AIDS Care Watch

Saturday, May 21, 2005

South Africa: 'HIV/Aids causes 30% of deaths'

May 20, 2005- The health department declined to comment on Tuesday on a new Medical Research Council (MRC) report putting the proportion of deaths attributable to Aids in 2000 at nearly 30 percent.

"The (MRC) report has not been released officially, which means the minister and the director-general haven't seen it yet. We therefore cannot comment," said department spokesperson Solly Mabotha.

MRC interim president Professor Anthony Mbewu confirmed that "we haven't actually released that report", which he said was normally done from his office.

But the report was made available to Sapa on request.

The leading cause of death

It states that 29.8 percent of deaths in the country in 2000 were due to Aids. "HIV/Aids is the leading cause of death and premature mortality for all provinces," the document says.

The figure confirmed a finding in the MRC's previous report, released in 2003, on causes of mortality in the country in 2000, lead researcher Debbie Bradshaw said.

40 percent of KZN deaths due to Aids

But the latest report contained the first provincial breakdown — putting KwaZulu-Natal in the lead with 41.5 percent of deaths attributable to Aids.

This was followed by Mpumalanga with 40.7 percent, Gauteng with 32.5 percent, the Free State with 32.3 percent, and the North West with 30 percent.

Limpopo was sixth on the list with 24.4 percent of deaths related to Aids, followed by the Eastern Cape with 20.3 percent, the Northern Cape with 13.9 percent and the Western Cape with 8.4 percent.

"The best estimates available

The MRC conceded that its calculations were based on estimations.

"We think we are getting the picture reasonably correct," Bradshaw told Sapa.

"There is some uncertainty, because we don't have the truth at hand to compare it against. But we don't think we are over- or understating the picture. These are the best estimates we can come up with."

In determining its estimates, the MRC used "quite a few" data sets, including Statistics SA's cause of death figures.

It also considered changing patterns in death ratios, and identified nine death-causing conditions showing a "very distinct change", Bradshaw said.

These included diarrhoea, tuberculosis, pneumonia and meningitis — which were claiming more and more lives of increasingly younger people, she explained.

These were considered to be Aids "indicator" conditions.

The findings also took into account the prevalence of HIV in ante-natal clinics, projected onto the population at large.

Better death registration system needed

Bradshaw said a better death registration system would boost the MRC's ability to obtain clear statistics.

Death certificates reflected the immediate cause of death, and often neglected to state information on pre-existing conditions.

Doctors often did not include this information for a fear of stigma, and other times because they simply didn't know, Bradshaw said. Many doctors did not have access to their patients' full medical history.

Treatment, prevention needed

"The high death rates due to HIV/Aids highlight the urgency to accelerate the implementation of the comprehensive plan for the treatment and prevention of HIV and Aids," the report states.

This referred to the provision of anti-retroviral treatment, as well as a renewed focus on prevention through condom use, Bradshaw said.

"The two go hand-in-hand. If treatment is readily available, people will be more likely to get tested — which also acts as a preventative measure."

Apart from HIV/Aids, the study found homicide and traffic accidents, stroke, heart disease, tuberculosis, diarrhoea and lower respiratory infections to be among the top causes of death in all provinces.

Quadruple burden

The report points to a "quadruple" mortality burden experienced by South Africa. This referred to a combination of so-called "pre-transitional" causes of death found in poor countries like diarrhoea, tuberculosis and nutritional deficiencies; chronic diseases like cancer more prevalent in developed nations; injury caused by crime, violence and traffic accidents; and HIV/Aids.

"The quadruple burden experienced in all provinces requires a broad range of interventions including improved access to health care, ensuring basic needs such as those related to water and sanitation are met, the active promotion of a healthy lifestyle over the entire life course, broad-range disease and injury prevention, and a reduction of risk factors."

The report found that life expectancy in KwaZulu-Natal and Mpumalanga was about 10 years lower than the Western Cape's 63 years.

The Western Cape had the lowest under-five child mortality rate of about 46 per 1000 live births, compared to 116 per 1000 in KwaZulu-Natal.

The authors of the report urged planners to use the findings to "modify the emphasis of national policies to meet the health needs of their communities".