Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study

Summary Background In southern Africa, a substantial health transition is underway, with the heavy burden of chronic infectious illness (HIV/AIDS and tuberculosis) paralleled by the growing threat of non-communicable diseases. We investigated the extent and nature of this health transition and consi...

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Bibliographic Details
Published in:The Lancet (British edition) 2008-09, Vol.372 (9642), p.893-901
Main Authors: Tollman, Stephen M, Prof, Kahn, Kathleen, MD, Sartorius, Benn, MSc, Collinson, Mark A, MSc, Clark, Samuel J, PhD, Garenne, Michel L, PhD
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adolescent
Adult
Age Distribution
Aged
AIDS
Cause of Death - trends
Child
Child, Preschool
Chronic illnesses
Data collection
Female
Fertility
Health care
HIV
Human immunodeficiency virus
Humans
Infant
Internal Medicine
Life expectancy
Life Expectancy - trends
Male
Middle Aged
Mortality
Mycobacterium
Population number
Population Surveillance - methods
Primary care
Primary Health Care - statistics & numerical data
Primary Health Care - trends
Public health
Replacement level
Rural Health - statistics & numerical data
Rural Health - trends
Sex Distribution
South Africa - epidemiology
Studies
Young adults
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Summary:Summary Background In southern Africa, a substantial health transition is underway, with the heavy burden of chronic infectious illness (HIV/AIDS and tuberculosis) paralleled by the growing threat of non-communicable diseases. We investigated the extent and nature of this health transition and considered the implications for primary health care. Methods Health and sociodemographic surveillance started in the Agincourt subdistrict, rural South Africa, in 1992. In a population of 70 000, deaths (n=6153) were rigorously monitored with a validated verbal autopsy instrument to establish probable cause. We used age-standardised analyses to investigate the dynamics of the mortality transition by comparing the period 2002–05 with 1992–94. Findings Mortality from chronic non-communicable disease ranked highest in adults aged 50 years and older in 1992–94 (41% of deaths [123/298]), whereas acute diarrhoea and malnutrition accounted for 37% of deaths (59/158) in children younger than 5 years. Since then, all-cause mortality increased substantially (risk ratio 1·87 [95% CI 1·73–2·03]; p
ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(08)61399-9