Distinguishing disease profiles in different communities in South Africa
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1 Distinguishing disease profiles in different communities in South Africa Candy Day PSSA Conference June
2 The constant we all will die The variation the differences in how people live, fall ill and die can sometimes be hard to see from perspective on the ground.
3 Outline Measures of disease burden, sources of data DALYs, YLLs, mortality rates, prevalence Leading causes of premature mortality (Years of Life Lost, YLLs) Age-standardised mortality rates Leading causes of death district profiles Morbidity hypertension prevalence Opportunities to improve health services Health service coverage
4 Measures and sources of disease burden information DALYS (Disability-Adjusted Life Years) YLLs + YLDs YLLs (Years of Life Lost) premature mortality Deaths crude and relative mortality rates Adjustments for data quality issues Age standardisation: adjusting for age structure Stats SA Causes of death Disease prevalence number of cases of disease in a population at a particular time Surveys SABSSM, NiDS, SADHS Health service delivery indicators measures of load, coverage Routine data DHIS, Tier.Net, ETR
5 District Health Barometer
6 Percentage of YLLs by broad cause, SA, NCDs 40%
7 Percentage of YLLs by broad cause, by district, 2015 Which of these NC districts is at the top? (mostly NCDs) Which is at the bottom? (mostly Infectious disease, maternal, perinatal) JT Gaetsewe Namakwa
8 % YLLs due to NCDs (blue) and Communicable etc (yellow-brown) JT Gaetsewe JT Gaetsewe Namakwa Namakwa
9 Leading YLLs (single causes), SA, 2015
10 Leading YLLs (single cause), rank by district, 2015 Some common themes Some differences
11 Leading YLLs (single cause), rank by district, 2015 HIV leading in most districts, 3 rd in Namakwa and Overberg Similarly for TB in 2 nd place overall Cerebrovascular disease 3 rd 9 th (Namakwa) leading cause Diarrhoeal diseases 6 th leading cause overall not in 3 WC districts and NMA Malaria only shows up for Vhembe, in 20 th place Cancers less visible since each type listed as a single cause
12 Malaria in Vhembe, Prostate cancer in West Coast
13 Age-standardised mortality rates in the metros, 2015 Incomplete data
14 Leading age-standardised mortality rates, 2015 (e.g. BUF, CPT)
15 District burden of disease profiles - % of deaths
16 Single leading causes by sex and age groups - % of deaths
17 Single leading causes by sex and age groups - % of deaths
18 Disease prevalence hypertension as a major risk factor Estimated from measurements of blood pressure and self-reported use of antihypertensive medication in adults (15+) Only South African survey that enables us to estimate disease prevalence at the district level NiDS the National Income Dynamics Study
19 Lowest prevalence
20 Highest prevalence
21 Opportunities to improve health services Hypertension strengthening the cascade of care Testing and diagnosis Treatment Effective treatment (control) HIV testing coverage Deliveries to women under 18 years contraceptive services (impact on maternal, perinatal conditions) Immunisation coverage
22 Hypertension treatment coverage 48% in SA, 2015
23 Hypertensives controlled on treatment 52% in SA, 2015
24 HIV testing coverage, by district, 2016/ %
25 Delivery in facilities <18 years, by district, 2016/17 6.8%
26 Immunisation coverage, by district, 2016/ %
27 Acknowledgements and References The District Health Barometer is produced by Health Systems Trust, and is currently funded by the National Department of Health. Several staff and external collaborators contributed to this work including: Naomi Massyn, Nazia Peer, Ashnie Padarath, Noluthando Ndlovu, Annibale Cois Pam Groenewald, Debbie Bradshaw and Ria Laubscher from the Burden of Disease unit at the Medical Research Council. Massyn N, Peer N, Padarath A, Day C, editors. District Health Barometer 2016/17. Durban: Health Systems Trust; Massyn N, Peer N, English R, Padarath A, Barron P, Day C, et al. District Health Barometer 2015/16. Durban: Health Systems Trust; Available from
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