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Kyu HH, Jahagirdar D, Cunningham M, Walters M, Brewer E, Novotney A, Wool E, Dippennar I, Sharara F, Han C, Balassyano S, Bertolacci G, Murray CJL, Naghavi M. Accounting for misclassified and unknown cause of death data in vital registration systems for estimating trends in HIV mortality. J Int AIDS Soc 2021; 24 Suppl 5:e25791. [PMID: 34546661 PMCID: PMC8454675 DOI: 10.1002/jia2.25791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/21/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Misclassification of HIV deaths can substantially diminish the usefulness of cause of death data for decision-making. In this study, we describe the methods developed by the Global Burden of Disease Study to account for the misclassified cause of death data from vital registration systems for estimating HIV mortality in 132 countries and territories. METHODS The cause of death data were obtained from the World Health Organization Mortality Database and official country-specific mortality databases. We implemented two steps to adjust the raw cause of death data: (1) redistributing garbage codes to underlying causes of death, including HIV/AIDS by applying methods, such as analysis of multiple cause data and proportional redistribution, and (2) reassigning HIV deaths misclassified as other causes to HIV/AIDS by examining the age patterns of underlying causes in location and years with and without HIV epidemics. RESULTS In 132 countries, during the period from 1990 to 2018, 1,848,761 deaths were reported as caused by HIV/AIDS. After garbage code redistribution in these 132 countries, this number increased to 4,165,015 deaths. An additional 1,944,291 deaths were added through correction of HIV deaths misclassified as other causes in 44 countries. The proportion of HIV deaths derived from garbage code redistribution decreased over time, from 0.4 in 1990 to 0.1 in 2018. The proportion of deaths derived from HIV misclassification correction peaked at 0.4 in 2006 and declined afterwards to 0.08 in 2018. The greatest contributors to garbage code redistribution were "immunodeficiency antibody" (ICD 9: 279-279.1; ICD 10: D80-D80.9) and "immunodeficiency other" (ICD 9: 279, 279.5-279.9; ICD 10: D83-D84.9, D89, D89.8-D89.9), which together contributed 77% of all redistributed deaths at their peak in 1995. Respiratory tuberculosis (ICD 9: 010-012.9; ICD 10: A10-A14, A15-A16.9) contributed the greatest proportion of all HIV misclassified deaths (25-62% per year) over the most years. CONCLUSIONS Correcting for miscoding and misclassification of cause of death data can enhance the utility of the data for analyzing trends in HIV mortality and tracking progress toward the Sustainable Development Goal targets.
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Affiliation(s)
- Hmwe H. Kyu
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
- Department of Health Metrics SciencesUniversity of WashingtonSeattleWashingtonUSA
| | | | | | | | - Edmond Brewer
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
| | - Amanda Novotney
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
| | - Eve Wool
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
| | - Ilse Dippennar
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
| | - Fablina Sharara
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
| | - Chieh Han
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
| | | | - Greg Bertolacci
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
| | - Christopher J. L. Murray
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
- Department of Health Metrics SciencesUniversity of WashingtonSeattleWashingtonUSA
| | - Mohsen Naghavi
- Institute for Health Metrics and EvaluationSeattleWashingtonUSA
- Department of Health Metrics SciencesUniversity of WashingtonSeattleWashingtonUSA
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Johnson SC, Cunningham M, Dippenaar IN, Sharara F, Wool EE, Agesa KM, Han C, Miller-Petrie MK, Wilson S, Fuller JE, Balassyano S, Bertolacci GJ, Davis Weaver N, Lopez AD, Murray CJL, Naghavi M. Public health utility of cause of death data: applying empirical algorithms to improve data quality. BMC Med Inform Decis Mak 2021; 21:175. [PMID: 34078366 PMCID: PMC8170729 DOI: 10.1186/s12911-021-01501-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Accurate, comprehensive, cause-specific mortality estimates are crucial for informing public health decision making worldwide. Incorrectly or vaguely assigned deaths, defined as garbage-coded deaths, mask the true cause distribution. The Global Burden of Disease (GBD) study has developed methods to create comparable, timely, cause-specific mortality estimates; an impactful data processing method is the reallocation of garbage-coded deaths to a plausible underlying cause of death. We identify the pattern of garbage-coded deaths in the world and present the methods used to determine their redistribution to generate more plausible cause of death assignments. METHODS We describe the methods developed for the GBD 2019 study and subsequent iterations to redistribute garbage-coded deaths in vital registration data to plausible underlying causes. These methods include analysis of multiple cause data, negative correlation, impairment, and proportional redistribution. We classify garbage codes into classes according to the level of specificity of the reported cause of death (CoD) and capture trends in the global pattern of proportion of garbage-coded deaths, disaggregated by these classes, and the relationship between this proportion and the Socio-Demographic Index. We examine the relative importance of the top four garbage codes by age and sex and demonstrate the impact of redistribution on the annual GBD CoD rankings. RESULTS The proportion of least-specific (class 1 and 2) garbage-coded deaths ranged from 3.7% of all vital registration deaths to 67.3% in 2015, and the age-standardized proportion had an overall negative association with the Socio-Demographic Index. When broken down by age and sex, the category for unspecified lower respiratory infections was responsible for nearly 30% of garbage-coded deaths in those under 1 year of age for both sexes, representing the largest proportion of garbage codes for that age group. We show how the cause distribution by number of deaths changes before and after redistribution for four countries: Brazil, the United States, Japan, and France, highlighting the necessity of accounting for garbage-coded deaths in the GBD. CONCLUSIONS We provide a detailed description of redistribution methods developed for CoD data in the GBD; these methods represent an overall improvement in empiricism compared to past reliance on a priori knowledge.
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Affiliation(s)
| | - Matthew Cunningham
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ilse N Dippenaar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Fablina Sharara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Eve E Wool
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kareha M Agesa
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chieh Han
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly K Miller-Petrie
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Shadrach Wilson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - John E Fuller
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Shelly Balassyano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gregory J Bertolacci
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, Director of Subnational Burden of Disease Estimation, Institute for Health Metrics and Evaluation School of Medicine, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA, 98121, USA.
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Prevalence and associated risk factors of peripheral artery disease in virologically suppressed HIV-infected individuals on antiretroviral therapy in Kwara state, Nigeria: a cross sectional study. BMC Public Health 2019; 19:1143. [PMID: 31429736 PMCID: PMC6700806 DOI: 10.1186/s12889-019-7496-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background The association between HIV and cardiovascular disease (CVD) has been reported in several studies. However, there is paucity of information on the prevalence of subclinical disease as well as its associated risk factors in sub-Saharan African population. The aim of this study was to determine the prevalence and associated risk factors of peripheral artery disease (PAD) among virologically suppressed HIV-infected participants in Kwara State, Nigeria. Methods This study was conducted between July 2018 and December 2018. A total of 150 HIV-infected participants aged between 20 and 55 years and 50 HIV non-infected age-matched controls were randomly recruited in the study. Sociodemographic, anthropometric and clinical data were collected using a well-structured questionnaire. Ankle brachial index (ABI) was measured, PAD was defined as ABI of < 0.9. Cryopreserved serum was used to evaluate lipid profile parameters. Student’s t-test and Chi-square were used to compare continuous and categorical variables. Associations of CVD risk factors and clinical data, and lipid profile with low ABI were assessed using logistic regression analysis. Results The study participants had a mean age of 43.73 ± 8.74, majority were females (72.7%) with a mean duration on ART of 7.73 ± 3.52 years. Hypertension was present in 15.9%, diabetes 4%, family history of CVD 8.6% and metabolic syndrome 17.3% in the study group. The study participants recorded significantly lower mean values for ABI, HDL-C and significantly higher mean values of TG (P < 0.05) compared to the control group. The prevalence of low ABI (14.6%) was higher in the study group compared to the control group (2%). A significantly negative correlation between ABI and duration on ART (r = − 0.163, P = 0.041) and a positive correlation between viral load and TG were observed in the study group. TC (OR 1.784, P = 0.011), LDL-C (OR 1.824, P = 0.010) and CD4 cell count < 200 cells/mm3 (OR 2.635, P = 0.364) were associated with low ABI in the participants. Conclusion Viral suppression with combined antiretroviral therapy and long term treatment is associated with dyslipidaemia, with increased risk of PAD. Prevalence of PAD in virologically-suppressed individuals does not differ from the controls in the population studied. Electronic supplementary material The online version of this article (10.1186/s12889-019-7496-4) contains supplementary material, which is available to authorized users.
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Black A, Sitas F, Chibrawara T, Gill Z, Kubanje M, Williams B. HIV-attributable causes of death in the medical ward at the Chris Hani Baragwanath Hospital, South Africa. PLoS One 2019; 14:e0215591. [PMID: 31059528 PMCID: PMC6502348 DOI: 10.1371/journal.pone.0215591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/04/2019] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Data on the association between HIV infection and deaths from underlying medical conditions are needed to understand and assess the impact of HIV on mortality. We present data on mortality in the Chris Hani Baragwanath Hospital (CHBH) South Africa and analyse the relationship between each cause of death and HIV. METHODS From 2006 to 2009 data were collected on 15,725 deaths including age, sex, day of admittance and of death, HIV status, ART initiation and CD4+ cell counts. Causes of death associated with HIV were cases, causes of death not associated with HIV were controls. We calculate the odds-ratios (ORs) for being HIV-positive and for each AIDS related condition the disease-attributable fraction (DAF) and the population-attributable fraction (PAF) due to HIV for cases relative to controls. RESULTS Among those that died, the prevalence of HIV was 61% and of acquired immune deficiency syndrome (AIDS) related conditions was 69%. The HIV-attributable fraction was 36% in the whole sample and 60% in those that were HIV-positive. Cryptococcosis, Kaposi's sarcoma and Pneumocystis jirovecii, TB, gastroenteritis and anaemia were highly predictive of HIV with odds ratios for being HIV-positive ranging from 8 to 124, while genito-urinary conditions, meningitis, other respiratory conditions and sepsis, lymphoma and conditions of skin and bone were significantly associated with HIV with odds ratios for being HIV-positive ranging from 3 to 8. Most of the deaths attributable to HIV were among those dying of TB or of other respiratory conditions. CONCLUSIONS The high prevalence of HIV among those that died, peaking at 70% in those aged 30 years but still 7% in those aged 80 years, demonstrates the impact of the HIV epidemic on adult mortality and on hospital services and the extent to which early anti-retroviral treatment would have reduced the burden of both. These data make it possible to better assess mortality and morbidity due to HIV in this still high prevalence setting and, in particular, to identify those causes of death that are most strongly associated with HIV.
