Modelling Of Cause Of Death In Federal Medical Centre, Owerri, Imo State: A Multinomial Logistic Regression Approach

ABSTRACT

This research work is aimed at modeling the causes of death among adult patients aged 15 years and above admitted at Federal Medical Centre (FMC), Owerri, Imo state. The data used for the study were extracted from record available at the Data Unit of Federal Medical Centre, Owerri, Imo State, and covered the period, 2013 – 2018. The data were analyzed using descriptive and multinomial logistic regression methods. 368 out of the 998 patients admitted died, implying a mortality rate of 369 per thousand of such patients. The average mortality rate was higher in the females (372 per 1,000 patients) group compared to male,(366 per 1,000 patients) group. The sex ratio shows excess female deaths over male deaths in the two youngest age groups 15-29 and 30-44, while the reverse was the case in the older age groups. Four major groups of diseases accounted for 70 percent of all deaths among the patients; they include Cardiovascular diseases, Infections diseases, Genitourinary diseases, and Digestive disorder. The most fatal of these groups of diseases is Genitourinary diseases with a fatality rate of 527 deaths per one thousand cases, which seems to be higher for males (578 deaths per 1,000 cases) than for females (407 deaths per 1,000 cases). The result of the multinomial logistic Regression revealed that Genitourinary group of diseases has the highest probability (0.7672) of causing death among adult patients admitted in Federal Medical Centre, Owerri. Other less fatal diseases include Malignant neoplasms with a probability of 0.0802, and Digestive disorder with probability of 0.0522.

TABLE OF CONTENTS

Title Page                                                                                                                    i

Declaration                                                                                                                  ii

Certification                                                                                                                iii

Dedication                                                                                                                  iv

Acknowledgements                                                                                                    v

Acronyms                                                                                                                    vii

Table of Contents                                                                                                       ix

List of Tables                                                                                                              x

List of Figures                                                                                                             xii

Abstract                                                                                                                      xiii

CHAPTER 1: INTRODUCTION                                                                          1

1.1       Background of the Study                                                                               1

1.2       Statement of Problem                                                                                     5

1.3       Aim and Objective                                                                                          5

1.3.1    General Objective                                                                                           6

1.3.2    The Specific Objective                                                                                    6

1.4       Significant of Study                                                                                       6

1.5       Scope of Study                                                                                               7

CHAPTER 2:            LITERATURE REVIEW                                                               8

2.1       Conceptual Framework                                                                                   8

2.1.1    Leading cause of death                                                                                   8

2.1.2    Causes of the sudden natural death in various hospital                                  11

2.1.3    Maternal mortality in Nigeria hospital                                                            11

2.2       Empirical Review                                                                                            13    

CHAPTER 3: METHODOLOGY                                                                          18

3.1       Sources of Data                                                                                              18

3.2       Variable Specification                                                                                     18

3.2.1    The response variable and baseline category                                                 18

3.2.2    Explanatory variables                                                                                      19

3.2.3    Model building                                                                                               19

3.3       Method of Analysis                                                                                        20

3.3.1    Age- sex structure of the research data.                                                         20

3.4       Multinomial Logistic Regression Model                                                        21

3.4.1    Estimating response probability of cause of death among patients aged       22

           years and above .

3.4.2    Parameter estimation                                                                                       25

3.5       Assumptions of Multinomial Logistic Regression                                         28

3.5.1    Goodness-of-fit test                                                                                        28

3.5.2    Test for multicollinearity                                                                                 30

3.5.3    Variance inflation factor (VIF):                                                                      30

3.5.4    Remedial measures for multicollinearity                                                         31

3.5.5   Classification table of the polytomous predicted variable                               31

3.6       Estimating the Wald test statistic                                                                   33

3.7       Estimating the Pseudo R² test statistic                                                           34

CHAPTER 4: RESULTS AND DISCUSSION

4.1       The response variable categories                                                                     36

4.2       Determining the Leading Causes of Death In FMC Owerri                          39

4.3:      Result for Goodness-of-Fit-Test                                                                     46

4.4       Tests for Multicollinearity                                                                               47

4.4.1    Examination of the Pearson correlation                                                          47

4.4.2    Multicollinearity test using variance inflation factor (VIF)                            48

4.5       Multinomial Results                                                                                        49

4.6       Predicting The Probability of Dying of Each Cause of Death                       60

4.7       Fitting A Statistical Model to Causes of Death Data Among And

            Patient Aged 15 Years and Above                                                                 63                                                                                           

4.7.1  The estimated result of the model fitting information                                      65

4.7.2  Likelihood Ratio Tests for selected model                                                       66

4.8    Results for Pseudo R-Square                                                                             68

CHAPTER 5: CONCLUSION AND RECOMMENDATIONS

5.1       Conclusion                                                                                                      69

5.2       Recommendations                                                                                          70

            References                                                                                                      71

Appendix                                                                                                        76

LIST OF TABLES

3.2:      Explanatory variables and their categories                                                     19

4.1:      Frequencies of the response variable categories                                             36

4.2:      Distribution of patients aged 15 years and above admitted in

            FMC, Owerri and deaths among them, 2013-2018.                                       38

4.3:      Levels and trend of mortality rates among patients aged 15 years

            and above admitted at FMC, Owerri 2013-2018.                                          39

 4.4:     Distribution of death by cause, place of residence, for the period

           2013-2018, Federal Medical Centre, Owerri.                                                  40

 4.5:     Cause of death structure for patients aged 15 years and above 

           admitted in FMC, Owerri 2013 -2018.                                                            41

4.6:         Distribution of deaths by age and sex period 2013-2018

           at FMC, Owerri.                                                                                              42

 4.7:     Fatality rate of diseases for which patients Aged 15 years and

           above were admitted in FMC, Owerri 2013-2018                                          44

 4.8:  The estimation of the deviance and Pearson’s chi-square

         goodness-of-fit test                                                                                            46

 4.9:     Pearson correlation for the explanatory variables                                           47

 4.10:   Estimated collinearity statistics (tolerance and VIF) of explanatory

           variables   for patient age 15 years and above, who were admitted at

            FMC, Owerri   2013-2018.                                                                             48

4.11:    Logit coefficients from multinomial                                                               50

 4.12:     Logit coefficients, of multinomial logistic regression of dying

           of 1of 9 causes Vs dying of other causes, on  selected predictor

            among patients  aged  15 years and above admitted in FMC,

Owerri, 2013-2018.                                                                                         57

 4.13:   Estimated probability of dying for each response variable

category among patients Age 15 years and above admitted in Federal

Medical Centre Owerri,  from 2013-2018.                                                     63

4.14:    Estimated step summary of fitted model                                                       65

 4.15:   Estimated   model fitting information                                                            66

4.16:    Estimated likelihood ratio tests for selected model of the patient

age 15years and admitted in the Federal Medical Centre Owerri,

2013-2018.                                                                                                      67.

 4.17:   Pseudo R-Square                                                                                            68

LIST OF FIGURES

4.1:      Percentage distribution of total deaths by cause according to sex

among patients age 15  years and above, FMC, Owerri: 2013-2018.             42

4.2:      Case fatality rate by sex among patients aged 15 years and above, FMC,

Owerri: 2013-2018.                                                                                         45