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    • The majority of adult deaths

    2018-11-05

    The majority of adult deaths occurred in males, as expected. However, more than half of the adult female deaths occurred in a health facility. Sex of the adult decedents was significantly associated with the place of death. Consistent with previous studies in Ethiopia (Anteneh et al., 2013), in Japan (Kinoshita et al., 2014), in Scotland (Black et al., 2016), in Germany (Dasch et al., 2015), in Canada (Jayaraman & Joseph, 2013) and in United States (Grunier et al., 2007; Lackan et al., 2009), adult female deaths were more likely to occur in a health facility compared to male adult deaths. Males were more likely to die at home. In the sub-Saharan African context, possible explanations for this situation could be: first, a sizeable proportion of these deaths may be attributed to maternal causes; a point that requires further investigation. Second, while women play the traditional role of caring and they are available to provide home based care for men when they are ill up to the point of death; on the contrary, men are not available to provide the same care to women―instead―the women are taken to be hospitalized at a health facility where they die (Anteneh et al., 2013; Dasch et al., 2015; Kinoshita et al., 2014). Additionally, women are also more likely to access and utilize health care services than men (Zyaambo, Siziya, & Fylkesnes, 2012). We did not find a significant association between age and place of death. In the descriptive analysis, the proportions of adult deaths across the age groups were not significantly different from each other with respect to the place of death. Even when age at death was included as a discrete variable in the model, it nos inhibitor was still not significant (results not shown). Our finding is contrary to previous studies conducted in other countries (Anteneh et al., 2013; Black et al., 2016; Cardenas-Turanzas et al., 2007; Costantini et al., 2000; Gomes et al., 2011; Hong et al., 2011; Jayaraman & Joseph, 2013; Lin & Lin, 2007). Previous studies found that age was a strong predictor of place of death. Younger people below the age of 60 years were more likely to die at home while older people above the age of 60 years were more likely to die in a health facility/nursing home. The level of educational attainment of adult decedents was significantly associated with place of death. The likelihood of an adult death occurring in a health facility increased with the level of education. The opposite was the case for an adult death occurring at home with respect to the education level. Our finding is consistent with previous studies in Ethiopia (Anteneh et al., 2013), Korea (Cohen et al., 2015) and Mexico (Cardenas-Turanzas et al., 2007; Cohen et al., 2015). Education enlightens people, who in turn transform their attitudes and beliefs as Hotspot become more knowledgeable about health services. In addition, education is associated with income, which enables access to modern health services (Phiri & Ataguba, 2014; Zyaambo et al., 2012). It is, therefore, an important resource that facilitates healthy lifestyles, access to and utilization of health care. Contrary results, however, were found in Italy, Spain, Belgium and Czech (Cohen et al., 2015) were those with higher educational attainment were more likely to die at home than those with low educational attainment. In the United States of America there was no difference found with educational attainment (Cohen et al., 2015). More than half of the adult deaths occurred among the married/living with partner decedents. The majority of these individuals died in a health facility. Consistent with previous studies in: Ethiopia (Anteneh et al., 2013), Canada (Goodridge et al., 2010; Jayaraman & Joseph, 2013), United States of America (Grunier et al., 2007), and Mexico (Cardenas-Turanzas et al., 2007) we found that adult decedents who were married/living with a partner were more likely to die in a health facility compared to the never married decedents. Conversely, Cohen et al., (2015) in a study comparing 14 countries and 4 continents, Africa excluded, found that married people were more likely to die at home compared with the divorced, unmarried and widowed. In most sub-Saharan African countries, marriage is still valuable and common. In Zambia, for example, 62 per cent of men and 52 per cent of women were currently married (Central Statistical Office (CSO), [Zambia], Ministry of Health (MoH), [Zambia], & ICF International, 2014). Marital status is sometimes used as a proxy indicator for social support.