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Affiliation(s)
- Andrew Black
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Freddy Sitas
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Camperdown, Australia
| | - Trust Chibrawara
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Zoe Gill
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Mmamapudi Kubanje
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Brian Williams
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
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Dicker D, Nguyen G, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdel-Rahman O, Abdi A, Abdollahpour I, Abdulkader RS, Abdurahman AA, Abebe HT, Abebe M, Abebe Z, Abebo TA, Aboyans V, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya P, Adebayo OM, Adedeji IA, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adhikari TB, Adib MG, Adou AK, Adsuar JC, Afarideh M, Afshin A, Agarwal G, Aggarwal R, Aghayan SA, Agrawal S, Agrawal A, Ahmadi M, Ahmadi A, Ahmadieh H, Ahmed MLCB, Ahmed S, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akanda AS, Akbari ME, Akibu M, Akinyemi RO, Akinyemiju T, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alebel A, Aleman AV, Alene KA, Al-Eyadhy A, Ali R, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Allen CA, Alonso J, Al-Raddadi RM, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Anlay DZ, Ansari H, Ansariadi A, Ansha MG, Antonio CAT, Appiah SCY, Aremu O, Areri HA, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asadi-Lari M, Asayesh H, Asfaw ET, Asgedom SW, Assadi R, Ataro Z, Atey TMM, Athari SS, Atique S, Atre SR, Atteraya MS, Attia EF, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Awuah B, Ayala Quintanilla BP, Ayele HT, Ayele Y, Ayer R, Ayuk TB, Azzopardi PS, Azzopardi-Muscat N, Badali H, Badawi A, Balakrishnan K, Bali AG, Banach M, Banstola A, Barac A, Barboza MA, Barquera S, Barrero LH, Basaleem H, Bassat Q, Basu A, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Bekele BB, Belachew AB, Belay AG, Belay E, Belay SA, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Berman AE, Bernabe E, Bernstein RS, Bertolacci GJ, Beuran M, Beyranvand T, Bhala N, Bhatia E, Bhatt S, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bililign N, Bin Sayeed MS, Birlik SM, Birungi C, Bisanzio D, Biswas T, Bjørge T, Bleyer A, Basara BB, Bose D, Bosetti C, Boufous S, Bourne R, Brady OJ, Bragazzi NL, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Britton G, Brugha T, Burke KE, Busse R, Butt ZA, Cahuana-Hurtado L, Callender CSKH, Campos-Nonato IR, Campuzano Rincon JC, Cano J, Car M, Cárdenas R, Carreras G, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Çavlin A, Cerin E, Chaiah Y, Champs AP, Chang HY, Chang JC, Chattopadhyay A, Chaturvedi P, Chen W, Chiang PPC, Chimed-Ochir O, Chin KL, Chisumpa VH, Chitheer A, Choi JYJ, Christensen H, Christopher DJ, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Cohen AJ, Collado-Mateo D, Constantin MM, Conti S, Cooper C, Cooper LT, Cortesi PA, Cortinovis M, Cousin E, Criqui MH, Cromwell EA, Crowe CS, Crump JA, Cucu A, Cunningham M, Daba AK, Dachew BA, Dadi AF, Dandona L, Dandona R, Dang AK, Dargan PI, Daryani A, Das SK, Das Gupta R, das Neves J, Dasa TT, Dash AP, Weaver ND, Davitoiu DV, Davletov K, Dayama A, Courten BD, De la Hoz FP, De leo D, De Neve JW, Degefa MG, Degenhardt L, Degfie TT, Deiparine S, Dellavalle RP, Demoz GT, Demtsu BB, Denova-Gutiérrez E, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dhimal M, Ding EL, Djalalinia S, Doku DT, Dolan KA, Donnelly CA, Dorsey ER, Douwes-Schultz D, Doyle KE, Drake TM, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Edessa D, Edvardsson D, Eggen AE, El Bcheraoui C, El Sayed Zaki M, Elfaramawi M, El-Khatib Z, Ellingsen CL, Elyazar IRF, Enayati A, Endries AYY, Er B, Ermakov SP, Eshrati B, Eskandarieh S, Esmaeili R, Esteghamati A, Esteghamati S, Fakhar M, Fakhim H, Farag T, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Farzaei MH, Fazeli MS, Feigin VL, Feigl AB, Feizy F, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Feyissa GT, Fijabi DO, Filip I, Finegold S, Fischer F, Flor LS, Foigt NA, Ford JA, Foreman KJ, Fornari C, Frank TD, Franklin RC, Fukumoto T, Fuller JE, Fullman N, Fürst T, Furtado JM, Futran ND, Galan A, Gallus S, Gambashidze K, Gamkrelidze A, Gankpe FG, Garcia-Basteiro AL, Garcia-Gordillo MA, Gebre T, Gebre AK, Gebregergs GB, Gebrehiwot TT, Gebremedhin AT, Gelano TF, Gelaw YA, Geleijnse JM, Genova-Maleras R, Gessner BD, Getachew S, Gething PW, Gezae KE, Ghadami MR, Ghadimi R, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghiasvand H, Ghimire M, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Giussani G, Goenka S, Goli S, Gomez RS, Gomez-Cabrera MC, Gómez-Dantés H, Gona PN, Goodridge A, Gopalani SV, Goto A, Goulart AC, Goulart BNG, Grada A, Grosso G, Gugnani HC, Guimaraes ALS, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Hagos TB, Hailegiyorgis TT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haririan H, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hay RJ, Hay SI, He Y, Hedayatizadeh-Omran A, Hegazy MI, Heibati B, Heidari M, Hendrie D, Henok A, Henry NJ, Heredia-Pi I, Herteliu C, Heydarpour F, Heydarpour P, Heydarpour S, Hibstu DT, Hoek HW, Hole MK, Homaie Rad E, Hoogar P, Horino M, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc S, Hostiuc M, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Husseini A, Hussen MM, Hutfless S, Iburg KM, Igumbor EU, Ikeda CT, Ilesanmi OS, Iqbal U, Irvani SSN, Isehunwa OO, Islam SMS, Islami F, Jahangiry L, Jahanmehr N, Jain R, Jain SK, Jakovljevic M, James SL, Javanbakht M, Jayaraman S, Jayatilleke AU, Jee SH, Jeemon P, Jha RP, Jha V, Ji JS, Johnson SC, Jonas JB, Joshi A, Jozwiak JJ, Jungari SB, Jürisson M, K M, Kabir Z, Kadel R, Kahsay A, Kahssay M, Kalani R, Kapil U, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Karimi-Sari H, Kasaeian A, Kassa GM, Kassa TD, Kassa ZY, Kassebaum NJ, Katibeh M, Katikireddi SV, Kaul A, Kawakami N, Kazemeini H, Kazemi Z, Karyani AK, K C P, Kebede S, Keiyoro PN, Kemp GR, Kengne AP, Keren A, Kereselidze M, Khader YS, Khafaie MA, Khajavi A, Khalid N, Khalil IA, Khan EA, Khan G, Khan MS, Khan MA, Khang YH, Khanna T, Khater MM, Khatony A, Khazaie H, Khoja AT, Khosravi A, Khosravi MH, Khubchandani J, Kiadaliri AA, Kibret GDD, Kim CI, Kim D, Kim JY, Kim YE, Kimokoti RW, Kinfu Y, Kinra S, Kisa A, Kissimova-Skarbek K, Kissoon N, Kivimäki M, Kleber ME, Knibbs LD, Knudsen AKS, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosek MN, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krishnaswami S, Kuate Defo B, Kucuk Bicer B, Kudom AA, Kuipers EJ, Kulikoff XR, Kumar GA, Kumar M, Kumar P, Kumsa FA, Kutz MJ, Lad SD, Lafranconi A, Lal DK, Lalloo R, Lam H, Lami FH, Lan Q, Langan SM, Lansingh VC, Lansky S, Larson HJ, Laryea DO, Lassi ZS, Latifi A, Lavados PM, Laxmaiah A, Lazarus JV, Lebedev G, Lee PH, Leigh J, Leshargie CT, Leta S, Levi M, Li S, Li Y, Li X, Liang J, Liang X, Liben ML, Lim LL, Lim SS, Limenih MA, Linn S, Liu S, Liu Y, Lodha R, Logroscino G, Lonsdale C, Lorch SA, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Lunevicius R, Lyons RA, Ma S, Mabika C, Macarayan ERK, Mackay MT, Maddison ER, Maddison R, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malik MA, Malta DC, Mamun AA, Manamo WA, Manda AL, Mansournia MA, Mantovani LG, Mapoma CC, Marami D, Maravilla JC, Marcenes W, Marina S, Martinez-Raga J, Martins SCO, Martins-Melo FR, März W, Marzan MB, Mashamba-Thompson TP, Masiye F, Massenburg BB, Maulik PK, Mazidi M, McGrath JJ, McKee M, Mehata S, Mehendale SM, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mekonen T, Mekonnen TC, Meles HG, Meles KG, Melese A, Melku M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezgebe HB, Miangotar Y, Miazgowski B, Miazgowski T, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Misganaw AT, Moazen B, Moges NA, Mohammad KA, Mohammadi M, Mohammadifard N, Mohammadi-Khanaposhtani M, Mohammadnia-Afrouzi M, Mohammed S, Mohammed MA, Mohan V, Mokdad AH, Molokhia M, Monasta L, Moradi G, Moradi M, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-da-Costa J, Morrison SD, Mosapour A, Moschos MM, Mousavi SM, Muche AA, Muchie KF, Mueller UO, Mukhopadhyay S, Mullany EC, Muller K, Murhekar M, Murphy TB, Murthy GVS, Murthy S, Musa J, Musa KI, Mustafa G, Muthupandian S, Nachega JB, Nagel G, Naghavi M, Naheed A, Nahvijou A, Naik G, Nair S, Najafi F, Nangia V, Nansseu JR, Nascimento BR, Nawaz H, Ncama BP, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngalesoni FN, Ngunjiri JW, Nguyen HT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen TH, Ningrum DNA, Nirayo YL, Nisar MI, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nsoesie EO, Nyasulu PS, Ofori-Asenso R, Ogah OS, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olusanya BO, Olusanya JO, Ong SK, Opio JN, Oren E, Ortiz JR, Ortiz A, Ota E, Otstavnov SS, Øverland S, Owolabi MO, Oyekale AS, P A M, Pacella R, Pakhale S, Pakhare AP, Pana A, Panda BK, Panda-Jonas S, Pandey AR, Pandian JD, Parisi A, Park EK, Parry CDH, Parsian H, Patel S, Patle A, Patten SB, Patton GC, Paudel D, Pearce N, Peprah EK, Pereira A, Pereira DM, Perez KM, Perico N, Pervaiz A, Pesudovs K, Petri WA, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pirsaheb M, Pishgar F, Plass D, Polinder S, Pond CD, Popova S, Postma MJ, Pourmalek F, Pourshams A, Poustchi H, Prabhakaran D, Prakash V, Prakash S, Prasad N, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman MA, Rahman SU, Rai RK, Rajati F, Rajsic S, Raju SB, Ram U, Ranabhat CL, Ranjan P, Ranta A, Rasella D, Rawaf DL, Rawaf S, Ray SE, Razo-García C, Rego MAS, Rehm J, Reiner RC, Reinig N, Reis C, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezaeian S, Rezai MS, Riahi SM, Ribeiro ALP, Riojas H, Rios-Blancas MJ, Roba KT, Robinson SR, Roever L, Ronfani L, Roshandel G, Roshchin DO, Rostami A, Rothenbacher D, Rubagotti E, Ruhago GM, Saadat S, Sabde YD, Sachdev PS, Saddik B, Sadeghi E, Moghaddam SS, Safari H, Safari Y, Safari-Faramani R, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salahshoor MR, Salam N, Salama JS, Salamati P, Saldanha RDF, Salimi Y, Salimzadeh H, Salz I, Sambala EZ, Samy AM, Sanabria J, Sanchez-Niño MD, Santos IS, Santos JV, Santric Milicevic MM, Sao Jose BP, Sardana M, Sarker AR, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Savic M, Sawant AR, Sawhney M, Saxena S, Sayyah M, Scaria V, Schaeffner E, Schelonka K, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Shabaninejad H, Shackelford KA, Shafieesabet A, Shaheen AA, Shaikh MA, Shakir RA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi H, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma M, Sharma J, Sharma R, She J, Sheikh A, Sheth KN, Shi P, Shibuya K, Shifa GT, Shiferaw MS, Shigematsu M, Shiri R, Shirkoohi R, Shiue I, Shokraneh F, Shrime MG, Shukla