South African Medical Research Council (SAMRC)
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Burden of Disease Research Unit


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Research highlights 

National Burden of Disease Study

The Burden of Disease Research Unit completed the first National Burden of Disease study for South Africa for the year 2000. Following the Global Burden of Disease study methodology the main focus of the study was to estimate the burden due to premature mortality (years of life lost). Attempts were made to estimate the additional burden contributed by morbidity (years lived with disability), to estimate the disability adjusted life years, and to project the impact of HIV/AIDS on premature mortality in the year 2010. Estimates were derived from different data sources for the levels and underlying causes of disease and injury deaths. The top 20 causes of death and premature mortality were ranked and those contributing the greatest burden can be prioritised for seeking cost-effective health interventions. Initial Burden of Disease Estimates for South Africa, 2000 (pdf format, 466kb)

The Second National Burden of Disease study is currently underway in South Africa. Over the next three years this study aims to conducts epidemiological analyses on available data sources and develop coherent estimates of the number of deaths, years of life lost due to premature mortality for the period 1997 and 2010 and disability adjusted life years for 2000 and 2010. Estimation of the number of deaths for South Africa included the development of a regression model to estimate the number of deaths for HIV/AIDS. For the first time, this study will report trends in mortality for the period 1997 – 2010 for the country and each province. Preliminary results suggest a decrease in the mortality rates for HIV/AIDS and TB, non-communicable diseases, and injuries for the South Africa in 2010. In addition, a comparative risk assessment will be conducted for 2010 to quantify the contribution of 21 modifiable risk factors.

The unit conducted a review of available empirical data of levels and causes of mortality during childhood, which consolidated information about the changes that occurred between 1997 and 2007. The consistency between data sources was considered to estimate childhood mortality rates utilizing 11 years of vital registration data, national household surveys and censuses, injury surveillance data as well as demographic surveillance and health service data. The review concluded that substantial improvement in the completeness of registration had occurred, reaching levels of 90% for infants and 60% for children aged 1-4 years infant. The increased mortality experienced by children under-5 in the late 1990’s had stabilized in the new Millennium and the cause of death pattern indicated that by 2007 the “Big Five” health challenges for the country were HIV/AIDS, pregnancy and childbirth complications, newborn illness, childhood infections and malnutrition.

Rapid Mortality Surveillance

The work done by the unit in estimating the mortality trends in South Africa brought into sharp focus the extent of the impact of HIV/AIDS ( The public interest in the initial findings was unprecedented and it was l ultimately utilised by policy makers in guiding and evaluating the nation’s response to the epidemic The unit was part of an Interdepartmental Task team to assist with improving mortality statistics and estimating the impact of HIV/AIDS set up in 2001. This involved briefing sessions with various heads of government departments and resulted in Statistics South Africa strengthening their systems for processing cause of death data. While much progress has been made in improving the national cause of death statistics, there are still areas of concern.

In terms of timely monitoring of childhood and adult mortality rates, the unit, in collaboration with the Centre for Actuarial Research at UCT and the MRC Biostatistics Unit has developed the Rapid Mortality Surveillance (RMS) system to monitor the trend and the number of deaths recorded on the national population register. Since 2009, analysis of the RMS data has provided empirical estimates of the following key health-related indicators: the maternal mortality ratio, the neonatal, infant and under-5 mortality rates as well as life expectancy and measures of adult mortality. The system produces an annual report of these universal indicators two years sooner than the published vital registration data.

Western Cape Mortality Surveillance System
The unit has been involved in a collaborative project with the Western Cape Department of Health and the City of Cape Town to develop a mortality surveillance system that reports on mortality at district and sub-district levels in the province. It makes use of cause of death information provided on death notifications for deaths registered with the Department of Home Affairs. It groups causes into meaningful categories, makes adjustments for the ill-defined causes and makes use of population estimates for calculating age-standardised mortality rates. The latest report presents the Western Cape mortality profile for 2011, by sub-district, and includes a more complete analysis of the causes of death in children under-5 years than in previous reports. Western Cape mortality profile, 2011 (pdf format 3910 kb)
Injury Mortality Survey
The unit conducted a survey of more than 22,000 non-natural deaths that presented to mortuaries in 2009 in order to inform the injury estimates for the second National Burden of Disease study. This is the first nationally representative sample of injury mortality and provides more accurate injury mortality estimates and cause-specific profiles not available from other sources. Estimates were compared with official statistics and Global Burden of Disease (GBD) country estimates. The study indicated that there had been a significant decrease in injury–related mortality since 2000, attributable primarily to the significant decrease in homicide.
Eastern Cape Province Cancer Registry
This is the only population-based cancer registry in South Africa which has been in existence for more than 20 years. The overall aim of the registry is to continuously identify and register all incident cancer cases who reside in eight selected magisterial districts in the former Transkei region of the Eastern Cape Province. Both active and passive methods are used in data collection; with the former being mainly used. A reliable database is generated and maintained to provide information about incidence of cancers and trends over time in a rural setting of South Africa and contributes to pooled studies of cancer epidemiology that include staging and cancer survival studies. Furthermore, data from the register are used periodically to contribute to the Africa chapter in Cancer Incidence in Five Continents (CI5) published by the WHO International Agency for Research on Cancer (IARC). Cancer incidence in selected municipalities of the Eastern Cape Province, 2003-2007 (pdf 734 kb)
South African Demographic and Health Surveys

The unit played an important role in co-ordinating South Africa's first Demographic and Health Survey (SADHS) of 1998. The findings of the SADHS highlight the health inequalities that exist in South African society. The survey is a key tool to assist policy makes in redressing the unequal distribution of health care and to ensure that health policy and legislation are consistent with the objectives of achieving greater access and better quality of care and other health benefits for all South Africans. This was repeated by the National Department of Health in 2003 and a new SADHS is planned to be in the field in 2015.

Evaluation of Health Information Systems

The Burden of Diseases Unit in collaboration with John Snow’ Enhancing Strategic information (ESI), and the South African National Department of Health conducted a Rapid Information Needs Assessment of the District Health Information System in 2012, to inform health information system priorities and give input into the National Strategic Plan for Health Information Systems (HIS) in South Africa. The assessment focused on human resources, hardware and DHIS software.

The unit is also currently undertaking a comprehensive evaluation of the performance of the routine health information systems (RHIS) in selected districts in KwaZulu Natal and the Western Cape, in terms of data accuracy and use of information at both the facility and district levels. This research focuses on strengthening the RHIS that support maternal and child health programmes, specifically focusing on data quality of the Prevention of Mother-to-Child Transmission of HIV (PMTCT), and immunization programmes. The study also assesses the behavioural (competence in RHIS tasks, data quality checking skills, problem-solving skills, and motivation) and organisational determinants (supervision, planning, training, governance) affecting RHIS performance in South Africa.

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Last updated:
29 February, 2016
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