Is South Africa at crossroads? A shift in the burden of disease in South Africa points to a reduction in communicable diseases and an increase in injuries and non-communicable diseases

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Statistics South Africa published the 2011 statistical release on Mortality and Causes of Death report which presents statistics on the number and causes of death for 2011 by selected characteristics. In total, 505 803 deaths that occurred in 2011 were registered. The downward trend observed since 2007 in the number of deaths occurring in the country per year continues.

The number of deaths between 2010 and 2011 decreased by 7,7% while during 2009–2010 and 2008–2009 the number of deaths decreased by 5,6% and 2,6%, respectively, which is an indication that the number of deaths are annually decreasing at an increasing rate. The statistical release also provides information on trends in mortality and causes of deaths that occurred during the period 1997 to 2011.

The release is based on data collected by the Department of Home Affairs (DHA) through the death registration system. It is estimated that this system covered 94% of adult deaths in the country during 2007–2011. For all these periods, the rate of decrease was much higher for females as opposed to males. Between 2010 and 2011 female deaths decreased by 8,2% while male deaths decreased by 7,5%.

Increasing levels of mortality that was observed before 2007 was prominent among females. The increase in the number of deaths was also associated with increases in deaths due to communicable diseases particularly tuberculosis, influenza and pneumonia and intestinal infectious diseases which have remained in the ten leading causes of death in the country since 1997.

The decrease in the number of deaths observed since 2007 has also been associated with decreases in tuberculosis, influenza and pneumonia and intestinal infectious diseases, more so among females. While these causes remain among the ten leading causes of death in the country, their relative importance in mortality is decreasing over time. However, among the ten leading causes of death due to communicable diseases, the proportion of deaths due to HIV disease continues to increase, although at a very slow pace (from 3,1% in 2009 to 3,4% in 2010).

In the recent years, there has been a modest increase in the proportion of deaths due to specific non-communicable diseases. Among the ten leading causes of death, the proportion of death due to the following causes increased: other forms of heart disease (particularly heart failure), cerebrovascular disease (largely stroke), diabetes mellitus, and hypertensive diseases. The contribution of these diseases to the overall number of deaths in 2009 was 15,2% and increased to 17,0% in 2011. The proportion of deaths due to injuries also increased slightly from 8,7% in 2009 to 9,1% in 2011.

On a general note, the proportion of deaths due to certain infectious and parasitic diseases and diseases of the respiratory diseases have declined while there has been an increase in the proportion of deaths due to diseases of the circulatory system; neoplasms (cancers); endocrine, nutritional and metabolic disease; and external causes of morbidity and mortality.

On the one hand, there is clear indication that communicable diseases are decreasing in the country and that the force of mortality is reducing particularly for females. On the other hand, the relative contribution of non-communicable diseases and injuries are on the increase. Do these changes leave the health system at crossroads in terms of what should be prioritised, without losing the battle on the existing burden of communicable diseases and addressing emerging health issues?

-The full report is available on the Statistics South Africa website: www.statssa.gov.za