SR, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silpakit N, Silva DAS, Silva JP, Silveira DGA, Singam NSV, Singh JA, Singh V, Sinha AP, Sinha DN, Sitas F, Skirbekk V, Sliwa K, Soares Filho AM, Sobaih BH, Sobhani S, Soofi M, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Srivastava RK, Starodubov VI, Stathopoulou V, Steel N, Stein DJ, Steiner C, Stewart LG, Stokes MA, Sudaryanto A, Sufiyan MB, Sulo G, Sunguya BF, Sur PJ, Sutradhar I, Sykes BL, Sylaja PN, Sylte DO, Szoeke CEI, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Takahashi K, Tandon N, Tassew AA, Tassew SG, Tavakkoli M, Taveira N, Tawye NY, Tehrani-Banihashemi A, Tekalign TG, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Teshale MY, Tessema B, Teweldemedhin M, Thakur JS, Thankappan KR, Thirunavukkarasu S, Thomas LA, Thomas N, Thrift AG, Tilahun B, To QG, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Tortajada-Girbés M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Tripathi S, Tripathy SP, Truelsen TC, Truong NT, Tsadik AG, Tsilimparis N, Tudor Car L, Tuzcu EM, Tyrovolas S, Ukwaja KN, Ullah I, Usman MS, Uthman OA, Uzun SB, Vaduganathan M, Vaezi A, Vaidya G, Valdez PR, Varavikova E, Varughese S, Vasankari TJ, Vasconcelos AMN, Venketasubramanian N, Vidavalur R, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Vosoughi K, Vujcic IS, Wagner GR, Wagnew FWS, Waheed Y, Wang Y, Wang YP, Wassie MM, Weiderpass E, Weintraub RG, Weiss DJ, Weiss J, Weldegebreal F, Weldegwergs KG, Werdecker A, Westerman R, Whiteford HA, Widecka J, Widecka K, Wijeratne T, Winkler AS, Wiysonge CS, Wolfe CDA, Wondemagegn SA, Wu S, Wyper GMA, Xu G, Yadav R, Yakob B, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Ye P, Yearwood JA, Yentür GK, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, York HW, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zachariah G, Zadnik V, Zafar S, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeeb H, Zeleke MM, Zenebe ZM, Zerfu TA, Zhang K, Zhang X, Zhou M, Zhu J, Zodpey S, Zucker I, Zuhlke LJJ, Lopez AD, Gakidou E, Murray CJL. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1684-1735. [PMID: 30496102 PMCID: PMC6227504 DOI: 10.1016/s0140-6736(18)31891-9] [Citation(s) in RCA: 575] [Impact Index Per Article: 95.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/14/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. FUNDING Bill & Melinda Gates Foundation.
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Ghys PD, Williams BG, Over M, Hallett TB, Godfrey-Faussett P. Epidemiological metrics and benchmarks for a transition in the HIV epidemic. PLoS Med 2018; 15:e1002678. [PMID: 30359372 PMCID: PMC6201869 DOI: 10.1371/journal.pmed.1002678] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Peter Godfrey-Faussett and colleagues present six epidemiological metrics for tracking progress in reducing the public health threat of HIV.
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Affiliation(s)
- Peter D. Ghys
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Brian G. Williams
- South Africa Centre for Epidemiological Modelling and Analysis, Stellenbosch, South Africa
| | - Mead Over
- Center for Global Development, Washington, DC, United States of America
| | - Timothy B. Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Pillay-van Wyk V, Msemburi W, Laubscher R, Dorrington RE, Groenewald P, Glass T, Nojilana B, Joubert JD, Matzopoulos R, Prinsloo M, Nannan N, Gwebushe N, Vos T, Somdyala N, Sithole N, Neethling I, Nicol E, Rossouw A, Bradshaw D. Mortality trends and differentials in South Africa from 1997 to 2012: second National Burden of Disease Study. LANCET GLOBAL HEALTH 2018; 4:e642-53. [PMID: 27539806 DOI: 10.1016/s2214-109x(16)30113-9] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The poor health of South Africans is known to be associated with a quadruple disease burden. In the second National Burden of Disease (NBD) study, we aimed to analyse cause of death data for 1997-2012 and develop national, population group, and provincial estimates of the levels and causes of mortality. METHOD We used underlying cause of death data from death notifications for 1997-2012 obtained from Statistics South Africa. These data were adjusted for completeness using indirect demographic techniques for adults and comparison with survey and census estimates for child mortality. A regression approach was used to estimate misclassified HIV/AIDS deaths and so-called garbage codes were proportionally redistributed by age, sex, and population group population group (black African, Indian or Asian descent, white [European descent], and coloured [of mixed ancestry according to the preceding categories]). Injury deaths were estimated from additional data sources. Age-standardised death rates were calculated with mid-year population estimates and the WHO age standard. Institute of Health Metrics and Evaluation Global Burden of Disease (IHME GBD) estimates for South Africa were obtained from the IHME GHDx website for comparison. FINDINGS All-cause age-standardised death rates increased rapidly since 1997, peaked in 2006 and then declined, driven by changes in HIV/AIDS. Mortality from tuberculosis, non-communicable diseases, and injuries decreased slightly. In 2012, HIV/AIDS caused the most deaths (29·1%) followed by cerebrovascular disease (7·5%) and lower respiratory infections (4·9%). All-cause age-standardised death rates were 1·7 times higher in the province with the highest death rate compared to the province with the lowest death rate, 2·2 times higher in black Africans compared to whites, and 1·4 times higher in males compared with females. Comparison with the IHME GBD estimates for South Africa revealed substantial differences for estimated deaths from all causes, particularly HIV/AIDS and interpersonal violence. INTERPRETATION This study shows the reversal of HIV/AIDS, non-communicable disease, and injury mortality trends in South Africa during the study period. Mortality differentials show the importance of social determinants, raise concerns about the quality of health services, and provide relevant information to policy makers for addressing inequalities. Differences between GBD estimates for South Africa and this study emphasise the need for more careful calibration of global models with local data. FUNDING South African Medical Research Council's Flagships Awards Project.
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Affiliation(s)
- Victoria Pillay-van Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - William Msemburi
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rob E Dorrington
- Centre for Actuarial Research, University of Cape Town, South Africa
| | - Pam Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tracy Glass
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Beatrice Nojilana
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jané D Joubert
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Megan Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nadine Nannan
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nomonde Gwebushe
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Theo Vos
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nontuthuzelo Somdyala
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nomfuneko Sithole
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ian Neethling
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Anastasia Rossouw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, South Africa
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De Wet N. Gendered differences in AIDS and AIDS-related cause of death among youth with secondary education in South Africa, 2009-2011. SAHARA J 2016; 13:170-177. [PMID: 27739338 PMCID: PMC5642439 DOI: 10.1080/17290376.2016.1242434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The prevalence of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is higher among females than males in Sub-Saharan Africa. Education is associated with better health outcomes. For this and other reasons, African countries have made a concerted effort to increase youth education rates. However, in South Africa males have lower secondary education rates than females, yet females have a higher prevalence of HIV/AIDS. This study examines if a gender disparity exists in AIDS mortality rates among youth with secondary education in South Africa. METHODS This study uses descriptive statistics and life table techniques. A sample of 4386 deaths of youth with secondary education is used. Of this total sample, 987 deaths were among males and 340 were among females with secondary education. RESULTS This study shows that AIDS mortality is higher among females than males in South Africa. Males and females with secondary education have lower AIDS mortality than all males and females in the population, yet the rates are higher for females. Using cause-deleted life tables, the probability of youth dying from HIV/AIDS practically disappears for both males and females. Odds ratio calculations show that secondary education does not have a protective effect from AIDS mortality among male and female youth. CONCLUSION Given the gendered difference in AIDS mortality among youth with secondary education, efforts to increase secondary education among males and further research into other factors exacerbating AIDS mortality among females with secondary education is needed in the country.
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Affiliation(s)
- Nicole De Wet
- PhD, Lecturer in Demography and Population Studies Programme, University of the Witwatersrand, Johannesburg, South Africa
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Probst C, Parry CDH, Rehm J. Socio-economic differences in HIV/AIDS mortality in South Africa. Trop Med Int Health 2016; 21:846-55. [PMID: 27118253 DOI: 10.1111/tmi.12712] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To quantify socio-economic differences in the risk of HIV/AIDS mortality in South Africa for different measures of socio-economic status. METHODS Systematic literature search in Web of Knowledge and PubMed. Measures of relative risk (RR) were pooled separately for education, income, assets score and employment status as measures of socio-economic status, using inverse-variance weighted DerSimonian-Laird random effects meta-analyses. RESULTS Ten studies were eligible for inclusion comprising over 175 000 participants and 6700 deaths. For income (RR 1.55, 95% confidence interval (CI) 1.15-2.09), assets score (RR 1.63, 95% CI 1.12-2.36) and employment status (RR 1.52, 95% CI 1.21-1.92), persons of low socio-economic status had an over 50% higher risk of dying from HIV/AIDS. The RR of 1.10 for education was not significant (95% CI 0.74-1.65). CONCLUSIONS Future research should identify effective strategies to reduce HIV/AIDS mortality and alleviate the consequences of HIV/AIDS deaths, particularly for poorer households.
