Dying to make a fresh start: mortality and health transition in a new South Africa
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
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.
Umeå University medical dissertations, ISSN 0346-6612 ; 1056
age-specific mortality, agincourt, demographic surveillance system, epidemiologic transition, health transition, mortality trends, rural, South Africa, verbal autopsy, vital registration.
Public Health, Global Health, Social Medicine and Epidemiology
IdentifiersURN: urn:nbn:se:umu:diva-928ISBN: 91-7264-173-8OAI: oai:DiVA.org:umu-928DiVA: diva2:145081
2006-12-11, Sal B, 1D, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Diwan, Vinod, Professor
Ivarsson, Anneli, Universitetslektor/överläkareWall, Stig, ProfessorGarenne, Michel, PhD/Director researchBradshaw, Debbie, Ass Professor/Director
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