Mortality and causes of death in the country: briefing by Statistics South Africa

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Health

10 September 2013
Chairperson: Ms B Ngcobo (ANC) (Acting)
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Meeting Summary

Statistic South Africa briefed the Committee on the health profile of the South African population and provided the findings obtained through the 2011 General Household Survey and 2010 death notification system. The report showed that 74.5% of respondents were satisfied with the health care services they received and that 61.2% of health care users used public sector clinics, compared to 24.3% who used private doctors and specialists. Satisfaction was found to be the highest in Western Cape and lowest in KwaZulu-Natal. Many people did not use the nearest health care facility out of the desire to use a private health institution and because waiting times were too long. Over 47% of respondents were found to walk to clinics, 29.1% used public transport and 22.1% used their own transport.  When broken down into race, Black and Coloured Africans were more likely to walk or use public transport then White and Indian South Africans who preferred their own transport. Black Africans also had the highest wait time out of any race group.

It was found that only 16% of the South African population was covered by medical aid and this statistic was particularly low in Limpopo.  This led 22.5% of all ill or injured people to not seek out the consultation of a health worker; many people opted to instead attempt self medication.  This statistic was higher in the age 15-24 age bracket where more people took risks and lived a more dangerous lifestyle.  The most common diseases in South Africa were tuberculosis and the flu/acute respiratory disease.  Tuberculosis was more common in Black Africans and Indian/Asian people as was HIV/AIDS.  However HIV/AIDS did have a broader age spectrum. The report stated that diabetes was more common in Indian/Asian and Coloured South Africans of an older age, while hypertension was most common in older White South Africans.

The presentation then moved to mortality and Thabo Mofutsanyane District Municipality was noted as having the highest mortality rate in the country. It was suggested that this was due to poverty and poor road conditions. The importance of proper documentation of deaths was mentioned as a critical aspect to understanding the causes of death in South Africa better. The statistics for the year 2010 were then broken down to demonstrate which causes of death were most common- infectious and parasitic diseases led the way with 25% of deaths being related to these. Of these diseases tuberculosis was the most common.  It was noted that after peaking in 2006 the mortality rate had been on the decline and life expectancy at birth was on the rise. This ran in conjunction with population fluctuations and it was stated that the mortality rate was highest in the most populous areas. 

Members expressed concern about the lack of focus on HIV/AIDS and the lack of statistics related to rape and sexual assault. They also suggested that some statistics presented could be flawed due to deaths not being properly documented. Members also asked for clarification on what the subcategory of other meant in some cases, as it seemed to be a vague term and more detail would be appreciated.  It was also suggested that satisfactory rates be broken down into subsections which demonstrate satisfaction with services in public versus private sectors. It was also asked why Black Africans had such a low rate of hypertension compared to White South Africans and why there was a prevalence of tuberculosis in KwaZulu-Natal when a large population in the Eastern Cape worked in mines. Members reiterated their concern with the statistics presented about HIV/AIDS as they all seemed low.  Was this due to misreporting due to the stigma attached, or was it due to lack of professionalism?

Meeting report

Election of Acting Chairperson

Ms B Ngcobo (ANC) was elected to chair the meeting in the absence of the Chairperson, Mr B Goqwana (ANC).
 

Briefing by Statistics South Africa (Stats SA) on the health profile of the South African population
Mr Pali Lehohla, Statistician General, Statistics South Africa, informed Members that the content of the presentation would spur a conversation about more than just the statistics presented as they were a direct result of the social constructs of South Africa.  Many matters of health were worrisome, including HIV/AIDS and other lifestyle diseases. The presentation would also touch on health care infrastructure and how to promote health care.

The statistics presented were achieved through the 2011 General Household Survey (GHS) and the 2010 death notification system. The statistics related to what type of health facilities were used by households were presented as follows; public sector clinics 61.2%, private doctor or specialist 24.3%, public sector hospital 9.5%, private hospital 2.0% and other 3.2%. With this it was determined that 74.5% of respondents claimed they were very satisfied with the health services received.  The satisfaction statistics were sorted by province. The highest level of satisfaction was the Western Cape at 81.1% and the lowest was KwaZulu-Natal at 63.8%.  When respondents were asked why they did not use the nearest health facility the most frequent response was that the use of a private health institution was preferred followed by the waiting times being too long.

In terms of modes of transport used to reach a health facility, 47.4% of people walked, 29.1% used public transport and 22.1% used their own transport, 1.4% was allotted to alternative means. These statistics were further broken down by race. Most black Africans and coloured Africans walked to the health facilities, while the majority of Indian/Asian and white South Africans used their own transport to get to health facilities.  Black Africans also had the highest waiting times out of anyone at 26 minutes; almost double that of Indian/Asians who had the lowest wait time at 14 minutes. Whites waited for an average of 15 minutes while coloured South Africans waited for an average of 17 minutes.