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Affiliation(s)
- Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Charles D H Parry
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Abstract
OBJECTIVES Empirical estimates of the number of HIV/AIDS deaths are important for planning, budgeting, and calibrating models. However, there is an extensive misattribution of HIV/AIDS as an underlying cause-of-death. This study estimates the true numbers of AIDS deaths from South African vital statistics between 1997 and 2010. METHODS Individual-level cause-of-death data were grouped according to a local burden of disease list and source causes (i.e. causes under which AIDS deaths are misclassified) that recorded a rapid increase. After adjusting for completeness of registration, the mortality rate of the source causes, by age and sex, was regressed on the lagged HIV prevalence to estimate the rate of increase correlated with HIV. Background trends in the source-cause mortality rates were estimated from the trend experienced among 75-84 year olds. RESULTS Of 214 causes considered, 19 were identified as potential sources for cause misattribution. High proportions of deaths from tuberculosis, lower respiratory infections (mostly pneumonia), diarrhoeal diseases, and ill-defined natural causes were estimated to be HIV-related, with only 7% of the estimated AIDS deaths being recorded as HIV. Estimated HIV/AIDS deaths increased rapidly, then reversed after 2006, totalling 2.8 million deaths over the whole period. The number was lower than model estimates from Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Burden of Disease Study. CONCLUSION Empirically based estimates confirm the considerable loss of life from HIV/AIDS and should be used for calibrating models of the AIDS epidemic which generally appear too low for infants but too high for other ages. Doctors are urged to specify HIV on death notifications to provide reliable cause-of-death statistics.
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Abstract
Despite comprising 0.7% of the world population, South Africa is home to 18% of the global human immunodeficiency virus (HIV) prevalence. Unyielding HIV subepidemics among adolescents threaten national attempts to curtail the disease burden. Should an HIV vaccine become available, establishing its point of entry into the health system becomes a priority. This study assesses the impact of school-based HIV vaccination and explores how variations in vaccine characteristics affect cost-effectiveness. The cost per quality adjusted life year (QALY) gained associated with school-based adolescent HIV vaccination services was assessed using Markov modeling that simulated annual cycles based on national costing data. The estimation was based on a life expectancy of 70 years and employs the health care provider perspective. The simultaneous implementation of HIV vaccination services with current HIV management programs would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the incremental cost effectiveness ratio (ICER) was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to duration of vaccine mediated protection and variations in vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values. School-based HIV vaccine services of adolescents, in addition to current HIV prevention and treatment health services delivered, would be cost-effective.
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Affiliation(s)
- Nishila Moodley
- From the Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (NM, GG); South African HVTN AIDS Vaccine Early Stage Investigator Program (SHAPe) (NM); The South African Department of Science and Technology/National Research Foundation (DST/NRF), Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa (NM); and Health Systems Governance and Finance, World Health Organization, Geneva (MB)
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Joubert J, Bradshaw D, Kabudula C, Rao C, Kahn K, Mee P, Tollman S, Lopez AD, Vos T. Record-linkage comparison of verbal autopsy and routine civil registration death certification in rural north-east South Africa: 2006-09. Int J Epidemiol 2014; 43:1945-58. [PMID: 25146564 PMCID: PMC4276059 DOI: 10.1093/ije/dyu156] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: South African civil registration (CR) provides a key data source for local health decision making, and informs the levels and causes of mortality in data-lacking sub-Saharan African countries. We linked mortality data from CR and the Agincourt Health and Socio-demographic Surveillance System (Agincourt HDSS) to examine the quality of rural CR data. Methods: Deterministic and probabilistic techniques were used to link death data from 2006 to 2009. Causes of death were aggregated into the WHO Mortality Tabulation List 1 and a locally relevant short list of 15 causes. The matching rate was compared with informant-reported death registration. Using the VA diagnoses as reference, misclassification patterns, sensitivity, positive predictive values and cause-specific mortality fractions (CSMFs) were calculated for the short list. Results: A matching rate of 61% [95% confidence interval (CI): 59.2 to 62.3] was attained, lower than the informant-reported registration rate of 85% (CI: 83.4 to 85.8). For the 2264 matched cases, cause agreement was 15% (kappa 0.1083, CI: 0.0995 to 0.1171) for the WHO list, and 23% (kappa 0.1631, CI: 0.1511 to 0.1751) for the short list. CSMFs were significantly different for all but four (tuberculosis, cerebrovascular disease, other heart disease, and ill-defined natural) of the 15 causes evaluated. Conclusion: Despite data limitations, it is feasible to link official CR and HDSS verbal autopsy data. Data linkage proved a promising method to provide empirical evidence about the quality and utility of rural CR mortality data. Agreement of individual causes of death was low but, at the population level, careful interpretation of the CR data can assist health prioritization and planning.
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Affiliation(s)
- Jané Joubert
- Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Chodziwadziwa Kabudula
- Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Chalapati Rao
- Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Kathleen Kahn
- Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The Uni
| | - Paul Mee
- Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Stephen Tollman
- Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The Uni
| | - Alan D Lopez
- Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Theo Vos
- Burden of Disease Research Unit, South African Medical Research Council, Parow Vallei, Western Cape, South Africa, School of Population Health, The University of Queensland, Brisbane, QLD, Australia, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia and Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
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Phillips DE, Lozano R, Naghavi M, Atkinson C, Gonzalez-Medina D, Mikkelsen L, Murray CJ, Lopez AD. A composite metric for assessing data on mortality and causes of death: the vital statistics performance index. Popul Health Metr 2014; 12:14. [PMID: 24982595 PMCID: PMC4060759 DOI: 10.1186/1478-7954-12-14] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/23/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Timely and reliable data on causes of death are fundamental for informed decision-making in the health sector as well as public health research. An in-depth understanding of the quality of data from vital statistics (VS) is therefore indispensable for health policymakers and researchers. We propose a summary index to objectively measure the performance of VS systems in generating reliable mortality data and apply it to the comprehensive cause of death database assembled for the Global Burden of Disease (GBD) 2013 Study. METHODS We created a Vital Statistics Performance Index, a composite of six dimensions of VS strength, each assessed by a separate empirical indicator. The six dimensions include: quality of cause of death reporting, quality of age and sex reporting, internal consistency, completeness of death reporting, level of cause-specific detail, and data availability/timeliness. A simulation procedure was developed to combine indicators into a single index. This index was computed for all country-years of VS in the GBD 2013 cause of death database, yielding annual estimates of overall VS system performance for 148 countries or territories. RESULTS The six dimensions impacted the accuracy of data to varying extents. VS performance declines more steeply with declining simulated completeness than for any other indicator. The amount of detail in the cause list reported has a concave relationship with overall data accuracy, but is an important driver of observed VS performance. Indicators of cause of death data quality and age/sex reporting have more linear relationships with simulated VS performance, but poor cause of death reporting influences observed VS performance more strongly. VS performance is steadily improving at an average rate of 2.10% per year among the 148 countries that have available data, but only 19.0% of global deaths post-2000 occurred in countries with well-performing VS systems. CONCLUSIONS Objective and comparable information about the performance of VS systems and the utility of the data that they report will help to focus efforts to strengthen VS systems. Countries and the global health community alike need better intelligence about the accuracy of VS that are widely and often uncritically used in population health research and monitoring.
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Affiliation(s)
- David E Phillips
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA ; National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, MOR 62100, México
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Charles Atkinson
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Diego Gonzalez-Medina
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Lene Mikkelsen
- LM Consulting, Independent Consultant, 4/78 Cairns St., Brisbane, QLD 4169, Australia
| | - Christopher Jl Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, 207 Bouverie St., Level 5, Melbourne, VIC 3010, Australia
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Udjo EO, Lalthapersad-Pillay P. Estimating maternal mortality and causes in South Africa: National and provincial levels. Midwifery 2014; 30:512-8. [DOI: 10.1016/j.midw.2013.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 05/20/2013] [Accepted: 05/27/2013] [Indexed: 11/30/2022]
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The Age Pattern of Increases in Mortality Affected by HIV: Bayesian Fit of the Heligman-Pollard Model to Data from the Agincourt HDSS Field Site in Rural Northeast South Africa. DEMOGRAPHIC RESEARCH 2013; 29:1039-1096. [PMID: 24453696 DOI: 10.4054/demres.2013.29.39] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND We investigate the sex-age-specific changes in the mortality of a prospectively monitored rural population in South Africa. We quantify changes in the age pattern of mortality in a parsimonious way by estimating the eight parameters of the Heligman-Pollard (HP) model of age-specific mortality. In its traditional form this model is difficult to fit and does not account for uncertainty. OBJECTIVE 1. To quantify changes in the sex-age pattern of mortality experienced by a population with endemic HIV. 2. To develop and demonstrate a robust Bayesian estimation method for the HP model that accounts for uncertainty. METHODS Bayesian estimation methods are adapted to work with the HP model. Temporal changes in parameter values are related to changes in HIV prevalence. RESULTS Over the period when the HIV epidemic in South Africa was growing, mortality in the population described by our data increased profoundly with losses of life expectancy of ~15 years for both males and females. The temporal changes in the HP parameters reflect in a parsimonious way the changes in the age pattern of mortality. We develop a robust Bayesian method to estimate the eight parameters of the HP model and thoroughly demonstrate it. CONCLUSIONS Changes in mortality in South Africa over the past fifteen years have been profound. The HP model can be fit well using Bayesian methods, and the results can be useful in developing a parsimonious description of changes in the age pattern of mortality. COMMENTS The motivating aim of this work is to develop new methods that can be useful in applying the HP eight-parameter model of age-specific mortality. We have done this and chosen an interesting application to demonstrate the new methods.
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Joubert J, Rao C, Bradshaw D, Vos T, Lopez AD. Evaluating the quality of national mortality statistics from civil registration in South Africa, 1997-2007. PLoS One 2013; 8:e64592. [PMID: 23724066 PMCID: PMC3664567 DOI: 10.1371/journal.pone.0064592] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/16/2013] [Indexed: 11/17/2022] Open
Abstract
Background Two World Health Organization comparative assessments rated the quality of South Africa’s 1996 mortality data as low. Since then, focussed initiatives were introduced to improve civil registration and vital statistics. Furthermore, South African cause-of-death data are widely used by research and international development agencies as the basis for making estimates of cause-specific mortality in many African countries. It is hence important to assess the quality of more recent South African data. Methods We employed nine criteria to evaluate the quality of civil registration mortality data. Four criteria were assessed by analysing 5.38 million deaths that occurred nationally from 1997–2007. For the remaining five criteria, we reviewed relevant legislation, data repositories, and reports to highlight developments which shaped the current status of these criteria. Findings National mortality statistics from civil registration were rated satisfactory for coverage and completeness of death registration, temporal consistency, age/sex classification, timeliness, and sub-national availability. Epidemiological consistency could not be assessed conclusively as the model lacks the discriminatory power to enable an assessment for South Africa. Selected studies and the extent of ill-defined/non-specific codes suggest substantial shortcomings with single-cause data. The latter criterion and content validity were rated unsatisfactory. Conclusion In a region marred by mortality data absences and deficiencies, this analysis signifies optimism by revealing considerable progress from a dysfunctional mortality data system to one that offers all-cause mortality data that can be adjusted for demographic and health analysis. Additionally, timely and disaggregated single-cause data are available, certified and coded according to international standards. However, without skillfully estimating adjustments for biases, a considerable confidence gap remains for single-cause data to inform local health planning, or to fill gaps in sparse-data countries on the continent. Improving the accuracy of single-cause data will be a critical contribution to the epidemiologic and population health evidence base in Africa.
