Browsing by Author "Bradshaw, Debbie"

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    A comparative risk assessment for South Africa in 2000: Towards promoting health and preventing disease
    (2007) Norman, Rosana; Bradshaw, Debbie; Schneider, Michelle; Joubert, Jane; Groenewald, Pam; Lewin, Simon; Steyn, Krisela; Vos, Theo; Loubscher, Ria; Nannan, Nadine; Nojilana, Beatrice; Pieterse, Desiréé; the South African Comparative Risk Assessment Collaborating Group
    A landmark project of the Medical Research Council, the first South African National Burden of Disease (SA NBD) study, identified the underlying causes of premature mortality and morbidity experienced in South Africa in the year 2000. (1) These estimates were recently revised (2) on the basis of additional data to estimate the disability-adjusted life years (DALYs) for single causes for the first time in South Africa. DALYs are a comprehensive measure of the disease burden combining the years of life lost (YLLs) as a result of premature mortality and years lived with disability (YLDs) related to illness or injury. (3) Compared with the use of mortality as a measure of disease burden, DALYs also capture the contributions of conditions that do not result in large numbers of deaths. For example, mental health disorders have a large disability component relative to the number of deaths. The SA NBD study highlighted the fact that despite levels of uncertainty there is important information to guide public health responses to improve the health of the nation.
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    Alcohol as a risk factor for train commuting fatalities
    (2001) Matzopoulos, Richard; Peden, Margie; Bradshaw, Debbie
    Railway fatalities are an important subset of transport-related fatalities, which account for about 60% of the fatal unintentional injuries occurring in Cape Town. The Medical Research Council reviewed three and a half years of rail injury data and found that alcohol was one of the main risk factors. Furthermore, 33% of South Africa’s national rail fatalities tested positive for alcohol in 1999. Despite the links between alcohol and all types of transport- related injury, prevention efforts have targeted motor vehicle (MV) drivers exclusively. This study aimed to clarify the relationship between alcohol and the risk of all types of transport-related injury (particularly rail injury). Post mortem reports for transport fatalities were collected retrospectively from the two cape Town mortuaries at Salt River and Tygerberg for the period 1 January 1994 to 31 December 1996. A case control study design was used with the cases comprising rail passenger and rail pedestrian fatalities, while motor vehicle drivers and passengers were the controls for the passenger group and motor vehicle pedestrians were the controls for rail pedestrians. Blood alcohol concentration was the dependent variable, the independent variables were age, sex, race, date of death, day of week, time of injury and mechanism of death and the odds ratio was used as the measure of relative risk The study showed that alcohol consumption is an important risk-factor for rail fatalities. The odds ratios imply that rail passengers are 5.23 or 2.3 times as likely to be intoxicated than motor vehicle passengers or motor vehicle drivers respectively, while rail pedestrians are 1.44 times more likely to be intoxicated than motor vehicle pedestrian fatalities. Alcohol plays as important a role, if not more so, for drunken rail passengers and pedestrians as it does for drunken drivers and road pedestrians. The role of alcohol in rail pedestrian fatalities is significant when compared to motor-vehicle pedestrians as a control group. The study has also demonstrated that data provided by the National injury Mortality Surveillance System can form the basis for analytic studies on the risk-factors of injury. The results complement a growing body of research that documents the adverse health effects of excessive alcohol consumption and provide more evidence for public health campaigners to tackle endemic alcohol abuse in South Africa.
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    Child mortality in South Africa - we have lost touch
    (2007) Bradshaw, Debbie; Dorrington, Rob
    Reducing child mortality is, appropriately, one of the eight Millennium Development Goals (MDGs) for reducing poverty and inequality in the world. The target for this goal is to reduce child mortality by 2015 by two-thirds of the rate in 1990. Monitoring child mortality rates, however, is posing a challenge for low- and middle-income countries. Estimates that many countries, particularly in Africa, use to track progress in meeting this goal have to be extrapolated from earlier empirical data, since there are no up-to-date data. Despite great strides that have been made in improving population health statistics, South Africa is unfortunately no exception. The most recent reasonably reliable estimates of child mortality for South Africa are for the mid-1990s, in other words 10 years out of date.
