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Influences on place of death in Botswana

Published online by Cambridge University Press:  23 March 2010

Mark Lazenby ,
Tony Ma ,
Howard J. Moffat ,
Marjorie Funk ,
M. Tish Knobf  and
Ruth McCorkle
Mark Lazenby*
Affiliation:
Yale University School of Nursing, New Haven, Connecticut
Tony Ma
Affiliation:
Yale University School of Nursing, New Haven, Connecticut
Howard J. Moffat
Affiliation:
Ministry of Health, Republic of Botswana
Marjorie Funk
Affiliation:
Yale University School of Nursing, New Haven, Connecticut
M. Tish Knobf
Affiliation:
Yale University School of Nursing, New Haven, Connecticut
Ruth McCorkle
Affiliation:
Yale University School of Nursing, New Haven, Connecticut
*
Address correspondence and reprint requests to: Mark Lazenby, Yale University School of Nursing, P.O. Box 9740, New Haven, CT 06536-0740. E-mail: mark.lazenby@yale.edu
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Abstract

Objective:

There is an emerging body of research aimed at understanding the determinants of place of death, as where people die may influence the quality of their death. However, little is known about place of death for people of Southern Africa. This study describes place of death (home or hospital) and potential influencing factors (cause of death, age, gender, occupation, and district of residence).

Method:

We collected the death records for years 2005 and 2006 for all adult non-traumatic deaths that occurred in Botswana, described them, and looked for associations using bivariate and multivariate analyses.

Results:

The evaluable sample consisted of 18,869 death records. Home deaths accounted for 36% of all deaths, and were predominantly listed with “unknown” cause (82.3%). Causes of death for hospital deaths were HIV/AIDS (49.7%), cardiovascular disease (13.8%), and cancer (6.6%). The mean age at the time of all deaths was 53.2 years (SD = 20.9); with 61 years (SD = 22.5) for home deaths and 48.8 years (SD = 18.6) for hospital deaths (p < .001). Logistic regression analysis revealed the following independent predictors of dying at home: unknown cause of death; female gender; >80 years of age; and residing in a city or rural area (p < .05).

Significance of Results:

A major limitation of this study was documentation of cause of death; the majority of people who died at home were listed with an unknown cause of death. This finding impeded the ability of the study to determine whether cause of death influenced dying at home. Future study is needed to determine whether verbal autopsies would increase death-certificate listings of causes of home deaths. These data would help direct end-of-life care for patients in the home.

Keywords

Place of deathInfluences on home or hospital deathSouthern AfricaHIV/AIDSVerbal autopsies
Type
Original Articles
Information
Palliative & Supportive Care , Volume 8 , Issue 2 , June 2010 , pp. 177 - 185
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

