OBJECTIVE:To identify the leading causes of mortality and premature mortality in Cape Town, South Africa, and its subdistricts, and to compare levels of mortality between subdistricts.METHODS:Cape Town mortality data for the period 2001-2006 were analysed by age, cause of death and sex. Cause-of-death codes were aggregated into three main cause groups: (i) pre-transitional causes (e.g. communicable diseases, maternal causes, perinatal conditions and nutritional deficiencies), (ii) noncommunicable diseases and (iii) injuries. Premature mortality was calculated in years of life lost (YLLs). Population estimates for the Cape Town Metro district were used to calculate age-specific rates per 100,000 population, which were then age-standardized and compared across subdistricts.FINDINGS:The pattern of mortality in Cape Town reflects the quadruple burden of disease observed in the national cause-of-death profile, with HIV/AIDS, other infectious diseases, injuries and noncommunicable diseases all accounting for a significant proportion of deaths. HIV/AIDS has replaced homicide as the leading cause of death. HIV/AIDS, homicide, tuberculosis and road traffic injuries accounted for 44% of all premature mortality. Khayelitsha, the poorest subdistrict, had the highest levels of mortality for all main cause groups.CONCLUSION:Local mortality surveillance highlights the differential needs of the population of Cape Town and provides a wealth of data to inform planning and implementation of targeted interventions. Multisectoral interventions will be required to reduce the burden of disease.

Objectives: South Africa has among the highest levels of HIV prevalence in the world. Our objectives are to describe the distribution of South African infant and child mortality by age at fine resolution, to identify any trends over recent time and to examine these trends for HIV-associated and non HIV-associated causes of mortality. Methods: A retrospective review of vital registration data was conducted. All registered postneonatal deaths under 1 year of age in South Africa for the period 1997–2002 were analysed by age in months using a generalized linear model with a log link and Poisson family. Results: Postneonatal mortality increased each year over the period 1997–2002. A peak in HIV-related deaths was observed, centred at 2–3 months of age, rising monotonically over time. Conclusion: We interpret the peak in mortality at 2–3 months as an indicator for paediatric AIDS in a South African population with high HIV prevalence and where other causes of death are not sufficiently high to mask HIV effects. Intrauterine and intrapartum infection may contribute to this peak. It is potentially a useful surveillance tool, not requiring an exact cause of death. The findings also illustrate the need for early treatment of mother and child in settings with very high HIV prevalence.

Undoubtedly ART is contributing to the rising prevalence at the older ages, but to what extent the rise is due to this alone and to what extent it is due to high incidence cannot be decided without using modelling to see what would be expected, and for this researchers need access to the detailed survey data, as well as data on the extent of the ARV rollout.

BACKGROUND: In October 2003 South Africa embarked on a program of folic acid fortification of staple foods. We measured the change in prevalence of NTDs before and after fortification and assessed the cost benefit of this primary health care intervention. METHODS: Since the beginning of 2002 an ecological study was conducted among 12 public hospitals in four provinces of South Africa. NTDs as well as other birth defect rates were reported before and after fortification. Mortality data were also collected from two independent sources. RESULTS: This study shows a significant decline in the prevalence of NTDs following folic acid fortification in South Africa. A decline of 30.5% was observed, from 1.41 to 0.98 per 1,000 births (RR = 0.69; 95% CI: 0.49-0.98; p = .0379). The cost benefit ratio in averting NTDs was 46 to 1. Spina bifida showed a significant decline of 41.6% compared to 10.9% for anencephaly. Additionally, oro-facial clefts showed no significant decline (5.7%). An independent perinatal mortality surveillance system also shows a significant decline (65.9%) in NTD perinatal deaths, and in NTD infant mortality (38.8%). CONCLUSIONS: The decrease in NTD rates postfortification is consistent with decreases observed in other countries that have fortified their food supplies. This is the first time this has been observed in a predominantly African population. The economic benefit flowing from the prevention of NTDs greatly exceeds the costs of implementing folic acid fortification.

The adoption of an HIV/AIDS national strategic plan in South Africa has increased the necessity to monitor trends in the HIV epidemic. The National Department of Health uses antenatal survey results (showing an overall HIV prevalence of 28%) to reinforce those of the previous survey and argue that South Africa may be making some real progress in its response to the HIV epidemic and that the South African HIV epidemic is on a downward trend. While this may or may not be true in order for one to infer a trend in indicators from a sequence of surveys they need to be comparable year on year with one another. Unfortunately this is not the case with the antenatal surveys of the past 2 years. Interpretation of the trend in the antenatal survey data is becoming increasingly difficult as one has not only to allow for possible bias at the young ages (sexually active young women who have had unprotected sex do not represent all young women) but also for the impact of treatment on prevalence levels (on which the report is surprisingly silent). On the face of it analysis of these data appears to be becoming increasingly beyond the skills of the Department of Health and it would serve all if these data were made available to the broader scientific community to analyse and interpret more thoroughly. (excerpt)

Extracted from text ... October 2006, Vol. 96, No. 10 SAMJ SAMJ FORUM On 7 September 2006 Statistics South Africa released a report on estimates of adult mortality (age 15 - 64) derived from the death notifications in South Africa for 1997 - 2004, corrected for underregistration of deaths.1 In broad sweep the estimates show a trend, magnitude and to a certain extent a pattern by age that is consistent with what might be expected due to the impact of HIV/AIDS on mortality. To the extent that this confirms earlier work2-4 and contradicts a report released earlier this year by the same agency5 ..