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    Estimates of the level and shape of mortality rates in South Africa around 1985 and 1990 derived by applying indirect demographic techniques to reported deaths
    (1998) Dorrington, Rob; Bradshaw, Debbie; Wegner, Trevor
    This research attempts firstly to estimate both the level and shape of the mortality curve of the Black South African population group circa 1985 by the application of indirect demographic techniques to the reported deaths for Blacks for the period 1984- 86 and an estimate of the Black population in mid-1985. The life tables thus produced are then combined with the official South African Life Tables for Whites, Coloureds and Asians to produce a weighted average national life tables circa 1985. These national life tables are then compared with those produced by applying the Bennett and Horiuchi method to national data for the 1984-86 period in order to decide on suitable adjustments to make when applying the Bennett and Horiuchi method to national data for the period 1989-91 and beyond.
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    Estimating injury mortality in South Africa and identifying urban-rural differences
    (2019) Prinsloo, Megan; Myers, Jonathan; Bradshaw, Debbie; Matzopoulos, Richard
    The overarching aim of this thesis is to utilise national data on injury mortality in South Africa, to conduct advanced statistical analyses to identify urban-rural differences for injury deaths, and to gain insight into the explanatory variables for homicide in metropolitan- and non-metropolitan (metro- and non-metro) areas. The literature review describes the global and national estimates of injury mortality and reports higher rural than urban injury mortality rates for high-income countries. It further discusses a framework for assessing data quality and reviews South Africa’s fatal and non-fatal injury data sources, issues of under-reporting and misclassification of deaths. The risk factors for violence are reviewed, which inform particular hypotheses on the role of age, sex, race, day of week and firearms with regard to homicide. The Injury Mortality Survey (IMS) data, which estimated 52 493 injury deaths nationally in 2009, is utilised for this PhD study. Data quality is assessed using an internationally developed conceptual framework for mortality data. Exploratory and multiple correspondence analysis identified possible associations between metro/nonmetro and other explanatory variables, prior to more sophisticated multinomial logistic regression analysis, which adjusted for age, sex, race and metro/non-metro for each manner of death (homicide, suicide, transport-related and other unintentional injury deaths) to explore particular hypotheses for the differences in the metro/non-metro injury mortality profile. Age-standardised injury mortality rates were calculated to take into account the effects of different age structures for metro- and non-metro populations. Generalized linear models were fitted in relation to particular hypotheses to determine the explanatory variables for homicide deaths in both metro and nonmetro areas. Main findings include a significantly higher likelihood for homicide in metro areas compared to non-metro areas, while transport-related deaths were significantly lower in metro areas. The risk of homicide for Coloureds was higher than Blacks in metro areas, while Blacks, Coloureds and Asians had similar risks of homicide in non- metro areas. Whites had a similar risk and Asians a higher risk of homicide in nonmetro areas compared with metro areas. Firearm use was shown to significantly explain metro/non-metro differences in homicide risks. This study’s most significant knowledge contribution includes the identification of metro/non-metro as a significant predictor of the injury mortality profile in South Africa. The association of metro/non-metro differences in the pattern of homicide for Blacks and Coloureds, also resolved conflicting statements found in the literature regarding race and homicide in South Africa. The results are of considerable significance to national and provincial policy makers. Recommendations are made in relation to the main findings of this study.
