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BMC Public Health. 2017 May 10;17(1):424. doi: 10.1186/s12889-017-4312-x.

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

Kabudula CW1,2, Houle B3,4,5, Collinson MA3,6,7, Kahn K3,6,7, Gómez-Olivé FX3,6, Clark SJ3,5,6,8, Tollman S3,6,7.

Author information

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. chodziwadziwa.kabudula@wits.ac.za.
2
Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK. chodziwadziwa.kabudula@wits.ac.za.
3
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.
4
School of Demography, The Australian National University, Canberra, Australia.
5
CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA.
6
INDEPTH Network, Accra, Ghana.
7
Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
8
Department of Sociology, The Ohio State University, Columbus, OH, USA.

Abstract

BACKGROUND:

Virtually 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.

METHODS:

We 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.

RESULTS:

From 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.

CONCLUSIONS:

This 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.

KEYWORDS:

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

PMID:
28486934
PMCID:
PMC5424387
DOI:
10.1186/s12889-017-4312-x
[Indexed for MEDLINE]
Free PMC Article

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