Ria Laubscher

Hypertension in South African adults: results from the Demographic and Health Survey, 1998

Objectives To determine the prevalence and treatment status of hypertension in South Africa. Design National cross-sectional survey. Setting 13 802 randomly selected South Africans, 15 years and older, were visited in their homes in 1998. Methods Trained fieldworkers completed questionnaires on lifestyle and chronic diseases, measured blood pressure with an Omron manometer and recorded chronic drug utilization. Drugs were classified using the Anatomical Therapeutic Chemical index. Results The mean systolic blood pressure for men and women was 123 mmHg (SE 0.37) and 119 mmHg (SE 0.36), while the mean diastolic level was 76 mmHg (SE 0.25) and 75 mmHg (SE 0.20), respectively. When using a cut-off point of 140/90 mmHg the hypertension prevalence rate (age-adjusted to the South African Population, Census 1996) was 21% for both genders. Using the current cut-off point (160/95 mmHg) for South Africa, the prevalence rate was 11% for men and 14% for women. For men with hypertension, the level of awareness, taking antihypertensive medication and having controlled blood pressure (< 160/95 mmHg) were 41, 39 and 26% respectively, while for women these rates were 67, 55 and 38% respectively. Conclusions This survey revealed high levels of hypertension in the South African community with inadequate treatment status.

Identifying deaths from AIDS in South Africa.

Objective:To quantify the HIV/AIDS deaths misclassified to AIDS-related conditions in South Africa. Design:Retrospective analysis of vital registration data. Methods:Cause-specific death rates for 1996 and 2000–2001 were calculated using vital registration cause-of-death profiles applied to a model (ASSA2000) estimate of total mortality rates by age and sex. The difference in the age-specific death rates for these two periods was examined to identify conditions where there was a noticeable increase in mortality following the same age pattern as the HIV deaths, thus likely to be misclassified AIDS deaths. Results:The increase in the age-specific death rates for HIV-related deaths showed a distinct age pattern, which has been observed elsewhere. Out of the 22 potential causes of death investigated, there were nine that increased in the same distinct age pattern (tuberculosis, pneumonia, diarrhoea, meningitis, other respiratory disease, non-infective gastroenteritis, other infectious and parasitic diseases, deficiency anaemias and protein energy malnutrition) and could be considered AIDS-related conditions. The increase in these conditions accounted for 61% of the total deaths related to HIV/AIDS. When added to the deaths classified as HIV-related on the death certificate, the total accounts for 93% of the ASSA2000 model estimates of the number of AIDS deaths in 2000. Conclusion:As a large proportion of AIDS deaths appear to be classified to AIDS-related conditions, without reference to HIV, interpretation of death statistics in South Africa cannot be made on face value as a large proportion of deaths caused by HIV infection are misclassified.

Tobacco Use in South Africans During 1998: The First Demographic and Health Survey

Objective To determine smoking patterns in South Africa, and to identify groups requiring culturally appropriate smoking cessation programmes. Methods A random sample of 13826 people (> 15 years), was interviewed to identify tobacco use patterns and respiratory symptoms. Peak expiratory flow rates were measured. Multinomial regression analyses identified socio-demographic factors related to tobacco use, and the latters association with respiratory conditions. Results In 1998, 24.6% adults (44.2% of males and 11.0% of females) smoked regularly. Coloured women had a higher rate (39%) than African women (5.4%). About 24% of the regular smokers had attempted to quit, with only 9.9% succeeding. African women (13.2%) used smokeless tobacco more frequently than others. Of the nonsmokers 28% and 19% were exposed to environmental tobacco smoke in their homes and workplaces, respectively. The regression analysis showed that the demographic characteristics of light smokers (1–14 tobacco equivalents per day) and heavy smokers (≥ 15 tobacco equivalents per day) differed. Light smoking occurred significantly more frequently in the poorest, least educated and urban people. The relative risk for light smoking was 18 in Coloured women compared with African women. Heavy smoking occurred most frequently in the highest educated group. A dose—response was observed between the amount smoked and the presence of respiratory diseases. Conclusions Smoking in South Africa is decreasing and should continue with the recently passed tobacco control legislation. Culturally appropriate tobacco cessation programmes for the identified target groups need to be developed.

Provincial mortality in South Africa, 2000- priority-setting for now and a benchmark for the future

BACKGROUND Cause-of-death statistics are an essential component of health information. Despite improvements, underregistration and misclassification of causes make it difficult to interpret the official death statistics. OBJECTIVE To estimate consistent cause-specific death rates for the year 2000 and to identify the leading causes of death and premature mortality in the provinces. METHODS Total number of deaths and population size were estimated using the Actuarial Society of South Africa ASSA2000 AIDS and demographic model. Cause-of-death profiles based on Statistics South Africas 15% sample, adjusted for misclassification of deaths due to ill-defined causes and AIDS deaths due to indicator conditions, were applied to the total deaths by age and sex. Age-standardised rates and years of life lost were calculated using age weighting and discounting. RESULTS Life expectancy in KwaZulu-Natal and Mpumalanga is about 10 years lower than that in the Western Cape, the province with the lowest mortality rate. HIV/AIDS is the leading cause of premature mortality for all provinces. Mortality due to pre-transitional causes, such as diarrhoea, is more pronounced in the poorer and more rural provinces. In contrast, non-communicable disease mortality is similar across all provinces, although the cause profiles differ. Injury mortality rates are particularly high in provinces with large metropolitan areas and in Mpumalanga. CONCLUSION The quadruple burden experienced in all provinces requires a broad range of interventions, including improved access to health care; ensuring that basic needs such as those related to water and sanitation are met; disease and injury prevention; and promotion of a healthy lifestyle. High death rates as a result of HIV/AIDS highlight the urgent need to accelerate the implementation of the treatment and prevention plan. In addition, there is an urgent need to improve the cause-of-death data system to provide reliable cause-of-death statistics at health district level.