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    Estimating the burden of disease attributable to childhood and maternal undernutrition in South Africa in 2000
    (2007) Nannan, Nadine; Norman, Rosana; Hendricks, Michael; Dhansay, Muhammad A; Bradshaw, Debbie; South African Comparative Risk Assessment Collaborating Group
    Objectives. To estimate the disease burden attributable to being underweight as an indicator of undernutrition in children under 5 years of age and in pregnant women for the year 2000. Design. World Health Organization comparative risk assessment (CRA) methodology was followed. The 1999 National Food Consumption Survey prevalence of underweight classified in three low weight-for-age categories was compared with standard growth charts to estimate population-attributable fractions for mortality and morbidity outcomes, based on increased risk for each category and applied to revised burden of disease estimates for South Africa in 2000. Maternal underweight, leading to an increased risk of intra-uterine growth retardation and further risk of low birth weight (LBW), was also assessed using the approach adopted by the global assessment. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. Setting. South Africa. Subjects. Children under 5 years of age and pregnant women. Outcome measures. Mortality and disability-adjusted life years (DALYs) from protein- energy malnutrition and a fraction of those from diarrhoeal disease, pneumonia, malaria, other nonHIV/AIDS infectious and parasitic conditions in children aged 0 - 4 years, and LBW. Results. Among children under 5 years, 11.8% were underweight. In the same age group, 11 808 deaths (95% uncertainty interval 11 100 - 12 642) or 12.3% (95% uncertainty interval 11.5 - 13.1%) were attributable to being underweight. Protein-energy malnutrition contributed 44.7% and diarrhoeal disease 29.6% of the total attributable burden. Childhood and maternal underweight accounted for 2.7% (95% uncertainty interval 2.6 - 2.9%) of all DALYs in South Africa in 2000 and 10.8% (95% uncertainty interval 10.2 - 11.5%) of DALYs in children under 5. Conclusions. The study shows that reduction of the occurrence of underweight would have a substantial impact on child mortality, and also highlights the need to monitor this important indicator of child health.
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    Initial burden of disease estimates for South Africa, 2000
    (2003) Bradshaw, Debbie; Groenewald, Pam; Laubscher, Ria; Nannan, Nadine; Nojilana, Beatrice; Norman, Rosana; Pieterse, Desiréé; Schneider, Michelle; Bourne, David E; Ian M Timæus; Dorrington, Rob; Johnson, Leigh
    Background. This paper describes the first national burden of disease study for South Africa. The main focus is the burden due to premature mortality, i.e. years of life lost (YLLs). In addition, estimates of the burden contributed by morbidity, i.e. the years lived with disability (YLDs), are obtained to calculate disability-adjusted life years (DALYs); and the impact of AIDS on premature mortality in the year 2010 is assessed. Method. Owing to the rapid mortality transition and the lack of timely data, a modelling approach has been adopted. The total mortality for the year 2000 is estimated using a demographic and AIDS model. The non-AIDS cause-of-death profile is estimated using three sources of data: Statistics South Africa, the National Department of Home Affairs, and the National Injury Mortality Surveillance System. A ratio method is used to estimate the YLDs from the YLLestimates. Results. The top single cause of mortality burden was HIV/AIDS followed by homicide, tuberculosis, road traffic accidents and diarrhoea. HIV/AIDS accounted for 38% of total YLLs, which is proportionately higher for females (47%) than for males (33%). Pre-transitional diseases, usually associated with poverty and underdevelopment, accounted for 25%, non-communicable diseases 21% and injuries 16% of YLLs. The DALY estimates highlight the fact that mortality alone underestimates the burden of disease, especially with regard to unintentional injuries, respiratory disease, and nervous system, mental and sense organ disorders. The impact of HIV/AIDS is expected to more than double the burden of premature mortality by the year 2010 Conclusion. This study has drawn together data from a range of sources to develop coherent estimates of premature mortality by cause. South Africa is experiencing a quadruple burden of disease comprising the pre-transitional diseases, the emerging chronic diseases, injuries, and HIV/AIDS. Unless interventions that reduce morbidity and delay morbidity become widely available, the burden due to HIV/AIDS can be expected to grow very rapidly in the next few years. An improved base of information is needed to assess the morbidity impact more accurately
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    Initial burden of disease estimates for South Africa, 2000
    (2003) Bradshaw, Debbie; Groenewald, Pam; Laubscher, Ria; Nannan, Nadine; Nojilana, Beatrice; Rosana, Norman; Pieterse, Desiréé; Schneider, Michelle; Bourne, David E; Timæus, Ian M; Dorrington, Rob; Johnson, Leigh
