Browsing by Author "Dorrington, Rob E"

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    Open Access
    A comparison of death recording by health centres and civil registration in South Africans receiving antiretroviral treatment
    (Journal of the International AIDS Society, 2015-12-16) Johnson, Leigh F; Dorrington, Rob E; Laubscher, Ria; Hoffmann, Christopher J; Wood, Robin; Fox, Matthew P; Cornell, Morna; Schomaker, Michael; Prozesky, Hans; Tanser, Frank; Davies, Mary-Ann; Boulle, Andrew
    Introduction: There is uncertainty regarding the completeness of death recording by civil registration and by health centres in South Africa. This paper aims to compare death recording by the two systems, in cohorts of South African patients receiving antiretroviral treatment (ART). Methods: Completeness of death recording was estimated using a capture-recapture approach. Six ART programmes linked their patient record systems to the vital registration system using civil ID numbers, and provided data comparing the outcomes recorded in patient files and in the vital registration. Patients were excluded if they had missing/invalid IDs or had transferred to other ART programmes. Results: After exclusions, 91 548 patient records were included. Of deaths recorded in patients files after 2003, 94.0% (95% CI: 93.3-94.6%) were recorded by civil registration, with completeness being significantly higher in urban areas, older adults and females. Of deaths recorded by civil registration after 2003, only 35.0% (95% CI: 34.2-35.8%) were recorded in patient files, with this proportion dropping from 60% in 2004-2005 to 30% in 2010 and subsequent years. Recording of deaths in patient files was significantly higher in children and in locations within 50km of the health centre. When the information from the two systems was combined, an estimated 96.2% of all deaths were recorded (93.5% in children and 96.2% in adults). Conclusions: South Africa’s civil registration system has achieved a high level of completeness in the recording of mortality. However, the fraction of deaths recorded by health centres is low and information from patient records is insufficient by itself to evaluate levels and predictors of ART patient mortality. Previously-documented improvements in ART mortality over time may be biased if based only on data from patient records.
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    An investigation into the extent of uncertainty surrounding estimates of the impact of HIV/AIDS in South Africa
    (Academy of Science of South Africa, 2007) Johnson, Leigh F; Dorrington, Rob E; Matthews, Alan P
    HIV / AIDS statistics have been the source of much controversy in South Africa, but often the extent of uncertainty around these estimates is ignored. There is need for an assessment of the range of uncertainty around often-quoted HIV / AIDS statistics. This analysis determines ranges of uncertainty around the inputs and outputs of the ASSA2002 AIDS and Demographic model of the South African HIV / AIDS epidemic, using a generalized likelihood uncertainty estimation approach. A sample of 500 parameter combinations was drawn by weighting randomly generated parameter combinations by likelihood functions defined on the basis of four South African HIV / AIDS data sets. The estimated number of HIV infections in mid-2005 was 5.1 million (95% prediction interval: 4.2-6.0 million), equivalent to an HIV prevalence rate of 11.1% (9.1-13.1%). Between mid-2004 and mid-2005, the estimated number of new HIV infections was 490 000 (370 000-590 000) and the estimated number of AIDS deaths was 320 000 (270 000-380 000). The posterior mean HIV survival time was estimated to be 11.5 years (95% credibility interval: 10.0-12.9 years), longer than estimated for elsewhere in the developing world. This analysis confirms that South Africa is experiencing a severe HIV / AIDS epidemic, and suggests that HIV / AIDS epidemiology in the country probably differs from that elsewhere in Africa.
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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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    Rapid mortality surveillance using a national population register to monitor excess deaths during SARS-CoV-2 pandemic in South Africa
    (Springer International Publishing, 2021-09-03) Dorrington, Rob E; Moultrie, Tom A; Laubscher, Ria; Groenewald, Pam J; Bradshaw, Debbie
    This paper describes how an up-to-date national population register recording deaths by age and sex, whether deaths were due to natural or unnatural causes, and the offices at which the deaths were recorded can be used to monitor excess death during the SARS-CoV-2 pandemic, both nationally, and sub-nationally, in a country with a vital registration system that is neither up to date nor complete. Apart from suggesting an approach for estimating completeness of reporting at a sub-national level, the application produces estimates of the number of deaths in excess of those expected in the absence of the SARS-CoV-2 epidemic that are highly correlated with the confirmed number of COVID-19 deaths over time, but at a level 2.5 to 3 times higher than the official numbers of COVID-19 deaths. Apportioning the observed excess deaths more precisely to COVID, COVID-related and collateral deaths, and non-COVID deaths averted by interventions with reduced mobility and gatherings, etc., requires access to real-time cause-of-death information. It is suggested that the transition from ICD-10 to ICD-11 should be used as an opportunity to change from a paper-based system to electronic capture of the medical cause-of-death information.
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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.