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Affiliation(s)
- Jané Joubert
- School of Population Health, The University of Queensland, Herston, Brisbane, Queensland, Australia.
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Joubert J, Rao C, Bradshaw D, Dorrington RE, Vos T, Lopez AD. Characteristics, availability and uses of vital registration and other mortality data sources in post-democracy South Africa. Glob Health Action 2012; 5:1-19. [PMID: 23273252 PMCID: PMC3532367 DOI: 10.3402/gha.v5i0.19263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/18/2012] [Accepted: 11/21/2012] [Indexed: 11/03/2022] Open
Abstract
The value of good-quality mortality data for public health is widely acknowledged. While effective civil registration systems remains the 'gold standard' source for continuous mortality measurement, less than 25% of deaths are registered in most African countries. Alternative data collection systems can provide mortality data to complement those from civil registration, given an understanding of data source characteristics and data quality. We aim to document mortality data sources in post-democracy South Africa; to report on availability, limitations, strengths, and possible complementary uses of the data; and to make recommendations for improved data for mortality measurement. Civil registration and alternative mortality data collection systems, data availability, and complementary uses were assessed by reviewing blank questionnaires, death notification forms, death data capture sheets, and patient cards; legislation; electronic data archives and databases; and related information in scientific journals, research reports, statistical releases, government reports and books. Recent transformation has enhanced civil registration and official mortality data availability. Additionally, a range of mortality data items are available in three population censuses, three demographic surveillance systems, and a number of national surveys, mortality audits, and disease notification programmes. Child and adult mortality items were found in all national data sources, and maternal mortality items in most. Detailed cause-of-death data are available from civil registration and demographic surveillance. In a continent often reported as lacking the basic data to infer levels, patterns and trends of mortality, there is evidence of substantial improvement in South Africa in the availability of data for mortality assessment. Mortality data sources are many and varied, providing opportunity for comparing results and improved public health planning. However, more can and must be done to improve mortality measurement by improving data quality, triangulating data, and expanding analytic capacity. Cause data, in particular, must be improved.
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Affiliation(s)
- Jané Joubert
- School of Population Health, University of Queensland, Herston, QLD, Australia.
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18
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Burger EH, Groenewald P, Bradshaw D, Ward AM, Yudkin PL, Volmink J. Validation study of cause of death statistics in Cape Town, South Africa, found poor agreement. J Clin Epidemiol 2012; 65:309-16. [DOI: 10.1016/j.jclinepi.2011.08.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 06/02/2011] [Accepted: 08/08/2011] [Indexed: 11/30/2022]
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McIntyre D, Borghi J. Inside the black box: modelling health care financing reform in data-poor contexts. Health Policy Plan 2012; 27 Suppl 1:i77-87. [DOI: 10.1093/heapol/czs006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Foreman KJ, Lozano R, Lopez AD, Murray CJL. Modeling causes of death: an integrated approach using CODEm. Popul Health Metr 2012; 10:1. [PMID: 22226226 PMCID: PMC3315398 DOI: 10.1186/1478-7954-10-1] [Citation(s) in RCA: 281] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 01/06/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Data on causes of death by age and sex are a critical input into health decision-making. Priority setting in public health should be informed not only by the current magnitude of health problems but by trends in them. However, cause of death data are often not available or are subject to substantial problems of comparability. We propose five general principles for cause of death model development, validation, and reporting. METHODS We detail a specific implementation of these principles that is embodied in an analytical tool - the Cause of Death Ensemble model (CODEm) - which explores a large variety of possible models to estimate trends in causes of death. Possible models are identified using a covariate selection algorithm that yields many plausible combinations of covariates, which are then run through four model classes. The model classes include mixed effects linear models and spatial-temporal Gaussian Process Regression models for cause fractions and death rates. All models for each cause of death are then assessed using out-of-sample predictive validity and combined into an ensemble with optimal out-of-sample predictive performance. RESULTS Ensemble models for cause of death estimation outperform any single component model in tests of root mean square error, frequency of predicting correct temporal trends, and achieving 95% coverage of the prediction interval. We present detailed results for CODEm applied to maternal mortality and summary results for several other causes of death, including cardiovascular disease and several cancers. CONCLUSIONS CODEm produces better estimates of cause of death trends than previous methods and is less susceptible to bias in model specification. We demonstrate the utility of CODEm for the estimation of several major causes of death.
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Affiliation(s)
- Kyle J Foreman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Seattle, WA 98121, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Seattle, WA 98121, USA
| | - Alan D Lopez
- School of Population Health, University of Queensland, Level 2 Public Health, Herston Road, Herston QLD 4006, Australia
| | - Christopher JL Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Seattle, WA 98121, USA
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Byass P, Kahn K, Fottrell E, Mee P, Collinson MA, Tollman SM. Using verbal autopsy to track epidemic dynamics: the case of HIV-related mortality in South Africa. Popul Health Metr 2011; 9:46. [PMID: 21819601 PMCID: PMC3160939 DOI: 10.1186/1478-7954-9-46] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 08/05/2011] [Indexed: 11/15/2022] Open
Abstract
Background Verbal autopsy (VA) has often been used for point estimates of cause-specific mortality, but seldom to characterize long-term changes in epidemic patterns. Monitoring emerging causes of death involves practitioners' developing perceptions of diseases and demands consistent methods and practices. Here we retrospectively analyze HIV-related mortality in South Africa, using physician and modeled interpretation. Methods Between 1992 and 2005, 94% of 6,153 deaths which occurred in the Agincourt subdistrict had VAs completed, and coded by two physicians and the InterVA model. The physician causes of death were consolidated into a single consensus underlying cause per case, with an additional physician arbitrating where different diagnoses persisted. HIV-related mortality rates and proportions of deaths coded as HIV-related by individual physicians, physician consensus, and the InterVA model were compared over time. Results Approximately 20% of deaths were HIV-related, ranging from early low levels to tenfold-higher later population rates (2.5 per 1,000 person-years). Rates were higher among children under 5 years and adults 20 to 64 years. Adult mortality shifted to older ages as the epidemic progressed, with a noticeable number of HIV-related deaths in the over-65 year age group latterly. Early InterVA results suggested slightly higher initial HIV-related mortality than physician consensus found. Overall, physician consensus and InterVA results characterized the epidemic very similarly. Individual physicians showed marked interobserver variation, with consensus findings generally reflecting slightly lower proportions of HIV-related deaths. Aggregated findings for first versus second physician did not differ appreciably. Conclusions VA effectively detected a very significant epidemic of HIV-related mortality. Using either physicians or InterVA gave closely comparable findings regarding the epidemic. The consistency between two physician coders per case (from a pool of 14) suggests that double coding may be unnecessary, although the consensus rate of HIV-related mortality was approximately 8% lower than by individual physicians. Consistency within and between individual physicians, individual perceptions of epidemic dynamics, and the inherent consistency of models are important considerations here. The ability of the InterVA model to track a more than tenfold increase in HIV-related mortality over time suggests that finely tuned "local" versions of models for VA interpretation are not necessary.
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Affiliation(s)
- Peter Byass
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Glaziou P, Floyd K, Korenromp EL, Sismanidis C, Bierrenbach AL, Williams BG, Atun R, Raviglione M. Lives saved by tuberculosis control and prospects for achieving the 2015 global target for reducing tuberculosis mortality. Bull World Health Organ 2011; 89:573-82. [PMID: 21836756 DOI: 10.2471/blt.11.087510] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/04/2011] [Accepted: 05/11/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To assess whether the global target of halving tuberculosis (TB) mortality between 1990 and 2015 can be achieved and to conduct the first global assessment of the lives saved by the DOTS/Stop TB Strategy of the World Health Organization (WHO). METHODS Mortality from TB since 1990 was estimated for 213 countries using established methods endorsed by WHO. Mortality trends were estimated separately for people with and without human immunodeficiency virus (HIV) infection in accordance with the International classification of diseases. Lives saved by the DOTS/Stop TB Strategy were estimated with respect to the performance of TB control in 1995, the year that DOTS was introduced. FINDINGS TB mortality among HIV-negative (HIV-) people fell from 30 to 20 per 100,000 population (36%) between 1990 and 2009 and could be halved by 2015. The overall decline (when including HIV-positive [HIV+] people, who comprise 12% of all TB cases) was 19%. Between 1995 and 2009, 49 million TB patients were treated under the DOTS/Stop TB Strategy. This saved 4.6-6.3 million lives, including those of 0.23-0.28 million children and 1.4-1.7 million women of childbearing age. A further 1 million lives could be saved annually by 2015. CONCLUSION Improvements in TB care and control since 1995 have greatly reduced TB mortality, saved millions of lives and brought within reach the global target of halving TB deaths by 2015 relative to 1990. Intensified efforts to reduce deaths among HIV+ TB cases are needed, especially in sub-Saharan Africa.
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Affiliation(s)
- Philippe Glaziou
- World Health Organization, 20 avenue Appia 20, 1211 Geneva 27, Switzerland.
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Zwarenstein M, Fairall LR, Lombard C, Mayers P, Bheekie A, English RG, Lewin S, Bachmann MO, Bateman E. Outreach education for integration of HIV/AIDS care, antiretroviral treatment, and tuberculosis care in primary care clinics in South Africa: PALSA PLUS pragmatic cluster randomised trial. BMJ 2011; 342:d2022. [PMID: 21511783 PMCID: PMC3080737 DOI: 10.1136/bmj.d2022] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether PALSA PLUS, an on-site educational outreach programme of non-didactic, case based, iterative clinical education of staff, led by a trainer, can increase access to and comprehensiveness of care for patients with HIV/AIDS. DESIGN Cluster randomised trial. SETTING Public primary care clinics offering HIV/AIDS care, antiretroviral treatment (ART), tuberculosis care, and ambulatory primary care in Free State province, South Africa. PARTICIPANTS Fifteen clinics all implementing decentralisation and task shifting were randomised. The clinics cared for 400,000 general primary care patients and 10,136 patients in an HIV/AIDS/ART programme. There were 150 nurses. INTERVENTION On-site outreach education in eight clinics; no such education in seven (control). MAIN OUTCOME MEASURES Provision of co-trimoxazole prophylaxis among patients referred to the HIV/AIDS/ART programme, and detection of cases of tuberculosis among those in the programme. Proportion of patients in the programme enrolled through general primary care consultations. RESULTS Patients referred to the HIV/AIDS programme through general primary care at intervention clinics were more likely than those at control clinics to receive co-trimoxazole prophylaxis (41%, (2253/5523) v 32% (1340/4210); odds ratio 1.95, 95% confidence interval 1.11 to 3.40), and tuberculosis was more likely to be diagnosed among patients with HIV/AIDS/ART (7% (417/5793) v 6% (245/4343); 1.25, 1.01 to 1.55). Enrolment in the HIV/AIDS and ART programme through HIV testing in general primary care was not significantly increased (53% v 50%; 1.19, 0.51 to 2.77). Secondary outcomes were similar, except for weight gain, which was higher in the intervention group (2.3 kg v 1.9 kg, P<0.001). CONCLUSION Though outreach education is an effective and feasible strategy for improving comprehensiveness of care and wellbeing of patients with HIV/AIDS, there is no evidence that it increases access to the ART programme. It is now being widely implemented in South Africa. TRIAL REGISTRATION Current Controlled Trials ISRCTN 24820584.