    Background. This paper describes the first national burden of disease study for South Africa. The main focus is the burden due to premature mortality, i.e. years of life lost (YLLs). In addition, estimates of the burden contributed by morbidity, i.e. the years lived with disability (YLDs), are obtained to calculate disability-adjusted life years (DALYs); and the impact of AIDS on premature mortality in the year 2010 is assessed. Method. Owing to the rapid mortality transition and the lack of timely data, a modelling approach has been adopted. The total mortality for the year 2000 is estimated using a demographic and AIDS model. The non-AIDS cause-of-death profile is estimated using three sources of data: Statistics South Africa, the National Department of Home Affairs, and the National Injury Mortality Surveillance System. A ratio method is used to estimate the YLDs from the YLLestimates. Results. The top single cause of mortality burden was HIV/AIDS followed by homicide, tuberculosis, road traffic accidents and diarrhoea. HIV/AIDS accounted for 38% of total YLLs, which is proportionately higher for females (47%) than for males (33%). Pre-transitional diseases, usually associated with poverty and underdevelopment, accounted for 25%, non-communicable diseases 21% and injuries 16% of YLLs. The DALY estimates highlight the fact that mortality alone underestimates the burden of disease, especially with regard to unintentional injuries, respiratory disease, and nervous system, mental and sense organ disorders. The impact of HIV/AIDS is expected to more than double the burden of premature mortality by the year 2010. Conclusion. This study has drawn together data from a range of sources to develop coherent estimates of premature mortality by cause. South Africa is experiencing a quadruple burden of disease comprising the pre-transitional diseases, the emerging chronic diseases, injuries, and HIV/AIDS. Unless interventions that reduce morbidity and delay morbidity become widely available, the burden due to HIV/AIDS can be expected to grow very rapidly in the next few years. An improved base of information is needed to assess the morbidity impact more accurate.
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    The interaction between HIV and other sexually transmitted infections in South Africa: a model-based evaluation
    (2008) Johnson, Leigh F; Dorrington, Rob; Bradshaw, Debbie
    Sexually transmitted infections (STIs) have been shown to increase the probability of HIV transmission, but there remains much uncertainty regarding the role of STI treatment in HIV prevention. This thesis aims to develop a mathematical model to estimate the prevalence of STIs in South Africa, the contribution of STIs to the spread of HIV, and the effects of changes in sexual behaviour and changes in STI treatment. A deterministic model is developed to simulate the transmission of HIV and six other STIs (syphilis, genital herpes, chancroid, gonorrhoea, chlamydial infection and trichomoniasis), as well as the incidence of bacterial vaginosis and vaginal candidiasis in women. The model is fitted to national HIV prevalence survey data, STI prevalence data from sentinel surveys and data from sexual behaviour surveys, using Bayesian techniques. Model results suggest that South Africa has some of the highest STI prevalence levels in the world, but that certain STIs – notably syphilis, chancroid, gonorrhoea and trichomoniasis – have declined in prevalence since the mid-1990s, following the introduction of syndromic management programmes and increases in condom use. STIs account for more than half of new HIV infections, and genital herpes is the most significant STI promoting the transmission of HIV. Syndromic management programmes reduced HIV incidence in South Africa by 3-10% over the decade following their introduction (1994-2004). Further reductions in HIV incidence could be achieved by promoting patient-initiated treatment of genital herpes, by addressing rising levels of drug resistance in gonococcal isolates, and by encouraging prompt health seeking for STIs. Concurrent partnerships are a major factor driving HIV transmission, accounting for 74-87% of new HIV infections over the 1990-2000 period. Halving unprotected sex in non-spousal relationships would reduce HIV incidence over the 2010 -2020 period by 32-43%. This thesis contributes to the understanding of HIV/AIDS epidemiology in South Africa by quantifying the contribution of various behavioural and biological factors to HIV transmission. This thesis also high lights several opportunities for reducing the future incidence of HIV. In addition, this thesis advances the assessment of uncertainty in STI models by proposing a Bayesian approach to incorporating sexual behaviour data and STI prevalence data into the parameter estimation process
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    Maternal Mortality Ratio - trends in the vital registration data
    (2012) Bradshaw, Debbie; Dorrington, Rob E
    Background. The paucity of quality data on maternal deaths and possible mis-specification of models have resulted in a range of estimates of the maternal mortality ratio (MMR) for South Africa. Objectives. This paper contrasts the estimates from multi-country models for estimating the MMR with the South African data from vital registration. Method. A literature review was undertaken to identify estimates of the MMR for South Africa and methodologies used. In addition, cause of death data from Statistics SA were analysed for trends. Results. In contrast to prediction models used by international agencies, the Health Data Advisory and Co-ordinating Committee (HDACC) recommended the use of the vital registration data adjusted for under-registration and misclassification of causes to monitor maternal mortality. HDACC also recommended that, as is done by the Maternal Mortality Estimation Interagency Group (MMEIG), the number of maternal deaths identified be scaled up by 50% to account for the general under-reporting of maternal deaths. Based on this approach, the baseline MMR in 2008 was estimated to be 310 per 100 000 live births. From vital statistics, the indications are that by 2009, South Africa had not yet managed to reverse the upward trend in MMR. The increase is largely a result of an increase in the number of maternal deaths from indirect causes, as might be expected in the context of the HIV pandemic. However, the number of indirect maternal deaths increased markedly only since 2003, a few years later than the rapid increase in AIDS mortality. Conclusions. There are opportunities to improve monitoring maternal mortality, including strengthening the information systems (vital registration, the confidential enquiry and the routine health information system) and exploring opportunities for linking data from different sources. Better data on the role of HIV in maternal mortality are needed.
