Media statements

Latest report on causes of death and premature mortality in Cape Town,
2001 - 2006

This third report on cause of death and premature mortality presents key findings from a trend analysis of cause of death statistics for the Cape Town Metro District for 2001 until 2006, and the 8 new health sub-districts for 2003 to 2006. The data were collected directly from local offices of the Department of Home Affairs supplemented by information from the local mortuaries. Analysis focuses on the five programme priorities identified by the City of Cape Town and Provincial Department of Health in line with National Policy: HIV/AIDS, TB, Chronic Diseases, Child Health and Woman's Health.

Key findings and recommendations are as follows:

• HIV/AIDS mortality has increased dramatically since 2001; however, it appears to have stabilised since 2004, possibly demonstrating the impact of the prevention of mother-to-child transmission (PMTCT) and antiretroviral (ARV) programmes. It remains a leading cause of premature mortality across sub-districts, highlighting the need to strengthen intersectoral prevention strategies and to continue to strengthen the health service response. HIV/AIDS is particularly high in the sub-district of Khayelitsha and is accompanied by very high TB mortality.
  
  
• Injury-related mortality remains extremely high. Although there was evidence of a declining trend until 2004, there was an increase until 2006. The injury mortality rates - particularly homicide and road traffic injuries - are still among the highest in the world, particularly for men. Of particular concern are the high homicide and road traffic injury fatality rates among the male youth. Urgent attention needs to be given to identifying and implementing strategies to prevent injuries. Interventions to address the high burden of violence and homicide must be planned, implemented, monitored and evaluated multi-sectorally. National Injury Mortality Surveillance System data for Cape Town confirm a strong association between alcohol and fatal injuries.
  
  
• Mortality rates due to non-communicable diseases are high. Non-communicable diseases (such as diabetes, ischaemic heart disease, lung cancer and stroke) account for a high proportion of premature mortality, particularly among adult women. Smoking rates are particularly high in the coloured women. The emerging epidemic of non-communicable diseases must be tackled by strengthening primary care management, promoting healthy lifestyles and addressing upstream risk factors (the 'cause of causes').
  
  
• Child mortality appears to have remained constant over this period, but there was a noticeable increase in mortality from low birthweight until 2004 that needs further investigation. There is a suggestion that child mortality due to HIV/AIDS has started decreasing. The period studied covers only the beginning of the full-scale PMTCT
  roll-out.
  
  
• Mortality differentials between sub-districts remained fairly static, with Khayelitsha standing out with the highest rates of premature mortality. Here trends indicate that although child mortality has improved and HIV/AIDS mortality may have decreased, mortality from interpersonal violence has increased. However, it is likely that some
  other suburbs, such as Nyanga and Gugulethu, experience similarly high mortality but are masked by the new sub district boundaries. Equity must be prioritised in resource allocation between sub-districts to address the greatest needs.

Says Dr Ivan Bromfield, Executive Director City Health, City of Cape Town and Dr Keith Cloete, Chief Director, Metro District Health Services, Western Cape Department of Health: "In our district it is HIV, TB, homicide and road traffic injuries that account for almost half of all the premature deaths. Only by advocating for an integrated, multi-sectoral approach will these be successfully prevented. Global evidence shows that preventative efforts which take place in schools, workplaces and communities are just as important as the health services.

"Partnerships are therefore very important in reducing the burden of disease. The continued success and improvement of this mortality surveillance system depends on departments from the various spheres of government collaborating to ensure availability of quality information that can influence decision-making."

Background information

This report is the result of a partnership between the City of Cape Town, Western Cape Department of Health, Medical Research Council and University of Cape Town within the Western Cape Burden of Disease Reduction Project, where other partners are also involved.

Cause of death data are essential to identify the health needs of a community, monitor progress in the implementation of programmes and track changes over time. Limited resources and continuing disparities make sub-population data critical for identification and monitoring of inequalities in health status and prioritization of interventions, services and research at local level.

The City of Cape Town has collected cause of death statistics for more than 100 years as part of its public health programme. Evaluation of the statistical system identified the need for standardization of the coding and a more public health-oriented analysis of the statistics. The first report on cause of death and premature mortality in the Cape Town Metropole appeared in 2001, and showed marked variations in levels of mortality across the city which reflected socio-economic differences. 

Copies of the report can be downloaded from www.mrc.ac.za/bod/bod.htm,
www.capegateway.gov.za/health and www.capetown.gov.za/health.