Resume Objectif Etudier la qualite du codage des statistiques relatives aux causes de deces et evaluer les besoins en matiere de donnees de mortalite de la ville du Cap. Methodes Une etude a ete organisee selon une demarche de recherche pragmatique pour evaluer la qualite des donnees relatives aux causes de deces, l'exactitude de leur codage et la coherence des procedures de codage dans les sous-districts sanitaires les plus etendus. Les besoins en matiere de donnees de mortalite, ainsi que la meilleure maniere de presenter ces statistiques pour aider les gestionnaires dans le domaine sanitaire, ont ete examines. Resultats 75 % des certificats de deces contenaient des informations utiles, mais seulement 60 % environ de ces certificats indiquaient une cause de deces unique et certifiee et 55 % des formulaires etaient codes avec exactitude. Les problemes resultaient principalement du fait que les personnes chargees du codage de mortalite de routine enregistraient sous forme codee la cause immediate du deces au lieu de la cause sous-jacente. Une classification sommaire des causes de deces, reposant sur l'importance de ces causes sous l'angle de la sante publique, sur leur prevalence et sur une selection de pathologies associees, a ete introduite, en parallele avec une formation a l'identification des causes sous-jacentes. L'analyse des donnees pour l'annee 2001 a permis de determiner les causes principales de deces et de mortalite prematuree et a fait ressortir des differences frappantes entre les charges et les profils de morbidite des differents districts sanitaires. Conclusion La recherche pragmatique se revele particulierement utile pour ameliorer les systemes d'information et met en lumiere la necessite de normaliser les procedures de codage designant la cause sous-jacente. Les certificats de deces actuellement disponibles ne permettent pas d'atteindre le niveau de detail requis par la classification CIM integrale. L'utilisation d'une classification sommaire pour le codage offre un outil pratique et adapte a la surveillance en sante publique au niveau local. Il importe de veiller a ce que la presentation des statistiques relatives aux causes de deces permette aux decideurs d'utiliser ces donnees. Resumen Objetivo Examinar la calidad de la codificacion de las estadisticas sobre las causas de defuncion (CDD) y evaluar las necesidades de informacion sobre la mortalidad en Ciudad del Cabo. Metodos Utilizando un enfoque de investigacion-accion, se puso en marcha un estudio para investigar la calidad de la informacion sobre las CDD, la exactitud de la codificacion de las CDD y la coherencia de las practicas de codificacion en los subdistritos de salud de mayor tamano. Se estudiaron las necesidades de informacion sobre la mortalidad y la mejor manera de presentar las estadisticas para ayudar a los administradores sanitarios. Resultados Un 75% de los certificados de defuncion contenian informacion util, pero en casi un 60% de los casos solo se certificaba una sola causa; el 55% de los formularios se habian codificado con precision. Las discordancias se debian principalmente a que los codificadores codificaban la causa inmediata, no la subyacente. Se aplico una clasificacion abreviada de CDD, basada en causas relevantes para la salud publica, causas prevalentes y determinadas combinaciones de enfermedades, con capacitacion para determinar la causa subyacente. El analisis de los datos de 2001 permitio identificar las causas principales de muerte y mortalidad prematura y puso de relieve diferencias sorprendentes en la carga y la distribucion de la morbilidad entre los subdistritos de salud. Conclusion La investigacion-accion, una alternativa particularmente valiosa para mejorar los sistemas de informacion, revelo la necesidad de normalizar las practicas de codificacion seguidas para identificar las causas subyacentes. La especificidad del conjunto de la clasificacion CIE supera el nivel de detalle de los certificados de defuncion actualmente disponibles. …

3, although we are in the midst of demographic transition. The health of these children needs to be a priority, a principle adopted through the ratification of the1990 United Nations Convention of the Rights of the Child. The level of mortality is a fundamental indicator of child health and understanding the causes of death of children provides insight as to how it can be reduced. The lack of reliable vital statistics has created a void when it comes to these

South Africa is experiencing an HIV epidemic of shattering proportions. Demographic projections of the epidemic indicate that HIV/AIDS will cause a rapid change in the age and sex pattern of deaths with a large increase in the number of deaths among young adults particularly young women. According to various models these changes in mortality were expected to be large enough for use in monitoring AIDS mortality by examining changes in the number of deaths by age and sex. In particular recorded deaths were compared with the number projected by the ASSA600 model released by the Actuarial Society of South Africa in 1998. Overall the pattern in the empirical data is largely consistent with the pattern predicted by models of the AIDS epidemic in particular the ASSA600 model suggesting that it is reasonable to interpret the increase in young adult mortality as being essentially a consequence of HIV/AIDS. The study demonstrated the value of supplementing the routine vital statistics with rapid mortality surveillance making use of administrative data from the Population Register.

Researchers at the Department of Community Health University of Cape Town South Africa contended that using infant mortality for children dying 2 times that of white childrens deaths (7555 vs. 3060). Nevertheless both numbers are high. The number of white childrens deaths fell precipitously to a baseline by 6 months which indicated a developed country pattern. Yet colored childrens deaths did not reach a baseline until >24 months. Both infectious and parasitic diseases were the leading causes of death. In the 2nd year they were responsible for 52% of all deaths. These factors as well as others continued to affect the colored population after 12 months of age--the arbitrary cut off for the health status of a population. These results led the researchers to recommend that child mortality between 13-24 months be included when assessing the health status of the South African population.