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    Measuring child mortality in resource limited settings using alternative approaches: South African case study
    (2018) Nannan, Nadine; Dorrington, Rob; Bradshaw, Debbie
    Post the Millennium Development Goal project a significant number of countries are still faced with the challenge of monitoring child mortality. Despite numerous enquiries since 1996 to provide this basic health indicator, South Africa has experienced prolonged periods of uncertainty regarding the level and trend of infant and under-5 mortality. The thesis develops an analytical framework to review all available data sources and methods of analysis and presents the results of the four approaches adopted to measure child mortality trends. Reviewing the demographic indicators produced from seven census and survey enquiries, the overall performance and the strengths and limitations of each approach is evaluated. Poor and extremely poor quality of data for child mortality emerges as a pervasive challenge to census and survey data. The thesis presents the remarkable improvement in the completeness of birth and death registration through South Africa's CRVS system, particularly since 2000, illustrating the possibility of using CRVS data to monitor provincial child mortality in the future and highlighting statistical challenges arising from the movement of children. In conclusion, South Africa should focus on improving CRVS for purposes of monitoring childhood mortality provincially and the comprehensive evaluation of available data is a useful lesson for other upper-middle-income countries.
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    The setting of health research priorities in South Africa
    (2001) Schneider, Michelle; Bradshaw, Debbie
    The health and development of a nation are linked. Health research is a vital element helps bring about improved health and has the potential to serve as an impetus for equitable development. Generally, it is necessary to prioritise needs in order to optimise the use of scarce resources for development. The overall aim of this thesis is an analysis of the setting of health research priorities, with specific reference to South Africa. Other objectives include describing the technical approaches used for priority setting and developing a suitable framework for analysing and classifying health research. Two other objectives concern measurement for priority setting: Specifically, how burden of disease quantification fits into the process of priority setting and a thorough critique of the Disability Adjusted Life Expectancy (DALY). Another objective was to examine priority setting and Essential National Health Research (ENHR) in the South African context. A further important objective is the development of a framework for guiding the analysis of health research priorities. This framework is part of model for health research priority setting that incorporates ENHR strategy and burden of disease methodology. The methods used ranged from an extensive literature review to statistical analysis. The literature review included grey literature and draws on multiple disciplines such as economics, public health policy and economics.
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    Strengthening public health in South Africa: building a stronger evidence base for improving the health of the nation
    (2007) Bradshaw, Debbie; Norman, Rosana; Lewin, Simon; Joubert, Jané; Schneider, Michelle; Nannan, Nadine; Groenewald, Pam; Laubscher, Ria; Matzopoulos, Richard; Nojilana, Beatrice; Pieterse, Desiréé; Steyn, Krisela
    An assessment of the relative burden attributable to selected risk factors provides an important evidence base for prioritising risk factors that should be targeted for public health interventions. Selecting interventions should be based on a robust and transparent process of scientific evaluations of their effectiveness, as well as assessment of their cost effectiveness, local applicability and appropriateness, and likely effects on health inequalities. Establishing such an evidence base is an ongoing process that is still at an early stage in South Africa. A recent review of disease control priorities for developing countries (DCPP) examined the global evidence regarding the effectiveness of interventions for major health burdens. Despite acknowledging the lack of intervention trials in developing countries, this DCPP review provides a unique resource for identifying interventions that might be useful in South Africa.
