A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfilment of the requirements of the award of
the Masters in Science in Epidemiology in the field of Population-based Field
Epidemiology
April 2012 / Objective: To determine the causes of death and associated risk factors in women of
reproductive age in rural South Africa. .
Methods: The study population comprised all female members aged 15-49 years of
11 000 households of a rural South African Health and Demographic Surveillance
Site from 2000-2009. Deaths and person-years of observation (pyo) were determined
for individuals between 01 January 2000 and 31 December 2009. Cause of death was
ascertained by verbal autopsy interviews, based on ICD-10 coding; cause of death
were broadly categorized as AIDS/TB causes, Non-communicable causes,
Communicable/maternal/perinatal/nutrition causes, Injuries and another category of
undetermined (unknown) causes of death. Overall and cause specific mortality rates
(MR) with 95% confidence intervals (CI) were calculated. Cox proportional hazard
regression (HR, 95% CI) was used to determine risk factors associated with overall
and cause-specific mortality.
Results: 42703 eligible women were included; 3098 deaths were reported for 212607
person-years (pyo) of observation. Overall MR was 14.57 deaths/1000 pyo
(CI;14.07-15.09), increasing from 2000-2003 (2003: MR;18.15, CI;16.41-20.08) and
subsequently decreasing (2009: MR; 9.59, CI;8.43-10.91) after introduction of
antiretroviral treatment (ART) for HIV in public health system facilities in South
Africa in 2004. Mortality was highest for AIDS/TB (MR;10.66, CI;10.23-11.11) and
the cause of death for 73.1% of all recorded deaths. Maternal mortality was 0.07 (CI;
0.04-0.11). Women aged 30-34 years had the highest MR due to AIDS/TB (MR;
20.34/1000 pyo), women aged 45-49 years due to other causes (MR; 4.29/ 1000 pyo).
v
In multivariable analyses, external migration status was associated with increased
hazards of all cause mortality (HR; 1.87, CI; 1.56-2.26) and other causes of mortality
(HR; 1.782, CI; 1.24-2.57). Self reported poor health was significantly associated with
increased hazards of all cause mortality (HR; 11.052, CI; 4.24-28.82) but not with
mortality due to other causes. Positive HIV status was associated with increased
hazards of all cause mortality (HR; 8.53, CI; 6.81-10.67) and other causes of mortality
(HR; 2.84, CI; 1.97- 4.09).
Conclusion. AIDS was the main cause of death in the current study, with mortality
rates declining since introduction of ART for HIV in public health facilities in the
surveillance area in 2004. Further ART roll-out, increased community awareness and
sensitisation messages are still needed to reduce the spread of HIV and other sexually
transmitted diseases.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/13751 |
| Date | January 2012 |
| Creators | Nabukalu, Doreen |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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