Sunday Times (Johannesburg) - May 18, 2003
Debbie Bradshaw*

HIV/Aids is the biggest single reason for premature mortality in South Africa. The results of new research - the first Burden of Disease (BOD) study undertaken by the SA Medical Research Council - reveals that HIV/Aids was responsible for about 39% of premature deaths in 2000.

The report also reveals that if no intervention is made to extend the lives of South Africans living with the disease, the number of premature mortalities in South Africa could double by 2010.

In compiling the report, the research team made use of multiple sources of data. Through careful analysis, estimates of the levels of mortality and causes of death, along with estimates of years living with disease in South Africa were determined.

The main focus of the study was the mortality component - a measure of premature mortality that takes into account both the number of deaths and the years of life lost.

A country-wide analysis is important in helping policy-makers interpret incomplete health data, by providing the best possible estimates of death and ill-health.

Focusing on the causes of premature mortality helps to identify the public health initiatives needed to reduce the deaths of children and young adults. Young adults are a particularly important section of the population as they are in the prime productive phase of life.

Since the disease burden in South Africa is undergoing rapid change, mainly due to HIV/Aids, the usual Global Burden of Disease approach (used by the World Health Organisation) of using the most up-to-date data was inappropriate and a modelling approach, calibrated to empirical data, was adopted.

The total number of deaths for 2000 was calculated using a demographic and Aids model from the Actuarial Society of South Africa. A system that makes use of child and adult mortality estimates based on surveys, census results, vital statistics and the antenatal sero-prevalence survey.

The recently completed BOD report includes full details of the methods used in the study to estimate the number of deaths, premature mortality and the identification of the causes of mortality.

The non-Aids cause of death profile was estimated from three sources: cause-of-death data from Stats SA; information processed by the Department of Home Affairs; and the UNISA/MRC National Injury Mortality Surveillance System (NIMSS).

The top causes of mortality clearly reflect the quadruple burden that South Africa is facing. These were a combination of deaths due to HIV/Aids, chronic diseases, conditions associated with underdevelopment and injuries.

The typical double burden experienced by middle-income countries through the co-existence of diseases associated with underdevelopment as well as emerging chronic diseases, has been compounded by a large injury burden, and more recently by the impact of HIV/Aids.

HIV/Aids is now the leading cause of death, even when compared against a combination of diseases.

The next biggest cause of premature deaths is cardiovascular disease, which accounts for 17% of all deaths. Injury accounts for 13% of all deaths and is particularly high for young adult men. Infectious and parasitic disease (excluding HIV) accounts for 10% of all deaths with a high burden due to TB. Cancer accounts for 7% of all deaths.

The years of life lost through HIV/Aids is striking (39%), with the proportion higher for females (47%) than for males (33%). The prevalence is higher among women and occurs at a younger age.

Diseases and conditions associated with underdevelopment account for 25% of premature mortality with large losses through TB, diarrhoea, lower respiratory infections and low birth weight.

Non-communicable diseases account for 21% of the total; strokes being the most common among females and ischaemic heart disease the most common among males.

Injuries account for 16% of the years of life lost. The major causes of injury are homicide, road traffic accidents and fires.

Suicides also contribute to the figures, particularly among males.

More than half of the premature mortality experienced in 2000 can be attributed to four single causes: HIV/Aids; TB; homicide, and road traffic accidents.

The rates for all these causes were exceedingly high when compared with estimates for other regions throughout the world.

The study shows that the disease burden from HIV/Aids does not diminish the burden from other causes, but adds significantly to them. It also highlights that without intervention to extend the lives of people living with Aids, the total premature mortality burden in South Africa can be expected to double by 2010.

Aids will account for as much premature death as all other causes put together. The South African government is urged to implement its plan for providing treatment to those who are HIV positive . There is also a need to strengthen health promotion efforts if the overall burden of disease is to be reduced.

* Bradshaw is the director of the Medical Research Council's Burden of Disease Research Unit

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