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Dorrington RE, Bradshaw D. Maternal mortality in South Africa: lessons from a case study in the use of deaths reported by households in censuses and surveys. JOURNAL OF POPULATION RESEARCH 2011. [DOI: 10.1007/s12546-011-9050-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Birnbaum JK, Murray CJ, Lozano R. Exposing misclassified HIV/AIDS deaths in South Africa. Bull World Health Organ 2011; 89:278-85. [PMID: 21479092 DOI: 10.2471/blt.11.086280] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 01/18/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To quantify the deaths from human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) that are misattributed to other causes in South Africa's death registration data and to adjust for this bias. METHODS Deaths in the World Health Organization's mortality database were distributed among 48 mutually exclusive causes. For each cause, age- and sex-specific global death rates were compared with the average rate among people aged 65-69, 70-74 and 75-79 years to generate "relative" global death rates. Relative rates were also computed for South Africa alone. Differences between global and South African relative death rates were used to identify the causes to which deaths from HIV/AIDS were misattributed in South Africa and quantify the HIV/AIDS deaths misattributed to each. These deaths were then reattributed to HIV/AIDS. FINDINGS In South Africa, deaths from HIV/AIDS are often misclassified as being caused by 14 other conditions. Whereas in 1996-2006 deaths attributed to HIV/AIDS accounted for 2.0-2.5% of all registered deaths in South Africa, our analysis shows that the true cause-specific mortality fraction rose from 19% (uncertainty range: 7-28%) to 48% (uncertainty range: 38-50%) over that period. More than 90% of HIV/AIDS deaths were found to have been misattributed to other causes during 1996-2006. CONCLUSION Adjusting for cause of death misclassification, a simple procedure that can be carried out in any country, can improve death registration data and provide empirical estimates of HIV/AIDS deaths that may be useful in assessing estimates from demographic models.
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Affiliation(s)
- Jeanette Kurian Birnbaum
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue (Suite 600), Seattle, WA 98121, United States of America
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van Schalkwyk WA, Opie J, Novitzky N. The diagnostic utility of bone marrow biopsies performed for the investigation of fever and/or cytopenias in HIV-infected adults at Groote Schuur Hospital, Western Cape, South Africa. Int J Lab Hematol 2010; 33:258-66. [PMID: 21118385 DOI: 10.1111/j.1751-553x.2010.01280.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A bone marrow biopsy is frequently requested in the work-up of patients with human immunodeficiency virus (HIV) infection who present with fever and/or cytopenias in the search for opportunistic infections and malignancies. METHODS This is a retrospective review of the results of consecutive bone marrow biopsies performed at our institution over a three-year period on HIV-positive patients for the investigation of fever and/or cytopenias. Clinical data, haematological parameters, morphological features, Ziehl-Neelsen staining and microbiological culture results were analysed. The aim of the study was to determine the diagnostic yield of this investigation. RESULTS Sixty-three males and 84 female patients were included for analysis. The bone marrow biopsy gave a high diagnostic yield of 47% (70 patients) and a unique diagnosis in 33% (49 patients). Immune thrombocytopenic purpura and disseminated mycobacterial infections were the most common unique diagnoses made (14%, respectively), followed by malignancies (4%). In this cohort, four cases of primary bone marrow involvement by Hodgkin lymphoma and one case of involvement by non-Hodgkin lymphoma were diagnosed. CONCLUSION In our study group, a bone marrow biopsy was a useful investigation with a high diagnostic yield.
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Affiliation(s)
- W A van Schalkwyk
- Department of Haematology, Groote Schuur Hospital and National Health Laboratory Service, University of Cape Town, Cape Town, South Africa.
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Groenewald P, Bradshaw D, Daniels J, Zinyakatira N, Matzopoulos R, Bourne D, Shaikh N, Naledi T. Local-level mortality surveillance in resource-limited settings: a case study of Cape Town highlights disparities in health. Bull World Health Organ 2010; 88:444-51. [PMID: 20539858 PMCID: PMC2878147 DOI: 10.2471/blt.09.069435] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 10/27/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022] Open
Abstract
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.
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Affiliation(s)
- Pam Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa.
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Lopman B, Cook A, Smith J, Chawira G, Urassa M, Kumogola Y, Isingo R, Ihekweazu C, Ruwende J, Ndege M, Gregson S, Zaba B, Boerma T. Verbal autopsy can consistently measure AIDS mortality: a validation study in Tanzania and Zimbabwe. J Epidemiol Community Health 2010; 64:330-4. [PMID: 19854751 PMCID: PMC2922698 DOI: 10.1136/jech.2008.081554] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2009] [Indexed: 11/02/2022]
Abstract
BACKGROUND Verbal autopsy is currently the only option for obtaining cause of death information in most populations with a widespread HIV/AIDS epidemic. METHODS With the use of a data-driven algorithm, a set of criteria for classifying AIDS mortality was trained. Data from two longitudinal community studies in Tanzania and Zimbabwe were used, both of which have collected information on the HIV status of the population over a prolonged period and maintained a demographic surveillance system that collects information on cause of death through verbal autopsy. The algorithm was then tested in different times (two phases of the Zimbabwe study) and different places (Tanzania and Zimbabwe). RESULTS The trained algorithm, including nine signs and symptoms, performed consistently based on sensitivity and specificity on verbal autopsy data for deaths in 15-44-year-olds from Zimbabwe phase I (sensitivity 79%; specificity 79%), phase II (sensitivity 83%; specificity 75%) and Tanzania (sensitivity 75%; specificity 74%) studies. The sensitivity dropped markedly for classifying deaths in 45-59-year-olds. CONCLUSIONS Verbal autopsy can consistently measure AIDS mortality with a set of nine criteria. Surveillance should focus on deaths that occur in the 15-44-year age group for which the method performs reliably. Addition of a handful of questions related to opportunistic infections would enable other widely used verbal autopsy tools to apply this validated method in areas for which HIV testing and hospital records are unavailable or incomplete.
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Airhihenbuwa C, Okoror T, Shefer T, Brown D, Iwelunmor J, Smith E, Adam M, Simbayi L, Zungu N, Dlakulu R, Shisana O. Stigma, Culture, and HIV and AIDS in the Western Cape, South Africa: An Application of the PEN-3 Cultural Model for Community-Based Research. JOURNAL OF BLACK PSYCHOLOGY 2009; 35:407-432. [PMID: 22505784 PMCID: PMC3324276 DOI: 10.1177/0095798408329941] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV- and AIDS-related stigma has been reported to be a major factor contributing to the spread of HIV. In this study, the authors explore the meaning of stigma and its impact on HIV and AIDS in South African families and health care centers. They conducted focus group and key informant interviews among African and Colored populations in Khayelitsha, Gugulethu, and Mitchell's Plain in the Western Cape province. The audio-recorded interviews were transcribed and coded using NVivo. Using the PEN-3 cultural model, the authors analyzed results showing that participants' shared experiences ranged from positive/nonstigmatizing, to existential/unique to the contexts, to negative/stigmatizing. Families and health care centers were found to have both positive nonstigmatizing values and negative stigmatizing characteristics in addressing HIV/AIDS-related stigma. The authors conclude that a culture-centered analysis, relative to identity, is central to understanding the nature and contexts of HIV/AIDS-related stigma in South Africa.
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Taffa N, Will JC, Bodika S, Packel L, Motlapele D, Stein E, Roels TH, Kennedy G, Shenaaz EH. Validation of AIDS-related mortality in Botswana. J Int AIDS Soc 2009; 12:24. [PMID: 19852854 PMCID: PMC2775019 DOI: 10.1186/1758-2652-12-24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 10/24/2009] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mortality data are used to conduct disease surveillance, describe health status and inform planning processes for health service provision and resource allocation. In many countries, HIV- and AIDS-related deaths are believed to be under-reported in government statistics. METHODS To estimate the extent of under-reporting of HIV- and AIDS-related deaths in Botswana, we conducted a retrospective study of a sample of deaths reported in the government vital registration database from eight hospitals, where more than 40% of deaths in the country in 2005 occurred. We used the consensus of three physicians conducting independent reviews of medical records as the gold standard comparison. We examined the sensitivity, specificity and other validity statistics. RESULTS Of the 5276 deaths registered in the eight hospitals, 29% were HIV- and AIDS-related. The percentage of HIV- and AIDS-related deaths confirmed by physician consensus (positive predictive value) was 95.4%; however, the percentage of non-HIV- and non-AIDS-related deaths confirmed (negative predictive value) was only 69.1%. The sensitivity and specificity of the vital registration system was 55.7% and 97.3%, respectively. After correcting for misclassification, the percentage of HIV- and AIDS--related deaths was estimated to be in the range of 48.8% to 54.4%, depending on the definition. CONCLUSION Improvements in hospitals and within government offices are necessary to strengthen the vital registration system. These should include such strategies as training physicians and coders in accurate reporting and recording of death statistics, implementing continuous quality assurance methods, and working with the government to underscore the importance of using mortality statistics in future evidence-based planning.
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Affiliation(s)
- Negussie Taffa
- BOTUSA (Botswana-USA), Centers for Disease Control and Prevention, Gaborone, Botswana.
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Abstract
Modelling of trends in age-specific death rates in South Africa suggests that deaths attributable to HIV are often misclassified on death notification forms. We compared the underlying cause of death from death notification forms with that based on scrutiny of medical records for 683 deaths in Cape Town. Of 129 deaths caused by HIV according to medical records, only 35 (27.1%) were ascribed to HIV on the death notification form using strict coding and 83 (64.3%) using interpretive coding.
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Abstract
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.
