malaria Deaths by Region and Age 20 4.2.3 Malaria Deaths by Place of Treatment 20 4.2.4 Malaria Deaths by Region and Seasonality 21 4.2.5 Malaria Deaths by Region, Sex and Province 21 Table of Contents iii Zambia 2015/16 SAVVY Report Table of Contents Page 4.3 HIV Related Diseases 22 4.3.1 Deaths Due to HIV Related Diseases 22 4.3.2 Deaths due to HIV Related Diseases by Region and Age 22 4.3.3 Deaths due to HIV Related Diseases by Region and Sex 22 4.3.4 Deaths due to HIV Related Diseases by Province 23 4.3.5 Deaths due to HIV Related Diseases by Place of Treatment 23 4.4 External Causes 24 4.4.1 Percentage of Deaths Due to External Causes by Region and Sex 24 4.4.2 Deaths Due to External Causes by Province 25 4.4.3 Deaths Due to External Causes by Region and Age 25 4.4.4 External Causes of Death by Place of Treatment 26 4.4.5 External Causes of Death by Place of Death 26 4.4.6 Causes of Injuries and Accidents 27 4.5 Non-Communicable Diseases 27 4.5.1 Deaths due to Non-communicable Diseases by Type 28 4.5.2 Deaths due to non-communicable diseases by region and sex 28 4.5.3 Deaths due to Non-communicable Diseases by Place of Treatment 29 4.5.4 Deaths due to Non-communicate Diseases by Place of Death 29 4.5.5 Deaths due to Non-communicable Diseases by Region and Risk Factors 30 4.6 Maternal Health 30 4.6.1 SAVVY Maternal Mortality Ratio 30 4.6.2 Maternal Deaths by Region and Age-Groups 31 4.6.3 Maternal Deaths by Place of Treatment 31 4.6.4 Maternal Deaths by Place of Death 32 4.6.5 Maternal Deaths as a result of the Three Delays 32 Chapter 5: Treatment Received, Place and Type of Treatment, and Place of 33 Death 5.1 Introduction 33 5.2 Treatment Received during Illness 33 5.3 Type of Treatment Received 34 5.4 Place of Death 37 5.5 Place of Death by Region 37 Chapter 6: Discussion 39 REFERENCE 41 GLOSSARY 43 Appendix 1: Periodic Life Table and Percentage Distribution of Deaths Tables 47 Appendix 2: Key Persons Involved in the 2015/16 SAVVY Survey 49 Appendix 3: VA Death Certificate and Questionnaires 59 iv Table of Contents Zambia 2015/16 SAVVY Report List of Tables Page Table 2.1: Number of SAVVY sites at representative sub national levels 6 Table 2.2: Response rate for the SAVVY baseline census and verbal 10 autopsy, by Province Table 3.1: Distribution of deaths due to diseases of the circulatory system, 15 by specific cause, Zambia 2015/16 Table 3.2: Percentage distribution for the top five causes of death among 16 neonates, Zambia 2015/16. Table 4.1: Malaria deaths by demographic characteristics, Zambia 2015/16 21 Table 4.2: Deaths due to HIV related diseases by Province, Zambia 2015/16 23 Table 4.4: Percentage Distribution of deaths due to external causes by 25 rural/urban and province, Zambia 2015/16 Table 5.1: Treatment received during Illness that led to death by rural/ 33 urban, Zambia 2015/16 Table 5.2: Percentage distribution of deceased persons by place of death 38 and province, Zambia 2015/16 Table 1a: Periodic Life table for Zambia: 2015-2016 (Source: DNRPC SAVVY 47 Data) Table 1b: Percentage distribution of deaths due to specific causes by 47 region and sex Table 1c: Percentage distribution of deaths due malaria by age-group, 47 region and sex Table of Contents v Zambia 2015/16 SAVVY Report List of Figures Page Figure 3.1: Age Pattern of Mortality, Zambia 2015/16 13 Figure 3.2: Percentage distribution of top ten causes of death for all age 14 groups, Zambia 2015/16 Figure 3.3: Percentage distribution of top ten causes of death by sex, 15 Zambia 2015/16 Figure 3.4: Percent distribution of top ten causes of death by region, Zambia 16 2015/16 Figure 3.5: Percentage Distribution for the top ten causes of Death among 16 