Leading causes of death of women of reproductive age in the Republic of Georgia: findings from the National Reproductive Age Mortality Survey (2014)

Nino Lomia; Nino Berdzuli; Lela Sturua; Maia Kereselidze; Marina Topuridze; Ekaterine Pestvenidze; Babill Stray-Pedersen

doi:10.2147/IJWH.S164053

Leading causes of death of women of reproductive age in the Republic of Georgia: findings from the National Reproductive Age Mortality Survey (2014)

Int J Womens Health. 2018 Aug 15:10:437-452. doi: 10.2147/IJWH.S164053. eCollection 2018.

Authors

Nino Lomia¹, Nino Berdzuli¹, Lela Sturua², Maia Kereselidze³, Marina Topuridze⁴, Ekaterine Pestvenidze¹, Babill Stray-Pedersen^{1

5}

Affiliations

¹ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway, ninolomia@yahoo.com.
² Department of Non-Communicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia.
³ Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia.
⁴ Health Promotion Division, Department of Non-Communicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia.
⁵ Department of Obstetrics and Gynecology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.

Abstract

Purpose: An understanding of women's health problems during the reproductive years, based on reliable cause-of-death data, is of critical importance to avoid premature female mortality. This study aimed to investigate mortality levels, cause-specific patterns, and trends in women of reproductive age in Georgia.

Materials and methods: The National Reproductive Age Mortality Survey (2014) was conducted to identify all causes of death for women aged 15-49 years in 2012. The leading causes were compared with those in 2006, using directly age-standardized death rates (ASDRs). The accuracy of official cause-of-death data was assessed against verbal autopsy (VA) diagnoses, using kappa statistics, sensitivity, positive predictive value, and misclassification analyses.

Results: Of 913 eligible deaths, VAs were completed for 878 deaths. Noncommunicable diseases (NCDs) were the dominant causes of death (69.6% or 53.1/100,000), with cancer taking a major toll (45.2% or 34.5/100,000), followed by injuries (18.6% or 14.2/100,000). Breast cancer (12.5%), road injuries (9.1%), cervical cancer (6.5%), cerebrovascular diseases (5.2%), uterine cancer (4.1%), brain cancer (3.4%), suicide (3.1%), stomach cancer (3.0%), maternal disorders (2.6%), and liver cirrhosis (2.2%) contributed to the 10 leading specific causes of death, with the majority being substantially underreported in official statistics. This was primarily due to a significantly higher proportion (84%, p<0.05) of deaths routinely assigned ill-defined codes. Since 2006, statistically significant changes in ASDRs, with declines, were observed only for undetermined causes (40%, p<0.05) and ovarian cancer (54%, p<0.05); ovarian cancer and tuberculosis were replaced by stomach cancer and liver cirrhosis in the top 10 cause-of-death list.

Conclusion: NCDs continue to be the major health threats for Georgian women of reproductive age. The VA method proved a feasible tool to yield essential cause-of-death information for this population. Further research is needed to inform national health promotion and disease prevention interventions to be focused on NCDs and reproductive health needs with an integrated approach.

Keywords: cancer; injuries; mortality; noncommunicable diseases; verbal autopsy; women’s health.