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    The burden of disease attributable to sexually transmitted infections in South Africa in 2000
    (2007) Johnson, Leigh; Bradshaw, Debbie; Dorrington, Rob; South African Comparative Risk Assessment Collaborating Group
    Objectives. To estimate the burden of disease attributable to sexually transmitted infections (STIs) in South Africa, to identify the factors contributing to this burden, and to review successes and failures in reducing this burden. Design. Years of life lost (YLL) and years lived with disability (YLD) were estimated using different approaches for HIV/AIDS, other STIs and cervical cancer. Burden in respect of HIV/ AIDS was estimated using the ASSA2002 model, and for the other diseases the revised national burden of disease estimates for 2000 based on 1996 cause-of-death data were used. The ASSA2002 model was used to estimate numbers of AIDS deaths under different prevention and treatment scenarios. Setting. South Africa. Outcome measures. Deaths, YLL and disability-adjusted life years (DALYs) associated with HIV/AIDS, other STIs and cervical cancer. Results. STIs accounted for more than 26% of all deaths and over 5 million DALYs in 2000 and over 98% of this burden was due to HIV/AIDS. A combination of social, behavioural and biological conditions contribute to this burden. HIV/AIDS mortality and morbidity are estimated to have increased significantly since 2000, and the future change in this burden is largely dependent on the extent to which antiretroviral treatment and HIV prevention programmes are introduced. 2.5 million AIDS deaths could be prevented by 2015 if high levels of access to antiretroviral treatment are achieved. Conclusion. South Africa faces one of the largest STI epidemics in the world. A multifaceted strategy to prevent and treat STIs is needed, and burden of disease assessments should look beyond the role of ‘unsafe sex’ when attributing this disease burden to risk factors.
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    The effect of educational attainment and other factors on HIV risk in South African women: results from antenatal surveillance, 2000-2005
    (2009) Johnson, Leigh F; Dorrington, Rob E; Bradshaw, Debbie; du Plessis, Hendrika; Makubalo, Lindiwe
    Objectives: To assess the effect of educational attainment and other factors on the risk of HIV in pregnant South African women. Design: Repeated cross-sectional surveys. Methods: Pregnant women attending public antenatal clinics were tested for HIV annually between 2000 and 2005, and provided demographic information. Logistic regression models were applied separately to the data collected in each year, to identify factors associated with HIV infection. Data from all years were combined in a logistic regression model that tested for trends in HIV prevalence. Results: Amongst women aged 15–24 years, HIV risk in those who had completed secondary education was significantly lower than in those who had only primary education, in all years except 2000. HIV risk increased by 8% per annum (odds ratio 1.08, 95% confidence interval 1.04–1.12) in young women with no secondary education but did not increase in young women with secondary education. In women aged 25–49 years, HIV risk increased over the 2000–2005 period, at all levels of educational attainment, and did not differ between women with completed secondary education and women with only primary education. Conclusion: Together with other evidence, this study suggests that higher educational attainment did not protect against HIV in the early stages of the South African HIV/AIDS epidemic. In recent years, the risk of HIV infection in young South African women with completed secondary education has reduced significantly relative to that in young women with primary education, suggesting that HIV prevention strategies may have been more effective in more educated women.