Children aged 0-4 Years, Zambia 2015/2016 Figure 3.6: Percentage distribution for the top ten causes of death among 17 children aged 5-14 years, Zambia 2015/16. Figure 3.7: Percentage distribution of the top ten leading causes of death 17 among adults 15 years and older, Zambia 2015/16 Figure 3.8: Percentage distribution of the top ten leading causes of death 18 among adults aged 15 years and older by sex, Zambia 2015/16. Figure 3.9: Percentage distribution of deaths by Province, Zambia 2015/16 18 Figure 4.1: Percentage distribution of malaria deaths by region and by sex, 19 Zambia 2015/16 Figure 4.2: Percentage distribution of malaria deaths by region and age, 20 Zambia 2015/16 Figure 4.3: Percentage distribution of malaria deaths by place of treatment, 20 Zambia 2015/16 Figure 4.4: Percentage distribution of malaria deaths by region and 21 seasonality, Zambia 2015/16 Figure 4.5: Percentage distribution of HIV related diseases deaths by region 22 and age, Zambia 2015/16 Figure 4.6: Percent distribution of HIV deaths by region and sex, Zambia 22 2015/16 Figure 4.7: Percentage distribution of deaths due to HIV related diseases by 23 place of treatment, Zambia 2015/16 Figure 4.8: Percentage distribution of deaths due to external causes by 24 region and sex, Zambia 2015/16 Figure 4.9: Percentage distribution of deaths due to external causes by 25 region and age, Zambia 2015/16 Figure 4.10: Percentage distribution of external causes by place of 26 treatment, Zambia 2015/16 Figure 4.11: Percent distribution of deaths due to external causes by place of 27 death, Zambia 2015/16 Figure 4.12: Specific Causes contributing to Accidents and Injuries, Zambia 27 2015/16 Figure 4.13: Percentage distribution of NCD deaths. Zambia 2015/16 28 Figure 4.14: Percent distribution of deaths due to non-communicable 28 diseases by region and sex, Zambia 2015/16 vi Table of Contents Zambia 2015/16 SAVVY Report List of Figures Page Figure 4.15: Percentage distribution of NCD deaths by place of treatment, 29 Zambia 2015/16 Figure 4.16: Percentage distribution of deaths due to non-communicable 29 diseases by place of death, Zambia 2015/16 Figure 4.17: Percent distribution of deaths due to NCD associated with risk 30 factors, Zambia 2016/16 Figure 4.18: Percentage distribution of maternal deaths by region and age, 31 Zambia 2015/16 Figure 4.19: Percentage distribution of maternal deaths by place of 31 treatment, Zambia 2015/16 Figure 4.21: Percentage distribution of maternal deaths as a result of the 32 delays in seeking medical care, Zambia 2015/16 Figure 4.20: Percentage distribution of maternal deaths by place of death, 32 Zambia 2015/16 Figure 5.1: Treatment received during illness that led to death by sex, 33 Zambia 2015/16 Figure 5.2: Place of treatment for those who received treatment in the 34 period leading to death, Zambia 2015/16 Figure 5.3: Type of treatment for those who received treatment in the 35 period leading to death, Zambia 2015/16 Figure 5.4: Type of treatment by region for those who received treatment in 35 the period leading to death, Zambia 2015/16 Figure 5.6: Type of treatment for children aged 5-14 years who received 36 treatment in the period leading to deaths, Zambia 2015/16 Figure 5.5: Type of treatment for children aged 0-4 years who received 36 treatment in the period leading to deaths, Zambia 2015/16 Figure 5.7: Type of treatment for adults aged 15 years and older who 36 received treatment in the period leading to deaths, Zambia 2015/16 Figure 5.9: . Percentage distribution of deceased persons by place of death 37 and region, Zambia 2015/16 Figure 5.8: Percent distribution of deceased persons by place of Death, 37 Zambia 2015/16.