"It Was Just a Cold..." Circumstances of Death in Urban West Africa: A Classification of Final Care Pathways of Adults in Ouagadougou (Burkina Faso)

Ariane Sessego , Institut National d'Etudes Démographiques (INED) - Ecole des Hautes Etudes en Sciences Sociales (EHESS)
Géraldine Duthé, Institut National d'Études Démographiques (INED)
Bruno Lankoandé, Joseph Ki-Zerbo University (UJKZ)
Kassoum Dianou, Catholic University of Louvain (UCLouvain) and Joseph Ki-Zerbo University (UJKZ)

Identifying the barriers to healthcare access is crucial for public health action. In sub-Saharan Africa, healthcare provision is better in urban than in rural areas. However, costs of consultations and medication remain major obstacles, particularly for adults that rarely benefit from free healthcare programs. Few data are available to study these barriers. At local level, demographic and health surveillance sites (HDSS) collect mortality data. When a death is reported, illness history and symptoms are collected from the next of kin to identify probable cause(s). These verbal autopsies also collect data on the circumstances of death and qualitative narratives of the events leading to death. Rarely used, they could shed light on barriers to access care and improvable circumstances. Using 1,175 VAs of adult deaths (15 and older) from the HDSS of Ouagadougou (2010-2019), we propose a data-driven method to identify typical care pathways using Multiple Correspondence Analysis followed by Hierarchical Clustering, illustrating each cluster by a random sample of relatives’ narratives. We identify five clusters: 35% of deaths occurred at hospital without any specific issue in healthcare reported, 17% died at hospital with cost or healthcare issues, 17% experienced a cessation of care largely induced by costs, 25% occurred at home with no care and 7% of deaths occurred in public spaces, before any care could be received. Beyond the difficulties of the healthcare system to handle cancers and strokes, we highlight some the higher risks of elderly and widowed individual to experience an absence or a cessation of care.

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 Presented in Session 1. Health, Wellbeing and Morbidity in Old Age