sahr2001 - Health Systems Trust

Health Status Indicators
Mortality
Uncertainty is inherent in any modelling exercise. There are assumptions
underlying any model, and empirical data is open to interpretation. Given
the need to focus planning and operational attention on HIV, data beyond
the usual antenatal prevalence figures were sought.
The end of 2001 saw considerable attention being paid to a new report from
the Medical Research Council, entitled ‘The impact of HIV/AIDS on adult
mortality in South Africa’ [MRC AIDS Report]. As was explained in the
section on Demographic Indicators, the population projections provided were
drawn from the ASSA2000 model, among others. The MRC report was based
on the older ASSA600 model, which was not able accommodate changes in
the response to HIV. Nonetheless, the MRC report is a crucial piece of data,
for it showed that ‘the pattern of mortality from natural causes in South
Africa has shifted from the old to the young over the last decade particularly
for young women’. It estimated that ‘40% of the adult deaths aged 15-49
that occurred in the year 2000 were due to HIV/AIDS and that about 20%
of all adult deaths in that year were due to AIDS’. If these were combined
with the excess deaths noted in childhood, then AIDS was considered to be
responsible for 25% of all deaths in 2000 and to have become ‘the single
biggest cause of death’.
In addition to the 1998 South African Demographic and Health Survey,
material was obtained from two other reports - the Confidential Enquiries
into Maternal Deaths [Maternal Deaths 1998, 1999] and the perinatal care
survey [Saving Babies]. It should be noted that the methodology of confidential
enquiries make them a poor public health tool for estimating maternal
mortality ratios, primarily because reporting is health institution based and
often under-reported. For 1998, the only provinces where there is a fair degree
of confidence that the vast majority of deaths were recorded were the Free
State, Gauteng and Western Cape.
Definitions:
Infant Mortality Rate: The number of children less than one year old who
die in a year, per 1000 live births during that year.
Life expectancy at birth: The average number of additional years a person
could expect to live if current mortality trends were to continue for the rest
of that person’s life.
Maternal mortality ratio: The number of women who die as a result of
childbearing or within 42 days of termination of pregnancy in one year, per
100 000 live births during that year.
Perinatal Mortality Rate: The number of perinatal deaths per 1000 births.
The perinatal period starts as the beginning of foetal viability (28 weeks
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