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Kyobutungi C, Ziraba AK, Ezeh A, Yé Y. The burden of disease profile of residents of Nairobi's slums: results from a demographic surveillance system. Popul Health Metr 2008; 6:1. [PMID: 18331630 PMCID: PMC2292687 DOI: 10.1186/1478-7954-6-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 03/10/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With increasing urbanization in sub-Saharan Africa and poor economic performance, the growth of slums is unavoidable. About 71% of urban residents in Kenya live in slums. Slums are characteristically unplanned, underserved by social services, and their residents are largely underemployed and poor. Recent research shows that the urban poor fare worse than their rural counterparts on most health indicators, yet much about the health of the urban poor remains unknown. This study aims to quantify the burden of mortality of the residents in two Nairobi slums, using a Burden of Disease approach and data generated from a Demographic Surveillance System. METHODS Data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected between January 2003 and December 2005 were analysed. Core demographic events in the NUHDSS including deaths are updated three times a year; cause of death is ascertained by verbal autopsy and cause of death is assigned according to the ICD 10 classification. Years of Life Lost due to premature mortality (YLL) were calculated by multiplying deaths in each subcategory of sex, age group and cause of death, by the Global Burden of Disease standard life expectancy at that age. RESULTS The overall mortality burden per capita was 205 YLL/1,000 person years. Children under the age of five years had more than four times the mortality burden of the rest of the population, mostly due to pneumonia and diarrhoeal diseases. Among the population aged five years and above, HIV/AIDS and tuberculosis accounted for about 50% of the mortality burden. CONCLUSION Slum residents in Nairobi have a high mortality burden from preventable and treatable conditions. It is necessary to focus on these vulnerable populations since their health outcomes are comparable to or even worse than the health outcomes of rural dwellers who are often the focus of most interventions.
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Affiliation(s)
- Catherine Kyobutungi
- African Population & Health Research Center, P,O Box 10787, GPO 00100, Nairobi, Kenya.
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Yogurt containing probiotic Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 helps resolve moderate diarrhea and increases CD4 count in HIV/AIDS patients. J Clin Gastroenterol 2008; 42:239-43. [PMID: 18223503 DOI: 10.1097/mcg.0b013e31802c7465] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
HIV/AIDS is changing the human landscape in sub-Saharan Africa. Relatively few patients receive antiretroviral therapy, and many suffer from debilitating diarrhea that affects their quality of life. Given the track record of probiotics to alleviate diarrhea, conventional yogurt fermented with Lactobacillus delbruekii var bulgaricus and Streptococcus thermophilus was supplemented with probiotic Lactobacillus rhamnosus GR-1 and L. reuteri RC-14. Twenty-four HIV/AIDS adult female patients (18 to 44 y) with clinical signs of moderate diarrhea, CD4 counts over 200, and not receiving antiretrovirals or dietary supplements, consumed either 100 mL supplemented or unsupplemented yogurt per day for 15 days. Hematologic profiles, CD4 cell counts, and quality of life was evaluated at baseline, 15 and 30 days postprobiotic-yogurt feeding. There was no significant alteration in the hematologic parameters of both groups before and after the probiotic-yogurt feeding. The probiotic yogurt group at baseline, 15 and 30 days had a mean WBC count of 5.8+/-0.76 x 10(9)/L, 6.0+/-1.02 x 10(9)/L, and 5.4+/-0.14 x 10(9)/L, respectively. However, the mean CD4 cell count remained the same or increased at 15 and 30 days in 11/12 probiotic-treated subjects compared to 3/12 in the control. Diarrhea, flatulence, and nausea resolved in 12/12 probiotic-treated subjects within 2 days, compared to 2/12 receiving yogurt for 15 days. This is the first study to show the benefits of probiotic yogurt on quality of life of women in Nigeria with HIV/AIDS, and suggests that perhaps a simple fermented food can provide some relief in the management of the AIDS epidemic in Africa.
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Setel PW, Macfarlane SB, Szreter S, Mikkelsen L, Jha P, Stout S, AbouZahr C. A scandal of invisibility: making everyone count by counting everyone. Lancet 2007; 370:1569-77. [PMID: 17992727 DOI: 10.1016/s0140-6736(07)61307-5] [Citation(s) in RCA: 263] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cause of death and presence of respiratory disease at autopsy in an HIV-1 seroconversion cohort of southern African gold miners. AIDS 2007; 21 Suppl 6:S97-S104. [PMID: 18032945 DOI: 10.1097/01.aids.0000299416.61808.24] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe causes of death and respiratory infections in HIV-infected miners in the pre-antiretroviral era, by duration of HIV infection. DESIGN A retrospective cohort of 1950 gold miners with known dates of HIV seroconversion and 6164 HIV-negative miners was followed from the early 1990s to 2002. METHODS Causes of death were available from multiple sources: personnel records, clinical records, death certificates and autopsies of cardiorespiratory organs performed for compensation purposes. RESULTS Causes of death were known for 279 of 308 HIV-positive (91%) and 234 of 254 HIV-negative (92%) men who died while employed or within 6 months of leaving employment. The mortality rate from unnatural causes was similar in HIV-positive and HIV-negative miners and by duration of HIV infection. Among deaths from natural causes, 87% in HIV-positive and 41% in HIV-negative individuals were caused by infection (P < 0.001); 47% of HIV-positive and 26% of HIV-negative individuals had tuberculosis. The proportion of deaths from natural causes with any infection, or with specific infections (tuberculosis, cryptococcus, pneumocystis), did not vary with the duration of HIV infection. Autopsies were performed on 29% of men who died from natural causes: 83% of HIV-positive and 37% of HIV-negative men had respiratory infections (P < 0.001), half of which were clinically undiagnosed. CONCLUSION Tuberculosis was the leading cause of death in HIV-positive and negative men who died from natural causes. Although the mortality rate from natural causes increased greatly with the duration of HIV infection, the pattern of disease hardly changed, suggesting that slow and fast progressors succumb to the same range of diseases.
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Clarke DL, Thomson SR, Bissetty T, Madiba TE, Buccimazza I, Anderson F. A single surgical unit's experience with abdominal tuberculosis in the HIV/AIDS era. World J Surg 2007; 31:1087-96; discussion 1097-8. [PMID: 17426896 DOI: 10.1007/s00268-007-0402-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has resulted in a resurgence of abdominal tuberculosis in South Africa, and these patients often present to general surgeons. We describe a single-hospital experience in a region of high HIV prevalence. METHODS A prospective database of all patients with suspected abdominal tuberculosis was maintained from January 2003 until July 2005. RESULTS There were 67 patients (20 men, 47 women) with an average age of 32 years (range 27-61 years). The erythrocyte sedimentation rate was universally elevated (105 +/- 23). Altogether, 23 patients were HIV-positive and 7 were HIV-negative. The status was unknown in the remainder. Chest radiographs demonstrated an abnormality in 17 patients (22%). Abdominal ultrasonography was performed in 59 patients and computed tomography in 12. Twelve laparotomies were performed, seven as emergencies. None in the elective laparotomy group died, whereas the mortality rate in the emergency group was 60%. Laparoscopy was insufficient for a variety of reasons. Two patients underwent appendectomy and two excision of a perianal fistula. Two patients underwent biopsy of a palpable subcutaneous node, which confirmed the diagnosis in both cases. A definitive diagnosis was achieved in all 12 patients subjected to laparotomy and at colonoscopic biopsy in 2, lymph node biopsy in 2, appendectomy in 2, perianal fistulectomy in 2, and percutaneous drainage in 2. In the remaining 47 patients the diagnosis was made on the basis of the clinical presentation and radiologic imaging. The patients were commenced on antituberculous therapy. The in-hospital mortality in this group was 10%. Therapy was continued at a centralized tuberculosis facility independent of the hospital. Surgical follow-up was poor, with only five (7%) patients completing the 6-month review at a surgical clinic. CONCLUSIONS A resurgence in tuberculosis during the HIV era produces a new spectrum of presentations for the surgeon. Emergency surgery is associated with high mortality. Bacterial and histologic evidence of infection are difficult to obtain, and indirect clinical and imaging evidence are used to commence a trial of therapy. A short-term clinical response is regarded as proof of disease. Lack of follow-up means that the efficacy of this strategy is unproven. Health policy changes are needed to enable appropriate surgical follow-up to determine the most effective management algorithm.
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Affiliation(s)
- D L Clarke
- Department of General Surgery, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Congella, Durban, South Africa
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Spencer DC. Preventing bacterial disease in the HIV-infected of sub-saharan africa: The role of cotrimoxazole and the pneumococcal vaccines. Curr HIV/AIDS Rep 2007; 4:141-6. [PMID: 17884000 DOI: 10.1007/s11904-007-0021-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Bacterial infection is a major cause of morbidity and mortality among patients with HIV living in Africa. Broadening the scope of cotrimoxazole (CTX) prophylaxis to cover patients whose CD4 counts are above 200 cells/mm(3) has been suggested as a means of improving the control of infectious disease on the continent. CTX has demonstrated antimalarial benefit in Central and West Africa, but in areas of high bacterial resistance to CTX, the prophylactic role of CTX as an antibacterial agent is less clear. In particular there is little to suggest that prophylactic CTX provides reliable control against the pneumococcus. In both South Africa and the Gambia, several clinical studies with pneumococcal conjugate vaccines have resulted in improved clinical outcomes for children with and without HIV infection. There is clearly much more that needs to be done, and conjugate vaccines provide a unique opportunity to improve the future lives of Africa's children.
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Affiliation(s)
- David C Spencer
- Toga Laboratory and Kimera Consultants, Unit 7, Meadowdale Office Park, Cnr. Herman and Dick Kemp Streets, Meadowdale, Johannesburg 1610, South Africa.
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Reddi A, Leeper SC, Grobler AC, Geddes R, France KH, Dorse GL, Vlok WJ, Mntambo M, Thomas M, Nixon K, Holst HL, Karim QA, Rollins NC, Coovadia HM, Giddy J. Preliminary outcomes of a paediatric highly active antiretroviral therapy cohort from KwaZulu-Natal, South Africa. BMC Pediatr 2007; 7:13. [PMID: 17367540 PMCID: PMC1847430 DOI: 10.1186/1471-2431-7-13] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 03/17/2007] [Indexed: 12/02/2022] Open
Abstract
Background Few studies address the use of paediatric highly active antiretroviral therapy (HAART) in Africa. Methods We performed a retrospective cohort study to investigate preliminary outcomes of all children eligible for HAART at Sinikithemba HIV/AIDS clinic in KwaZulu-Natal, South Africa. Immunologic, virologic, clinical, mortality, primary caregiver, and psychosocial variables were collected and analyzed. Results From August 31, 2003 until October 31, 2005, 151 children initiated HAART. The median age at HAART initiation was 5.7 years (range 0.3–15.4). Median follow-up time of the cohort after HAART initiation was 8 months (IQR 3.5–13.5). The median change in CD4% from baseline (p < 0.001) was 10.2 (IQR 5.0–13.8) at 6 months (n = 90), and 16.2 (IQR 9.6–20.3) at 12 months (n = 59). Viral loads (VLs) were available for 100 children at 6 months of which 84% had HIV-1 RNA levels ≤ 50 copies/mL. At 12 months, 80.3% (n = 61) had undetectable VLs. Sixty-five out of 88 children (73.8%) reported a significant increase (p < 0.001) in weight after the first month. Eighty-nine percent of the cohort (n = 132) reported ≤ 2 missed doses during any given treatment month (> 95%adherence). Seventeen patients (11.3%) had a regimen change; two (1.3%) were due to antiretroviral toxicity. The Kaplan-Meier one year survival estimate was 90.9% (95%confidence interval (CI) 84.8–94.6). Thirteen children died during follow-up (8.6%), one changed service provider, and no children were lost to follow-up. All 13 deaths occurred in children with advanced HIV disease within 5 months of treatment initiation. In multivariate analysis of baseline variables against mortality using Cox proportional-hazards model, chronic gastroenteritis was associated with death [hazard ratio (HR), 12.34; 95%CI, 1.27–119.71) and an HIV-positive primary caregiver was found to be protective against mortality [HR, 0.12; 95%CI, 0.02–0.88). Age, orphanhood, baseline CD4%, and hemoglobin were not predicators of mortality in our cohort. Fifty-two percent of the cohort had at least one HIV-positive primary caregiver, and 38.4% had at least one primary caregiver also on HAART at Sinikithemba clinic. Conclusion This report suggests that paediatric HAART can be effective despite the challenges of a resource-limited setting.
