Browsing by Author "Schneider, Michelle"

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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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    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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    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.
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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.