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Validation and application of verbal autopsies in a rural area of South Africa
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2000 (English)In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 5, no 11, 824-831 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2000. Vol. 5, no 11, 824-831 p.
Identifiers
URN: urn:nbn:se:umu:diva-5533DOI: 10.1046/j.1365-3156.2000.00638.xPubMedID: 11123832OAI: oai:DiVA.org:umu-5533DiVA: diva2:145076
Available from: 2006-11-14 Created: 2006-11-14 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Dying to make a fresh start: mortality and health transition in a new South Africa
Open this publication in new window or tab >>Dying to make a fresh start: mortality and health transition in a new South Africa
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rationale: Vital registration is lacking in developing settings where health and development problems are most pressing. Policy-makers confront an “information paradox”: the critical need for information on which to base priorities and monitor progress, and the profound shortage of such information.

Aims: To better understand the dynamics of mortality transition in rural South Africa over a decade of profound socio-political change coupled with emerging HIV/AIDS. Thereby to inform health and development programming, policy formulation, and the research agenda; and contribute to debate on the nature of the ‘health transition’.

Methods: The Agincourt health and demographic surveillance system is based on continuous monitoring of the Agincourt sub-district population in rural north-east South Africa. This involves annual recording of all vital events, specifically deaths, births and migrations in 11,700 households comprising some 70,000 persons. A “verbal autopsy” is conducted on every death, and special modules provide additional data.

Key findings: A major health transition has occurred over the past decade, with marked changes in population structure and rapidly escalating mortality particularly among children and younger adults. A quadruple burden of disease is evident with persisting infectious disease and malnutrition in children, emerging non-communicable disease in the middle-aged and older, high levels of violence in an apparently peaceful community, and rapidly escalating HIV/AIDS and tuberculosis. There is evidence of sex differences and socio-economic differentials in mortality; vulnerable sub-groups include the children of Mozambican immigrants and recently returned labour migrants.

Implications: With respect to health transition, empirical data demonstrate a marked “counter transition” with mortality increasing in children and young adults; “epidemiologic polarization” is evident with the most vulnerable experiencing a higher mortality burden; and a “protracted transition” is reflected in the co-existence of persisting infectious disease and malnutrition, emerging HIV/AIDS, and increasing chronic non-communicable disease. With respect to health policy and practice there is urgent need to: strengthen HIV/AIDS prevention, treatment and care; offer effective long-term care to control the rising burden of chronic illness and related risk; maintain and improve maternal and child health services; and address differential access to care. This poses a substantial challenge to a severely stretched health system.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin, 2006. 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1056
Keyword
age-specific mortality, agincourt, demographic surveillance system, epidemiologic transition, health transition, mortality trends, rural, South Africa, verbal autopsy, vital registration.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-928 (URN)91-7264-173-8 (ISBN)
Public defence
2006-12-11, Sal B, 1D, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2006-11-14 Created: 2006-11-14 Last updated: 2010-01-11Bibliographically approved

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