Browsing by Author "Nannan, Nadine"

Now showing 1 - 8 of 8
  • Thumbnail Image
    Item
    Open Access
    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.
  • Thumbnail Image
    Item
    Open Access
    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.
  • Thumbnail Image
    Item
    Open Access
    Gender differences in homicide of neonates, infants, and children under 5 y in South Africa: results from the cross-sectional 2009 National Child Homicide Study
    (Public Library of Science, 2016) Abrahams, Naeemah; Mathews, Shanaaz; Martin, Lorna J; Lombard, Carl; Nannan, Nadine; Jewkes, Rachel
    Jewkes and colleagues present a cross-sectional study that reveals levels of child homicide in South Africa. Identifying causes and vulnerable mothers will lead to prevention methods and strategies.
  • Thumbnail Image
    Item
    Open Access
    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
  • Thumbnail Image
    Item
    Open Access
    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.
  • Thumbnail Image
    Item
    Open Access
    Investigation of level and differentials in child mortality in South Africa: insight from Census 2001 and 2011, Community Survey 2016 and Demographic and Health Survey 2016
    (2022) Matikinca, Ntombizandile; Nannan, Nadine
    Measuring levels of childhood mortality is important for low and middle-income countries to monitor overall development and progress towards improved child health. The overall aim of this research is to estimate the level and trend of childhood mortality in South Africa over time, and to examine the factors associated with and the determinants of childhood mortality. The study discovered that significant progress has been made to reduce the levels of childhood mortality in the country. The estimates derived through direct estimation using the 2016 South African Demographic and Health Survey (SADHS) for the period between 2012-2016 revealed age-specific mortality rates were: Neonatal Mortality Rate (NMR) was 22.0 per 1 000 live births, Post-neonatal Mortality Rate (PNMR) 13.1, 1q0 34.9, 1q4 5.5 and 5q0 40.2 per 1 000 live births. Investigation of the factors associated with childhood mortality revealed significant differentials in age group, sex, population group, province, socio-economic status and household characteristics. Overall, children aged less than one month and those aged between one to two months had a higher mortality risk than the other age groups; male children had an increased risk of dying than females; Black and Coloured children had an increased risk of dying compared to children in other population groups; children in Mpumalanga, Eastern Cape and North West had a higher risk of dying compared to children in other provinces; children whose mothers had below secondary education had higher risks of mortality; and children with poor water source and toilet facility were more likely to die than other children with better facilities. The results were generally in agreement with the existing literature. Although the study found significant improvement in the level of childhood mortality over the period 1996-2016, further progress is achievable as many children still continue to die of preventable or treatable causes. The findings of this study may assist government, policymakers and researchers to plan, and implement targeted interventions that will further reduce the levels of childhood mortality in South Africa.
  • Thumbnail Image
    Item
    Open Access
    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.
  • Thumbnail Image
    Item
    Open Access
    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.