To estimate the cause of death structure in rural areas, we implemented the Andhra Pradesh Rural Cause of Death (APRCD) study, 1998. All SCD-Rural death reports received by the state's Vital Statistics Division for a nine-month period, 1998 April to December, were systematically reviewed by a physician. SCD-Rural system uses verbal autopsy to determine cause of death in sample areas. Reports considered to have adequate information for assignment of cause of death from the non- medical list were coded by the physician. In some cases, this code was identical to code originally given by the SCD-Rural system and for some others there was a change in coding. Reports without adequate information for assignment of cause of death were dispatched for field enquiry and on-site review by a physician. A final cause of death code was assigned based on the on-site review. Additional deaths were detected by the visiting physicians from the same sample villages and pertaining to the study period. These deaths were investigated using verbal autopsy and a cause of death was assigned after systematic screening by another physician reviewer. Altogether 3842 deaths from the rural areas of Andhra Pradesh were investigated. For urban areas, MCCD data from the neighbouring state of Maharashtra for the years 1986-90 was used as an approximation. Deaths by cause in the rural and urban areas respectively were added up to arrive at the estimate of causes of death in Andhra Pradesh.

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Age pattern of cause-specific mortality proportions of ten leading causes of death in Andhra Pradesh.

The above figure indicates the cause-specific mortality proportions for the same ten causes but within different age groups. Lower respiratory infection (LRI), diarrhoeal diseases and low birth weight predominantly affect infants and children. Poor nutrition, unsafe water, poor sanitation, and personal hygiene as well as access to appropriate treatment are responsible for the three main causes of death among children. In young adults, suicides and tuberculosis are the top causes of death. High incidence of suicides is a pointer to educational, social and cultural factors. Tuberculosis continues to be an important public health problem despite decade-long programmes to control the incidence of this disease. Ischaemic heart disease shows up as an important cause of death among older adults and further increases as age advances. Other important causes of death for older adults are cerebrovascular disease, chronic obstructive pulmonary diseases, asthma and Stomach cancer. Ischaemic heart diseases, and cerebrovascular diseases call for changes in lifestyle. Chronic obstructive pulmonary diseases point to the need for control of indoor and outdoor air pollution and smoking. Stomach cancer could be, to some extent, dealt with by early diagnosis and treatment. In a nutshell, the mortality profile of Andhra Pradesh clearly reflects the persisting problems arising from poor nutrition, water supply and hygiene as also socio- cultural problems and the emergence of non communicable and degenerative diseases.

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