Adeyi, O., Smith, O. & Robles, S. (2007). Public Policy and the Challenge of Chronic Noncommunicable Diseases. Washington, DC: The World Bank.Google Scholar
Ahmad, S. & O'Mahony, M.S. (2005). Where older people die: A retrospective population-based study. Quarterly Journal of Medicine, 98, 865–870.Google Scholar
Akinsola, H.Y. & Ncube, E. (2000). Rural health care provision in Botswana: The context of nursing practice and the expanded role of the nurse. Africa Journal of Nursing and Midwifery, 2, 49–55.Google Scholar
Angus, D.C., Barnato, A.E., Linde-Zwirble, W.T., et al. (2004). Use of intensive care at the end of life in the United States: An epidemiologic study. Critical Care Medicine, 32, 638–643.CrossRefGoogle ScholarPubMed
Araya, T., Reniers, G., Schaap, A., et al. (2004). Lay diagnosis of causes of death for monitoring AIDS mortality in Addis Ababa, Ethiopia. Tropical Medicine and International Health, 9, 178–186.Google Scholar
Baiden, F., Bawah, A., Biai, S., et al. (2007). Setting international standards for verbal autopsy. Bulletin of the World Health Organization, 8, 570–571.Google Scholar
Bowling, A. (1983). The hospitalization of death: Should more people die at home? Journal of Medical Ethics, 9, 158–161.Google Scholar
Brown, M. & Colton, T. (2001). Dying epistemologies: An analysis of home death and its critique. Environment and Planning A, 33, 799–821.Google Scholar
Bruera, E., Russell, N., Sweeney, C., et al. (2002). Place of death and its predictors for local patients registered at a comprehensive cancer center. Journal of Clinical Oncology, 20, 2127–2133.Google Scholar
Bruera, E., Sweeney, C., Russell, N., et al. (2003). Place of death of Houston area residents with cancer over a two-year period. Journal of Pain and Symptom Management, 26, 637–643.Google Scholar
Bureau of Labor Statistics. (2002). 2002 Census occupational classification: Major occupational groups and detailed occupations used in the Current Population Survey beginning January 2003. Retrieved June 19, 2008, from http://www.bls.gov/cps/cenocc.pdf.Google Scholar
Cárdenas-Turanzas, M., Carrillo, M.T., Tovalín-Ahumada, H., et al. (2007). Factors associated with place of death of cancer patients in the Mexico City Metropolitan area. Support Care Cancer, 15, 243–249.CrossRefGoogle ScholarPubMed
Central Statistics Office of the Republic of Botswana. (2002). Population of Towns and Villages and Associated Localities in August 2001. Gaborone, Botswana: Central Statistics Office of the Republic of Botswana.Google Scholar
Chochinov, H.M., Hack, T., McClement, S., et al. (2002). Dignity in the terminally ill: A developing empirical model. Social Science & Medicine, 54, 433–443.Google Scholar
Clifford, C.A., Jolley, D.J. & Giles, G.G. (1991). Where people die in Victoria. Medical Journal of Australia, 155, 446–456.CrossRefGoogle ScholarPubMed
Cohen, J., Bilsen, J., Hooft, P., et al. (2006). Dying at home or in an institution: Using death certificates to explore the factors associated with place of death. Health Policy, 78, 319–329.Google Scholar
Collins, K. & Harding, R. (2007). Improving HIV management in Sub-Saharan Africa: How much palliative care is needed? AIDS Care, 19, 1304–1306.Google Scholar
Duda, D. (1982). A Guide to Dying at Home. Santa Fe, NM: John Muir Publishing, Inc.Google Scholar
Dunlop, R.J., Davies, R.J. & Hockley, J.M. (1989). Preferred versus actual place of death: A hospital palliative care support team experience. Palliative Medicine, 3, 197–201.Google Scholar
Earle, C.C., Park, E.R., Lai, B., et al. (2003). Identifying potential indicators of the quality of end-of-life cancer care from administrative data. Journal of Clinical Oncology, 21, 1133–1138.CrossRefGoogle ScholarPubMed
Fried, T.R., van Doorn, C., O'Leary, , Tinetti, M.E., et al. (1999). Older persons' preferences for site of terminal care. Annals of Internal Medicine, 131, 109–112.Google Scholar
Gallo, W.T., Baker, M.J. & Bradley, E.H. (2001). Factors associated with home versus institutional death among cancer patients in Connecticut. Journal of the American Geriatrics Society, 49, 771–777.Google Scholar
Grunier, A., Mor, V., Weitzen, S., et al. (2007). Where people die: A multilevel approach to understanding influences on site of death in America. Medical Care Research and Review, 64, 351–378.Google Scholar
Hays, J.C., Gold, D.T., Flint, E.P., et al. (1999). Patient preference for place of death: A qualitative approach. In End of Life Issues: Interdisciplinary and Multidisciplinary Perspectives. deVries, B. (ed.), pp. 3–22. New York: Springer.Google Scholar
Hays, J.C., Galanos, A.N., Palmer, T.A., et al. (2001). Preference for place of death in a continuing care retirement community. Gerontologist, 41, 287–300.Google Scholar
Hellinger, F. (2008). Practice makes perfect: A volume-outcome study of hospital patients with HIV disease. Journal of Acquired Immune Deficiency Syndrome, 47, 226–233.Google Scholar
Higginson, I.J. & Sen-Gupta, G.J.A. (2000). Place of death in advanced cancer: A qualitative systematic literature review of patient preferences. Journal of Palliative Medicine, 3, 287–300.Google Scholar
Institute of Medicine. (1997). Approaching Death: Improving Care at the End-of-Life. Field, M.J. & Cassel, C.K. (eds.), Washington, DC: National Academy Press.Google Scholar
Institute of Medicine. (2001). Improving Palliative Care for Cancer. Foley, K.M. & Gelband, H. (eds.), Washington, DC: National Academy Press.Google Scholar
The Joint United Nations Programme on HIV/AIDS. (2006). 2006 report on the global AIDS epidemic. New York: UNAIDS. Annex 1. Retrieved January 26, 2008, from http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008.Google Scholar