Estimating the burden of disease attributable to high blood pressure in South Africa in 2000

OBJECTIVES To estimate the burden of disease attributable to high blood pressure (BP) in adults aged 30 years and older in South Africa in 2000. DESIGN World Health Organization comparative risk assessment (CRA) methodology was followed. Mean systolic BP (SBP) estimates by age and sex were obtained from the 1998 South African Demographic and Health Survey adult data. Population-attributable fractions were calculated and applied to revised burden of disease estimates for the relevant disease categories for South Africa in 2000. Monte Carlo simulation-modelling techniques were used for uncertainty analysis. SETTING South Africa. SUBJECTS Adults aged 30 years and older. OUTCOME MEASURES Mortality and disability-adjusted life years (DALYs) from ischaemic heart disease (IHD), stroke, hypertensive disease and other cardiovascular disease (CVD). RESULTS High BP was estimated to have caused 46,888 deaths (95% uncertainty interval 44,878 - 48,566) or 9% (95% uncertainty interval 8.6 - 9.3%) of all deaths in South Africa in 2000, and 390,860 DALYs (95% uncertainty interval 377,955 - 402,256) or 2.4% of all DALYs (95% uncertainty interval 2.3 - 2.5%) in South Africa in 2000. Overall, 50% of stroke, 42% of IHD, 72% of hypertensive disease and 22% of other CVD burden in adult males and females (30+ years) were attributable to high BP (systolic BP >or= 115 mmHg). CONCLUSIONS High BP contributes to a considerable burden of CVD in South Africa and results indicate that there is considerable potential for health gain from implementing BP-lowering interventions that are known to be highly costeffective.

Prevalence and predictors of problematic alcohol use, risky sexual practices and other negative consequences associated with alcohol use among safety and security employees in the Western Cape, South Africa

IntroductionHarmful alcohol use can compromise worker health and productivity. Persons employed in safety-sensitive occupations are particularly vulnerable to hazardous alcohol use and its associated risks. This study describes the patterns of harmful alcohol use, related HIV risks and risk factors for the harmful use of alcohol among a sample of employees in South Africa working in the safety and security sector.MethodsA cross-sectional study that formed the baseline for a clustered randomized control trial was undertaken in 2011. A random sample of 325 employees employed within a safety and security sector of a local municipality in the Western Cape Province of South Africa participated in the study. Data were collected by means of an 18-page self-administered structured questionnaire and analyzed using SAS/STAT software version 9.2. For all significance testing, the F-statistic and p-values are reported.ResultsThree hundred and twenty-five employees were surveyed. Findings suggest that more than half (76.1%) of the 78.9% of participants who consumed alcohol engaged in binge drinking, with close to a quarter reporting a CAGE score greater than the cut-off of 2, indicating potentially hazardous drinking patterns. The study further found that employees who use alcohol are more likely to engage in risky sexual practices when under the influence. A favorable drinking climate (p < 0.001) and poor levels of group cohesion (p = 0.009) were significantly correlated to binge drinking.ConclusionThis study identifies alcohol-related behaviors and associated risks in the context of safety-sensitive occupations at the workplace. It suggests that persons employed within such positions are at high risk for developing alcohol-related disorders and for contracting HIV. This study highlights the need for testing a comprehensive package of services designed to prevent hazardous alcohol use among safety and security employees.

HIV/AIDS data in South Africa

Sir—In your Oct 27 editorial, you include an important error in that you accept and endorse data from the South African Medical Council (MRC) on the impact of HIV/AIDS on adult mortality. What the MRC published were actually extrapolations and projections based on Bangui and other questionable registrations in a situation in which reliable statistics are not available. The South African Government, therefore, was and still is justified in not accepting these data at face value.

ASSESSING FIELDWORKER RELIABILITY IN A NATIONAL STUDY OF INJURY MORTALITY IN SOUTH AFRICA

Background Vital registration data indicate that injury deaths have decreased since the first National Burden of Disease (NBD) study in South Africa for 2000 but it is not clear which injury types may have been affected as a high proportion have undetermined intent. In order to quantity injury types, as part of the second NBD study, we conducted a national survey of non-natural deaths presenting to South African mortuaries in 2009. Aims/Objectives/Purpose To test inter-observer reliability between fieldworkers. Methods Lay interviewers were trained to identify the external cause of injury and mobile telephones were used for data capture. The main study sampled 22 000 records from 45 mortuaries. Reliability was tested by two field-workers independently collecting data from the same folder on the same day for 5% of the sample. The proportion of potential agreement beyond chance between two data collectors extracting the same data was determined using the Kappa score, with a value of 0.6 denoting substantial and a value of greater than 0.8 denoting near perfect agreement. Results/Outcome Based on data from 1025 cases, the agreement on the manner of death showed high agreement with a Kappa of 0.861 (95% CI 0.837 to 0.884). There was 88.8% agreement on the detailed information about the external cause of the injury death. Significance/Contribution to the Field Fieldworker coding errors are a potential source of bias in injury surveys, particularly when information is interpreted from secondary sources. The current study provides a simple and cost-effective method with which to measure the reliability of information.