Causes of death among older children and adolescents (5-19 years) in the Magu Health and Demographic Surveillance Study, Tanzania, 1995-2022.

Background: Population data on mortality and causes of death among 5-19-year-olds are limited.

Objectives: To assess levels, trends, and risk factors of cause-specific mortality and place at death among 5-19-year-olds in Tanzania (1995-2022).

Methods: Using longitudinal data from the Magu Health and Demographic Surveillance System in northwest Tanzania, we identified leading causes of death among 5-19-year-olds from verbal autopsy interviews, using physician review and a Bayesian probabilistic model (InSilicoVA). We analyzed trends in cause and place of death using three periods: 1995-2004, 2005-2014 and 2015-2022, and assessed risk factors in a Cox-proportional hazards model. We compared the results with children aged 1-4 years and global estimates for Tanzania.

Results: Between 1995 and 2022, communicable disease mortality decreased by 73%, similar to the 76% decline among 1-4-year-olds. This decline in communicable disease mortality drove all-cause mortality declines of 43% and 48% among 5-14- and 15-19-year-olds, respectively. Non-communicable diseases and injuries gained importance, with their relative share of all deaths increasing from 15% in 1995-2004 to 58% in 2015-2022. Mortality risks were significantly higher among boys (particularly for injuries), those residing in rural areas (for non-communicable diseases), and those from the poorest households (for communicable diseases). By 2015-2022, 48% of 5-14 and 42% of 15-19-year-olds died in health facilities, up from 25% in 1995-2002.

Conclusions: Since 1995, the decline in communicable disease mortality drove a major all-cause mortality reduction among 5-19-year-olds. Further progress will depend on continued reduction in communicable disease mortality, particularly among the poorest, and effectively addressing non-communicable and injury mortality.