When sorted into age group, the percentage of people covered by medical aid was highest in older age brackets. This was due to more security in employment and the subsequent benefits that came from it.  Black children were found to have less access to health care. Only 16% of the South African population were covered by medical aid and this statistic was lowest in Limpopo where only 7% of the population were covered.  This led to 22.5% of ill or injured individuals not seeking the consultation of a health worker; the primary reasons for this were noted as being due to self medication and deeming consultation unnecessary.  The 15-24 age bracket had a high percentage of people who did not consult a health worker upon injury, and it was deemed that this was due to the more dangerous tendencies and lifestyles of the young age group.

Mr Lehohla then presented what diseases and illnesses were the most prevalent in South Africa and were divided by race.  The Flu or acute respiratory was the most common and was spread equally across race groups. Tuberculosis was present in 2.9% of cases and was most prevalent in KwaZulu-Natal and amongst Black Africans and Indian/Asian people. HIV/AIDS had a percentage of 1.7% and was most common among Black Africans between 30-44 and females. HIV/AIDS had a broader age spectrum than many of the other conditions presented. Diabetes was present in 4.7% of cases and was more common amongst Indian/Asians and Coloured South Africans of older age. White South Africans were the most likely race to suffer from hypertension and once again it was noted that it was most common in older people.

The age pattern of mortality was then discussed and graphs were presented depicting the mortality rate in relation to age in the highest and lowest rated areas. Focus was put on Thabo Mofutsanyane District Municipality (in the Free State) as it had the highest mortality rate in the country. This was due not just to disease but also to the poor road conditions in the area that had led to more deaths via accidents. Due to the variety of causes of death in Thabo Mofutsanyane, the profile of death in this region was different from other areas. It was also found that the onset of mortality in Thabo Mofutsanyane was higher in females. The leading cause of death in Thabo Mofutsanyane was listed as Influenza and Pneumonia, while in West Coast (the area with the lowest mortality rate) the highest cause was tuberculosis while Influenza and Pneumonia was only ranked eighth.

Mr Lehohla noted the importance of ensuring that deaths were properly documented as understanding the causes of death would help the living.  The registered death rate had peaked in 2006 and by 2010 had declined by 6.2%. However it was pointed out that this decline was in step with the decline of the National Population Register. South Africa had the highest rate of registered deaths in all of Africa at 90%. In 2010 just over half a million deaths were recorded and just under half occurred in health care facilities. Infant and child mortality also peaked in 2006 and had since been on the decline. Life expectancy at birth followed the same trend. These statistics also showed that males had a higher mortality rate overall and a lower life expectancy.

Of the 543 856 deaths in 2010, 25% were caused by infectious and parasitic diseases, 15% from circulatory system diseases, 12% from respiratory system diseases, 9% from accidents and other non natural external causes, 7% from cancer/neoplasm, 6% from endocrine, nutritional and metabolic diseases and 26% from causes deemed “other”. Accidental deaths were defined as intentional self-harm, medical and surgical complications, assault, transport accidents, undetermined intent and accidental injuries such as drowning. Under infectious and parasitic diseases tuberculosis was the leading cause of death, and had been for a decade, while HIV accounted for the deaths of 18 325 people. The statistics further showed that 15 774 people died from heart failures, and 20 707 died from strokes. In the respiratory system disease category, 38 413 people had died from pneumonia and 4 057 died from asthma. In terms of deaths due to cancers/neoplasm, 2 442 males died from prostate cancer, 2 858 females died from cervical cancer, 2 958 died from breast cancer, 1 120 people died from stomach cancer and 4 706 died from lung cancer.  It was noted that 21 475 South Africans died from diabetes.  Causes that fell under other included nervous system deaths, digestive system and urinary system related deaths, as well as perinatal and blood and immune deaths. 

Mr Lehohla noted that until 2002 death had preferred males, but by 2005 the gap between genders had begun to close. Female deaths peaked between the ages of 30-34 while male deaths peaked between the ages of 35-39. A higher rate of males died from tuberculosis and more females died from diabetes. In other categories males and females had similar numbers with minor variances. 70% of all non-natural deaths in South Africa occurred between the ages of 15-49, this was accounted to the lifestyles people had during those years.

The leading causes of death amongst Black Africans were tuberculosis, influenza and pneumonia, intestinal diseases, other forms of heart disease and cerebrovascular diseases.  The leading cause of death amongst Whites was related to heart diseases and cancer. For coloured South Africans and Indian South Africans the leading cause of death was tuberculosis, influenza and pneumonia as well as other forms of heart disease.

When looking at the proportions of death sorted by province, KwaZulu-Natal had 21% of all deaths, followed by Gauteng with 19%. The lowest region was the Northern Cape with 3% and the North West with 7%. It was noted that KwaZulu-Natal had the highest burden of deaths and the second highest population. The standardised age death rates were lowest in the Western Cape at 7.8% and highest in the Free State at 16.1%. The leading cause of death in all provinces was tuberculosis except in Limpopo and the Free State where influenza and pneumonia took the most lives.

