Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993–2013

BMC Public Health

Research Article

Samuel J. Clark¹  Chodziwadziwa W. Kabudula²  Francesc Xavier Gómez-Olivé³  Mark A. Collinson⁴  Stephen Tollman⁴  Kathleen Kahn⁴  Brian Houle⁵ 

[1] MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA;INDEPTH Network, Accra, Ghana;Department of Sociology, The Ohio State University, Columbus, OH, USA;MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK;MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;INDEPTH Network, Accra, Ghana;MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;INDEPTH Network, Accra, Ghana;Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;School of Demography, The Australian National University, Canberra, Australia;CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA;

关键词: South Africa;    Agincourt;    Rural;    Mortality;    HIV/Aids;    Cause composition;    Verbal autopsy;    InterVA;    Non-communicable diseases, epidemiological transition;   

DOI  :  10.1186/s12889-017-4312-x

 received in 2016-11-02, accepted in 2017-04-26,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundVirtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population.MethodsWe estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993–2013.ResultsFrom the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males.ConclusionsThis typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact on continued progress in reducing preventable mortality and improving health across the life course. Integrated healthcare planning and program delivery is required to improve access and adherence for HIV and non-communicable disease treatment. These findings from a local, rural setting over an extended period contribute to the evidence needed to inform further refinement and advancement of epidemiological transition theory.

【 授权许可】

CC BY   
© The Author(s). 2017

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