Mortality impact of AIDS in Abidjan, 1986-1992

Objectives: To quantify the mortality impact of AIDS in the city of Abidjan (Cote d'Ivoire) by a full scale analysis of mortality trends before and after the onset of the epidemic. Design: Data on deaths registered in the 10 vital registration centers of the city between 1973 and 1992, and data on causes of deaths in the four public hospitals were coded and investigated. Data on deaths were compared with census data in order to compute death rates. Methods: Life tables were computed for each of the 20 years of the study. The trends in death rates were analysed during the 10 years before the onset of the AIDS epidemic (1973-1982) and compared with the changing death rates in the following 10 years (1983-1992). Deaths attributable to AIDS were defined as those in excess of the original trends. The evolution in the number of deaths in the hospital allowed an analysis by cause of death. Results: There was a marked increase in death rates starting in 1986, date of the first diagnosed AIDS cases in the city. This increase was significant for both sexes, but more pronounced among men. It was concentrated primarily among young adults (aged 25-44 years) and among older children (aged 5-14 years), and most of it was considered to be attributable to AIDS and related infections, tuberculosis in particular. When data were cumulated from 1986 to 1992, approximately 25 000 persons were estimated to have died of AIDS. Conclusions: The high number of AIDS deaths estimated in Abidjan underlines the heavy toll already paid by African populations, and calls for intensive action.