# Cause-specific mortality transition among women of reproductive age with special reference to maternal mortality: the Magu health and demographic surveillance system, Tanzania, 1995–2022

## TL;DR

This study tracks mortality trends among women of reproductive age in Tanzania from 1995 to 2022, showing a significant decline in overall deaths, mainly due to reduced HIV/AIDS mortality, but maternal mortality remains a key cause.

## Contribution

The study provides long-term population-level data on cause-specific mortality trends among women in sub-Saharan Africa, filling a critical data gap.

## Key findings

- All-cause mortality among women 15–49 years declined threefold from 1995 to 2022, largely due to reduced HIV/AIDS mortality.
- Maternal mortality decreased but remained a leading cause of death, with no significant improvement in its share of total deaths since 2010.
- Health facility deaths increased over time, and most women sought care during terminal illness or maternity.

## Abstract

Limited population data exist on mortality and causes of death among women of reproductive age, including maternal mortality.

To present trends from 1995 to 2022 in mortality, cause of death, maternal mortality ratio and place of death from the rural Magu health and demographic surveillance site in north-west Tanzania.

Data on residency, fertility, and verbal autopsy were analysed to compute trends in all-cause and cause-specific mortality for women 15–49 years, using InSilicoVA, a Bayesian probabilistic model. Maternal mortality was estimated for three periods: 1995–2002, 2005–2011 and 2015–2022. We described place of death and healthcare utilization leading up to death by calendar time and broad cause of death.

All-cause mortality among women 15–49 declined from a peak of 9.0 deaths per 1000 person-years in the late 1990s to 3.5 in 2020. HIV/TB contributed 61% of this reduction. During 1995–2022, infectious diseases were the leading cause (54%), followed by NCD (29%). Maternal mortality declined but stagnated from approximately 2010 at 281 per 100,000 live births in 2015–2022 and remained a leading cause of death (12%). Comparing 2009–2015 and 2016–2022, more deaths occurred in health facilities (37.3%–45.9%), and more women sought care during terminal illness or maternity (85%–93%).

Despite a major reduction in all-cause mortality among women 15–49 years, mainly due to decreased HIV/AIDS deaths, infectious diseases remain the leading cause alongside a much-increased share of NCD. While maternal mortality levels have decreased, its share of total deaths has remained unchanged compared to 25 years ago.

Main findings: All-cause mortality among women of reproductive ages declined almost threefold in the Magu Health and Demographic Surveillance Site (HDSS) in northwest Tanzania during 1995–2022, mainly driven by a decline in HIV mortality during 2000–2014 while maternal mortality remained a major cause of deathAdded knowledge: The study contributes to the major gap in population data on long-term mortality trends by cause among women in sub-Saharan AfricaGlobal health impact for policy and action: HDSS are a critical source of population-based cause of death data, informing health strategies, in countries with poorly functioning vital statistics systems.

Main findings: All-cause mortality among women of reproductive ages declined almost threefold in the Magu Health and Demographic Surveillance Site (HDSS) in northwest Tanzania during 1995–2022, mainly driven by a decline in HIV mortality during 2000–2014 while maternal mortality remained a major cause of death

Added knowledge: The study contributes to the major gap in population data on long-term mortality trends by cause among women in sub-Saharan Africa

Global health impact for policy and action: HDSS are a critical source of population-based cause of death data, informing health strategies, in countries with poorly functioning vital statistics systems.