What are the statistics for HIV/AIDS mortality particularly in the Western Cape?

AfroAIDSinfo eNewsletter, South Africa


Summary

The objective of the following article is to provide an overview of a study by the Medical Research Council along with the University of Cape Town and the Institute of Health Metrics Evaluation that looked at the South African national and sub-national mortality trends from 1997 – 2009. This article will be focused on HIV-related deaths in the Western Cape Region.
– Information provided by Debbie Bradshaw and Victoria Pillay-van Wyk, Medical Research Council


Aim

This study was undertaken because the Global Burden of Diseases, Injuries and Risk Factors Study 2010 continued to show limitations of data quality and availability in the Africa region. South Africa, however, has contributed to the completeness and availability of mortality data, and therefore undertook a second National Burden of Disease Study in 1997 – 2009 (Pillay-van Wyk et al., 2013). The data below look at the Western Cape’s mortality profile according to Groenewald et al., (2013). The main aim of the study was to establish the age distribution of deaths from HIV/AIDS and tuberculosis (TB), as well as other communicable and non-communicable diseases and injuries. It also looked at South Africa’s national and provincial mortality profiles in order to improve the surveillance system (Pillay-van Wyk et al., 2013 & Groenewald et al, 2013)


Methods

The data collection included copies of death notification forms, information from which were captured into a database called the Local Mortality Surveillance System (LMSS). LMSS data were sent to the Medical Research Council for checking of duplicates. The natural causes of death were coded according to the ICD-10 coding system and the underlying cause of death was selected using the automated coding software, IRIS. The assessed data proved to be 92.2% complete compared to 83.7% in 2009 (Groenewald et al., 2013). After validity checks and redistribution of codes, the causes of death were grouped into four categories: a) HIV/AIDS and TB, b) other communicable diseases, c) non-communicable diseases, and d) injuries.

  
Results (Groenewald et al., 2013)

  • The total number of deaths in the Western Cape amounted to 42 067 for the year 2010, of which 55% were males
  • 7% of the mortalities for 2010 were due to HIV/AIDS,  which the highest cause of death for the Western Cape
  • Male deaths due to HIV/AIDS and TB peaked at ages 35 – 39 years, whereas in women peaked at ages 30 – 34 years
  • 2% of males died of HIV/AIDS in 2010, which is the third highest cause of death for males
  • 5% of females died of HIV/AIDS in 2010, the highest cause of death for females
  • HIV constituted 16.9% (n = 7 118) of all deaths in 2010
  • The leading cause for premature mortality in the Western Cape is HIV/AIDS at 13.2%
  • HIV/AIDS deaths for children under the age of 5 mounted to 4.9% (n = 141). A marked decline was noted from 2009 to 2010.


Limitations (Pillay-van Wyk et al., 2013)

  • Imperfect data (a lot of data that could not be used)
  • The quality and acceptability of the data of child mortality proved was not complete.
  • Death certification by doctors was not standardised

Although there are some limitations, the Western Cape study by Groenewald et al., (2013) was the first to provide a detailed mortality profile for the Western Cape and its sub-districts.


Discussion and Conclusion

  • Despite data limitations, it is clear that there was a rapid increase of HIV/AIDS and TB prevalence prior to 2006. However, due to the impact of availability of antiretroviral treatment, a downward turn was since then observed (Pillay-van Wyk et al., 2013).
  • Another finding was a large variation in burden of disease across districts. HIV/AIDS contributed to the most years of life lost in districts.
  • The downward mortality trend can be attributed to the extensive roll-out of antiretrovirals since 2005. Also, with regards to the      national data found in Pillay-van Wyk et al., (2013), the different provincial mortality trends reflect the different stages of      epidemiological transition and inequity of health services in the provinces. This provides relevant information for policy-makers to address inequalities across the entire national region, as well for the provincial districts.

Efforts to strengthen the quality of data are needed in order to improve the surveillance system for monitoring of child mortality rates and to assess the impact of health services and interventions. The web-based mortality surveillance system with automated coding has the potential to provide up to date mortality information to monitor deaths due to vaccine-preventable and notifiable diseases (Groenewald et el., 2013).

Although mortality due to HIV/AIDS has been declining, it is still the leading cause of premature mortality across all districts in the Western Cape. This highlights the need to strengthen intersectoral prevention strategies and to continue to strengthen the health service response, particularly with regard to providing chronic care at primary health care facilities. “

Posted by Stella Heuer 8 October 2013