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Affiliation(s)
- Anand Reddi
- Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa
| | | | - Anneke C Grobler
- CAPRISA, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Rosemary Geddes
- Department of Community Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - K Holly France
- Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa
| | - Gillian L Dorse
- Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa
| | - Willem J Vlok
- Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa
| | - Mbali Mntambo
- Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa
| | - Monty Thomas
- Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa
| | - Kristy Nixon
- Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa
| | - Helga L Holst
- Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa
| | - Quarraisha Abdool Karim
- CAPRISA, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Nigel C Rollins
- Department of Paediatrics and Child Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Hoosen M Coovadia
- Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Janet Giddy
- Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa
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Moyo S, Hawkridge T, Mahomed H, Workman L, Minnies D, Geiter LJ, Verver S, Kibel M, Hussey GD. Determining causes of mortality in children enrolled in a vaccine field trial in a rural area in the Western Cape Province of South Africa. J Paediatr Child Health 2007; 43:178-83. [PMID: 17316193 DOI: 10.1111/j.1440-1754.2007.01039.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM A mortality surveillance system was developed to identify and document causes of death among children enrolled in a tuberculosis vaccine field trial in South Africa. The aims of this study were to describe causes of mortality in children enrolled in a phase IV trial comparing intradermal with percutaneous administration of Bacille Calmette Guerin, and to compare causes of mortality recorded on death certificates with those obtained by clinical record review combined with verbal autopsies (CR/VA). METHODS For children who died, certified causes of death were compared with those determined by CR/VA. RESULTS Among 11677 children enrolled, 177 deaths were notified over 4 years. The incidence rate of death was 6.8/1000 person-years. Follow-up time ranged from 0.03 to 35.3 months (median 4 months; interquartile range 1.4-8.5). The infant mortality rate was 12.5/1000 live births and the neonatal mortality was 3/1000 live births. Pneumonia, gastroenteritis and septicaemia were among top causes of mortality by both methods. 'Sudden unexplained' and 'ill-defined' causes were among top causes of mortality based on CR/VA, while tuberculosis and 'natural causes' were among top causes based on death certificates. Important underlying causes of mortality by CR/VA include HIV/AIDS, prematurity/low birth weight and malnutrition. In 47% of deaths there was agreement on immediate causes of death. This increased to 54% when 'natural causes' and 'sudden unexplained deaths' were included. CONCLUSION In this cohort mortality was largely due to infectious diseases. While CR/VA provided additional information on most deaths, this was not always sufficient to assign specific causes of death.
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Affiliation(s)
- Sizulu Moyo
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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Hope is the pillar of the universe: Health-care providers’ experiences of delivering anti-retroviral therapy in primary health-care clinics in the Free State province of South Africa. Soc Sci Med 2007; 64:954-64. [DOI: 10.1016/j.socscimed.2006.10.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE To investigate the magnitude and temporal directionality of associations between illness and death, and income and expenditure, in households affected by HIV/AIDS. DESIGN AND SUBJECTS A cohort study with repeated measures carried out in 405 households (1913 occupants), known to have HIV-infected occupants and their neighbours, in one rural and one urban area of South Africa. MAIN OUTCOME MEASURES Monthly adult equivalent income and expenditure. Illness episodes and deaths attributed to HIV/AIDS, tuberculosis and pneumonia. METHODS Interview surveys of household heads were conducted at baseline and five more times, biannually, providing information on household economics, illnesses and deaths. Regression analyses used marginal structural models and 'before-after' models to analyse changes. RESULTS In marginal structural models, current or previous AIDS illness was independently associated with 34% [95% confidence intervals (CI) 23-43%] lower monthly expenditure, and current or recent poverty was associated with 1.74 (95% CI 0.94-3.2) times higher odds of an AIDS death. In before-after models, each AIDS death was independently associated with a 23% (95% CI 11-34%) greater expenditure decline over 3 years, and a 100 US dollars higher monthly expenditure at baseline was associated with 0.31 (95% CI 0.13-0.74) times as many AIDS deaths and with 0.41 (95% CI 0.27-0.64) times as many AIDS illness episodes over 3 years. CONCLUSION AIDS deaths and illnesses predicted declining expenditure and poverty predicted AIDS, suggesting that both welfare and effective treatment are needed.
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Affiliation(s)
- Max O Bachmann
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.
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43
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Book reviews. Population Studies 2006. [DOI: 10.1080/00324720600684734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chhagan MK, Kauchali S. Comorbidities and mortality among children hospitalized with diarrheal disease in an area of high prevalence of human immunodeficiency virus infection. Pediatr Infect Dis J 2006; 25:333-8. [PMID: 16567985 DOI: 10.1097/01.inf.0000207400.93627.4c] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the profile of comorbidities in children admitted with diarrhea to an urban hospital with high human immunodeficiency virus (HIV) prevalence in South Africa and to examine the contribution of comorbidities to inpatient mortality. METHODS Data from a retrospective random sample of 319 children were extracted and analyzed from a total of 1145 children hospitalized for diarrhea in 2001. We used multiple logistic regression models to determine the independent effects of HIV infection, malnutrition, pneumonia and bacteremia on inpatient mortality. RESULTS Overall 68% of the diarrheal admissions were classified as HIV-infected and 61% were classified as malnourished, with 53% having evidence of both. HIV infection was strongly associated with malnutrition, pneumonia and bacteremia. Inpatient mortality was 14% [95% confidence interval (CI), 11-19%]. Mortality was higher among HIV-infected than among uninfected children [crude odds ratio (OR), 6.0; 95% CI 2.1-17.0]. History of low birth weight, previous admission, malnutrition, HIV infection, pneumonia, bacteremia, low hemoglobin, total white blood cell count and serum albumin were significant predictors of mortality in univariate analyses. After adjustment, severe malnutrition (OR 2.1; 95% CI 1.0-4.9), bacteremia (OR 2.9; 95% CI 1.2-7.2) and pneumonia (OR 3.9; 95% CI 1.3-12.0) remained independent predictors of mortality, whereas the association between HIV infection and mortality was significantly diminished (OR 4.0; 95% CI 0.8-18.1). CONCLUSION In a setting of high HIV prevalence, malnutrition, bacteremia and pneumonia contribute independently to death in children hospitalized with diarrheal disease.
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Affiliation(s)
- Meera K Chhagan
- Department of Paediatrics and Child Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Abstract
Diarrhea in patients with AIDS is a worldwide problem that can have a devastating impact on quality of life for the patient. Chronic diarrhea, usually defined as at least 4 weeks' duration, is more common in patients with low CD4-positive T-lymphocyte counts, signaling advanced immunosuppression. Some organisms, such as Microsporidia, usually cause diarrhea only in the immunosuppressed; others, such as Cryptosporidium, Salmonella, Shigella, and Campylobacter, which are capable of causing diarrhea in the immunocompetent population, produce more severe or prolonged infections in people living with AIDS. Familiarity with the most common pathogens in the clinician's region will help with diagnosis and treatment. Because treatment options vary widely depending upon the infectious agent, thorough microbiologic evaluation is warranted. A stepped diagnostic approach of stool cultures and specialized microscopy and stains for protozoa, followed by sigmoidoscopy or colonoscopy and duodenoscopy with biopsies for histopathological examination is recommended in all patients with persistent, disabling diarrhea who have a CD4 count of less than 200/mm3, and should be considered for those with higher counts on an individual basis. Treatment, tailored to the specific pathogen, may need to be prolonged in the most severely immunocompromised patients to prevent relapse or recrudescence. For patients taking antiretroviral therapy (especially protease inhibitors) in whom no infectious agent can be found, diarrhea may be due to the medications. Nonspecific antidiarrheal agents should be tried until one that suits the patient is found. The most essential component of any therapeutic strategy for a patient with AIDS-associated diarrhea is restoration of the underlying immunologic defect using highly active antiretroviral therapy.
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Affiliation(s)
- Susan C Morpeth
- Division of Infectious Diseases and International Health, Duke University Medical Center, Box 3824, Durham, NC 27710, USA.
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Levy NC, Miksad RA, Fein OT. From treatment to prevention: the interplay between HIV/AIDS treatment availability and HIV/AIDS prevention programming in Khayelitsha, South Africa. J Urban Health 2005; 82:498-509. [PMID: 16049203 PMCID: PMC3456048 DOI: 10.1093/jurban/jti090] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
There is a paucity of research that illustrates the interplay between HIV/AIDS treatment and prevention programs. We describe the central role that public access to antiretroviral (ARV) medication has played in the development and efficacy of HIV/AIDS prevention programming in Khayelitsha, a resource-poor township in the Western Cape of South Africa. We document the range of preventive interventions and services available in Khayelitsha since the early 1990s and explore the impact of ARV availability on prevention efforts and disease stigma on the basis of extensive indepth interviews, supplemented by data collection. The information gathered suggests that the introduction of the mother-to-child-transmission (MTCT) prevention programs in 1999 and the three HIV treatment clinics run by Doctors Without Borders/Médecins Sans Frontières (MSF) in 2000 were turning points in the region's response to the HIV/AIDS epidemic. These programs have provided incentives for HIV testing, galvanized HIV/AIDS educators to reach populations most at risk, and decreased the HIV incidence rates in Khayeltisha compared to other areas in the Western Cape. Lessons learned in Khayelitsha about the value of treatment availability in facilitating prevention efforts can inform the development of comprehensive approaches to HIV/AIDS in other resource-poor areas.
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Affiliation(s)
- Nomi C. Levy
- Weill Medical College of Cornell University, 445 East 69th Street, 10021 New York, NY
| | - Rebecca A. Miksad
- WEill Cornell Medical Center of the New York-Presbyterian Hospital, New York, New York
| | - Oliver T. Fein
- Department of Medicine, Weill Medical College of Cornell University, New York, New York
- Department of Public Health, Weill Medical College of Cornell University, New York, New York
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Groenewald P, Bradshaw D, Dorrington R, Bourne D, Laubscher R, Nannan N. Identifying deaths from AIDS in South Africa: an update. AIDS 2005; 19:744-5. [PMID: 15821408 DOI: 10.1097/01.aids.0000166105.74756.62] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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