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    The prevalence of type 2 diabetes in South Africa: A systematic review
    (University of Cape Town, 2020) Pheiffer, Carmen; Bradshaw, Debbie; Pillay-Van Wyk, Victoria; Joubert, Jané
    The increasing prevalence of type 2 diabetes mellitus (T2DM) poses a major threat to the health and well-being of South Africans. Effective interventions to inform health planning and policy are hampered by the paucity of accurate national epidemiological data. Although several prevalence studies have been conducted, these estimates are not representative of the South African population or are sub-optimal due to the diagnostic methods employed. To address the lack of accurate and representative prevalence data, the aim of this dissertation is to use robust systematic review methods to collate, synthesise and summarise all T2DM prevalence data in South Africa. The dissertation comprises of four parts. Part A contains the study protocol that was published in BMJ Open in 2018. The protocol outlines the problem statement, motivation and rationale, aim, search strategy and robust systematic methods that were used to conduct the study. Part B provides an overview of T2DM enabling a broader understanding of the disease, with a focus on South Africa and the challenges of obtaining accurate T2DM prevalence estimates. We also describe prevention and management strategies for T2DM, and point to priority actions and approaches to achieve such prevention and management of T2DM. Part C consists of a manuscript that has been formatted for submission to BMJ Open and Part D is an Appendix with supporting information. This part addresses the aim of the dissertation and presents the systematic review "The prevalence of type 2 diabetes in South Africa: A systematic review". The manuscript outlines the rationale and methodologies, together with presenting and discussing the results of the systematic review. Our literature search, which included PubMed, Scopus, Web of Science and African Index Medicus, grey literature and references of included studies identified 1782 articles published in South Africa between January 1997 and May 2019. Of these, 15 met the inclusion criteria and were included in the systematic review. Heterogeneity across studies did not allow for a meta-analysis and a pooled estimate, thus results are described narratively. Some studies failed to report key methodological elements, which limited our ability to accurately appraise study quality. In conclusion, the systematic review highlights the high prevalence of glucose intolerance in South Africa and confirms the paucity of accurate and representative T2DM prevalence data. There is a need for well-designed epidemiological studies that use best-practice, uniform diagnostic methods to assess prevalence. Collaboration between public health scientists, diabetes specialists and policy makers is recommended to enable the collection of reliable national epidemiological data which can guide policy and planning towards effective diabetes prevention and management strategies.
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    Trends in adult tobacco use from two South African demographic and health surveys conducted in 1998 and 2003
    (2009) Peer, Nasheeta; Bradshaw, Debbie; Laubscher, Ria; Steyn, Krisela
    Introduction: Since tobacco use peaked in the early 1990s in South Africa, it has declined significantly. This reduction has been attributed to the government’s comprehensive tobacco control policies that were introduced in the 1990s. Objective: To assess the pattern of tobacco use between the South African Demographic and Health Surveys in 1998 and 2003. Methods: Multi-stage sampling was used to select approximately 11 000 households in cross-sectional national surveys. Face-to-face interviews, conducted with 13 826 adults (41% men) aged ≥15 years in 1998 and 8 115 (42% men) in 2003, included questions on tobacco use according to the WHO STEP-wise surveillance programme. Logistic regression analysis was used to assess the independent effects of selected characteristics on smoking prevalence. Results: Daily or occasional smoking prevalence among women remained unchanged at 10-11%; among men it decreased from 42% (1998) to 35% (2003). The decline for men was significant among the poorest and those aged 25-44 years. Strong age patterns were observed, peaking at 35-44 years, which was reduced for men in 2003. Higher income and education were associated with low prevalence of smoking while living in urban areas was associated with higher rates. African men and women smoked significantly less than other population groups. Conclusion: Despite decreasing smoking rates in some subgroups, a gap exists in the efforts to reduce tobacco use as smoking rates have remained unchanged in women and young adults, aged 15-24 years.
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    Unabated rise in number of adult deaths in South Africa
    (2004) Bradshaw, Debbie; Laubscher, Ria; Dorrington, Rob; Bourne, David E; Timaeus, Ian M
    Mortality statistics are a fundamental cornerstone of the health status data needed for planning and monitoring the impact of health programmes. In developed countries, such data are generated through the death registration system, dating back to the 19th century in the case of the UK and Sweden. Until recently, South Africa’s death registration system was recognised as inadequate to provide such statistics for the majority of the population,1 but the postApartheid government has prioritised the collection of such statistics, as evidenced by a new-found collaboration between the Departments of Health and Home Affairs and Statistics South Africa.2 Registration of adult deaths improved from about 50% in 1990 to over 90% in 20003 as a result of the incorporation of the former homelands as well as national efforts to improve coverage. However, the production of timely cause of death statistics remains a challenge; the most recent year with full officially published statistics is 1996.