Last Acts. (2002). Means to a better end: A report on dying in America today. Washington, D.C.: Last Acts. Available from http://www.rwjf.org/pr/product.jsp?id=15788.Google Scholar
Last Acts. (2005). Last acts: A vision for better care at the end of life. Washington, D.C.: Last Acts. Available from http://www.rwjf.org/pr/product.jsp?id=20938.Google Scholar
Latimer, E. (1991). Caring for seriously ill and dying patients: The philosophy and ethics. Canadian Medical Association Journal, 144, 859–864.Google Scholar
Lopez, A.D., Mathers, C.D., Ezzati, M., et al. (2006). Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet, 367, 1747–1757.Google Scholar
Mathers, C., Bernard, C., Iburg, K., et al. (2003). Global burden of disease in 2002: Data sources, methods, and results. (Global Programme on Evidence for Health Policy Discussion Paper No. 54). World Health Organization. Retrieved November 2, 2007, from http://www.who.int/healthinfo/paper54.pdf.Google Scholar
Mezey, M., Dubler, N.N., Mitty, E., et al. (2002). What impact do setting and transitions have on the quality of life at the end of life and the quality of the dying process? Gerontologist, 42, 54–67.Google Scholar
Mor, V. & Hiris, J. (1983). Determinants of site of death among hospice cancer patients. Journal of Health and Social Behavior, 24, 375–384.Google Scholar
Patrick, D.L., Engleberg, R.A. & Curtis, J.R. (2001). Evaluating the quality of dying and death. Journal of Pain and Symptom Management, 22, 717–726.CrossRefGoogle ScholarPubMed
Pritchard, R.S., Fisher, E.S., Teno, J.M., et al. (1998). Influence of patient preferences and local health system characteristics on the place of death. Journal of the American Geriatrics Society, 46, 1242–1250.Google Scholar
Pullman, D. (1996). Dying with dignity and the death of dignity. Health Law Journal, 4, 197–219.Google Scholar
Republic of Botswana. (2001). 2001 Housing and Population Census. Retrieved April 29, 2006, from http://www.cso.gov.bw/.Google Scholar
Setel, P.W., Rao, C., Hemed, Y., et al. (2006a). Core verbal autopsy procedures with comparative validation results from two countries. Public Library of Science Medicine, 3, e268.Google Scholar
Setel, P.W., Whiting, D.R., Hemed, Y., et al. (2006). Validity of verbal autopsy procedures for determining cause of death in Tanzania. Tropical Medicine and International Health, 11, 681–696.Google Scholar
Shaibu, S. & Wallhagen, M.I. (2002). Family caregiving of the elderly in Botswana: Boundaries of culturally acceptable options and resources. Journal of Cross-Cultural Gerontology, 17, 139–154.Google Scholar
Soleman, N., Chandramohan, D. & Shibuya, A. (2006). Verbal autopsy: Current practices and challenges. Bulletin of the World Health Organization, 84, 239–245.Google Scholar
Stearns, S.C., Kovar, M.G., Hayes, K., et al. (1996). Risk indicators for hospitalization during the last year of life. Health Services Research, 31, 49–69.Google Scholar
Tang, S.T. & McCorkle, R. (2001). Determinants of place of death for terminal cancer patients. Cancer Investigation, 19, 165–180.Google Scholar
Tang, S.T. (2002). Influencing factors of place of death among home care patients with cancer in Taiwan. Cancer Nursing, 25, 158–166.Google Scholar
Tang, S.T. (2003). When death is imminent: Where terminally ill patients with cancer prefer to die and why. Cancer Nursing, 26, 245–251.Google Scholar
Tang, S.T., Liu, T.-W., Tsai, C.-M., et al. (2008). Patient awareness of prognosis, patient-family caregiver congruence on the preferred place of death, and caregiving burden of families contribute to the quality of life for terminally ill cancer patients in Taiwan. Psycho-Oncology, 17, 1202–1209.Google Scholar
Tang, S.T., Wu, S.-C., Hung, Y.-N., et al. (2009). Trends in quality of life care for Taiwanese cancer patients who died in 2000–2006. Annals of Oncology, 20, 343–348.Google Scholar
Temkin-Greener, H. & Mukamel, D.B. (2002). Predicting place of death in the Program of All-Inclusive Care for the Elderly (PACE): Participants versus program characteristics. Journal of the American Geriatrics Society, 50, 125–135.Google Scholar
United Nations Development Programme. (2006). Human development report 2006: Beyond scarcity: Power, poverty and the global water crisis. Table 15: Inequality in income or expenditure. Retrieved January 26, 2008, from http://hdr.undp.org/en/reports/global/hdr2006/countires/data_sheets/cty_ds_BWA.html.CrossRefGoogle Scholar
Virning, B.A., McBean, M., King, S., et al. (2002). Hospice use before death: Variability across cancer diagnoses. Medical Care, 40, 73–78.Google Scholar
Weitzen, S., Teno, J.M., Fennell, M.L., et al. (2003). Factors associated with site of death: A national study of where people die. Medical Care, 41, 323–335.Google Scholar
Wilson, D.M., Northcott, H.C., Truman, S.L., et al. (2001). Location of death in Canada: A comparison of 20th-century hospital and nonhospital locations of death and corresponding population trends. Evaluation and the Health Professsions, 24, 385–403.Google Scholar
World Health Organization. (2007). International statistical classification of diseases and health related problems (9th rev.). Retrieved April 23, 2009, from http://www.who.int/classifications/apps/icd/icd9online/.Google Scholar
World Health Organization. (2003). WHO co-operation strategy Botswana. Retrieved October 3, 2007, from http://apps.who.int/classifications/apps/icd/icd10online/.Google Scholar
Yun, Y.H., Lim, M.K., Choi, K.-S., et al. (2006). Predictors associated with the place of death in a country with increasing hospital deaths. Palliative Medicine, 20, 455–461.CrossRefGoogle Scholar