Mr Lehohla then summarised the presentation and delivered the key findings including that Black Africans and those living in less privileged provinces continued to be at a disadvantage in terms of obtaining the general aspects of health. Many inequalities in access to health care existed in the country but deaths continued on a downward trend with female deaths on the decline recently. He reiterated that tuberculosis remained the leading cause of death in most provinces, but that deaths from tuberculosis, influenza and pneumonia declined from 2008-2010.On the other hand deaths due to diabetes mellitus and HIV had increased over the same three years. He added that the manifestation of diseases by race was very clear.

 

Discussion
The Chairperson thanked Mr Lehohla for his presentation and opened the floor for questions.

Ms M Segale-Diswai (ANC) advised Stats SA to number the slides in future briefings to the Committee in order to facilitate commenting.  Secondly, she then asked that when referring to the health facilities used, what fell under the category other.  Thirdly, she also asked about parts of the country such as Limpopo where more traditional medication was used, this was not reflected in the presentation. Thirdly, she expressed scepticism about the data obtained from death registration as she believed that many deaths were not reported, such as deaths of infants during home births.  Lastly, Ms Segale-Diswai also brought up the statistics about HIV and suggested that they were inaccurate because in many situations the death certificates do not say HIV, she asked if this was a reason so many deaths were attributed to tuberculosis.

Ms D Kganare (COPE) referred to the percentages of people who were satisfied with the health services they were provided and said that those statistics should be divided by public versus private sector.  In addition, she asked whether Stats SA had any plans in place to assess the impact of insurance programmes.

Ms T Kenye (ANC) noted that infant mortality did not seem to be a major concern in the presentation and that HIV/AIDS was not touched on enough. She wondered how the statistics on HIV/AIDS could be so low.  Why was there a prevalence of tuberculosis in KZN? In the Eastern Cape many people worked in the mines and it was a more rural area, how come the tuberculosis statistics were not higher there?  What about assault cases; the presentation did not directly address cases of rape and any gender based developments in this regard.

Ms S Kopane (DA) asked why diabetes was so high amongst the Indian population and why Black Africans had such low statistics with regards to hypertensions. Furthermore, she wondered why Whites had the highest rates of hypertension despite usually having better access to private health care and insurance. How did the lack of resources and professionals link to the mortality rate?


Mr G Lekgetho (ANC) expressed concern with the statistics about the average lifespan; he found it strange that according to the presentation women lived longer than men, why was this?  In the section about methods of transport to health centres what qualified as other?

Mr Lehohla began the responses by noting that Stats SA did not offer advice on what to change, as mandate was to report on the statistics and not to suggest change. It was deemed a matter of separation of duties as the Act prevented the Statistician General from commenting on policies.  He then addressed the limitations of their statistics, such as infant mortality cases that go unaccounted for because they happened so quickly that the hospital did not report them.  This meant that Statistics South Africa had to make an adjustment to account for under reporting of deaths.

In terms of the statistics dealing with deaths from HIV/AIDS, Mr Lehohla noted that HIV/AIDS was not the direct cause of death on many occasions; however it had created the conditions for death. Sometimes deaths due to HIV/AIDS were not recorded as such because of the stigma attached to them. He noted the importance of making doctors aware that recording the proper causes of deaths was essential to the better understanding of mortality issues in South Africa.

Mr Lehohla reported Stats SA was working towards finishing its report on the Millennium Development Goals (MDGs) and it was difficult to obtain all the proper statistics related to maternal mortality and infant mortality to help complete this report. There needed to be a concentrated effort on bettering the administrative records to enable better statistics.

Mr Lehohla then responded to the question on why hypertension was not as prevalent amongst Black Africans.  He stated that it was a case of cultural issues in that it was more prevalent among the rich. Further examples were provided in that rich people suffered from obesity while the poor were more likely to suffer from tuberculosis. It was then noted that for every 100 female children born, there was 105 males born.  However, males were more biologically vulnerable, especially at a young age. It was this vulnerability that had led to a higher female population.

Registration of people at Home Affairs was also raised as a concern for Stats SA as it was important to have a location attached to a person as the absence of a physical identifier made data collection very difficult. This would improve the Health Information Systems which was noted as having been steadily improving, but much work was left to be done. There needed to be more professionals in hospitals and expanded facilities in the rural areas where health services were much more difficult to obtain. Better promotion of health care facilities was also necessary in reducing mortality rates in that people needed to be informed that using health care facilities for things such as births was a safer option.

Mr Lehohla informed Members that the 1.4% of health facilities that were designated as other included pharmacies and traditional healers. In terms of what fell under other in transport, this included things such as transport via animals or wheelbarrows. The lack of statistics on rape and sexual assaults could be attributed to the fact that few cases were presented that death was 100% related to sexual assaults.

The Chairperson stated that the Committee hoped that the next presentation would shed more light on rape and sexual assault statistics. Nevertheless, the meeting had been informative and through the questions asked more information was shared. She noted the need for HIV/AIDS deaths to be better reported and that they would work with the Minister in this regard. She thanked Stats SA once again for the presentation. 

The meeting was adjourned.

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