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Selected health indicators for Free State and a reflection on how they relate to the MDGs
’Maletela Tuoane-NkhasiStatistics South Africa
Symposium on evidenced based decision-makingBloemfontein, 10-11 October 2013
Contents of presentation Government priorities on health Data sources of health statistics Selected health indicators for Free State
o Infant mortality
o Under-five mortality
o Maternal mortality
o Communicable diseases
o Non-communicable diseases
Concluding remarks
Government priorities on health
Three Millennium Development Goals related to health
“A long and healthy life for all South Africans”o Increasing life expectancy
o Decreasing maternal and child mortality
o Combating HIV and AIDS and decreasing the burden of disease from tuberculosis
The National Development Plan – 2030o Increase life expectancy at birth to 70 years
o Progressively improve tuberculosis prevention and cure
o Reduce maternal, infant and child mortality
o Significantly reduce prevalence of non-communicable diseases
o Reduce injury, accidents and violence by 50% from 2010 levels
Censuses
Population-based surveys
Health facility records
Mortuary records
Demographic surveillance sites
Civil registration system
Data sources on health statistics
There is no dedicated health survey that is conducted by Stats SA Limited/selected health statistics derived from the following
sources:o Censuses / Surveys:
– General Household Survey
– Living Conditions Survey
– Income and Expenditure Survey
– Community Survey
– Population censuses
o Administrative source:
– Death notification system
Data sources on health statistics – Stats SA
Selected health indicators for Free State MDG indicators
o Infant mortalityo Under-five mortalityo Maternal mortality
Selected communicable diseaseso Flu or acute respiratory tract infectionso Diarrhoeao TBo HIV/AIDS
Selected non-communicable diseaseso Asthmao Diabeteso Hypertensiono Arthritiso Injuries
Analyses on MDG indicators
Data sourceo Mortality and causes of death data from South Africa’s civil registration systemo This source was used for monitoring Goals 4 and 5 in the 2013 MDG report
Limitations with the datao Incomplete registration of deatho Ill-defined causes of deatho Misclassified causes of death
What is presentedo Absolute number and percentage distribution to show trendso Methodology of adjusting for incomplete registration of death at provincial level
under review
Infant mortality
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
1 000
2 000
3 000
4 000
5 000
6 000
Neonatal Postnatal
Year of death
Num
ber o
f dea
ths
Infant deaths by age: Free State, 1997-2010
Infant deaths by district: Free State, 1997-2010
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
400
800
1 200
1 600
Xhariep Lejweleputswa Thabo Mofutsanyane Fezile Dabi Mangaung Metro
Year of death
Num
ber o
f dea
ths
10 leading causes of death for infants: Free State, 2006 & 2010
Underlying cause of death2006 2010
Rank No. % Rank No. %
Influenza and pneumonia 1 1 250 23,8 2 596 17,1
Intestinal infectious diseases 2 1 020 19,4 1 698 20,1
Resp. & cardiovascular disorders specific to the perinatal period 3 638 12,2 3 524 15,1
Disorders related to length of gestation and fetal growth 4 241 4,6 6 146 4,2
Malnutrition 5 184 3,5 4 162 4,7
Protozoal diseases 6 122 2,3 … … …
Other disorders originating in the perinatal period 7 110 2,1 5 155 4,5
Other acute lower respiratory infections 8 102 1,9 8 66 1,9
Infections specific to the perinatal period 9 99 1,9 7 106 3,0
Certain disorders involving the immune mechanism 10 82 1,6 9 61 1,8
Foetus & newborn affected by maternal factors & by complications of pregnancy, labour and delivery … … … 10 47 1,4
Causes of death Rank Fezile Dabi
Rank Lejwe-leputs
waRank Manga
-ungRank Thabo
Mof.Rank Xha-
riep
Intestinal infectious diseases 1 23,9 1 23,4 1 21,4 1 17,0 3 10,1
Respiratory and cardiovascular disorders specific to the perinatal period 2 16,3 3 17,6 3 14,7 4 9,9 1 13,7
Influenza and pneumonia 3 15,5 2 20,9 2 21,2 2 13,5 2 12,6
Malnutrition 4 4,9 … 4 5,8 5 5,0 5 4,2
Other disorders originating in the perinatal period 5 4,2 5 4,3 … 3 6,0 4 6,1
Infections specific to the perinatal period … … 5 4,5 … …
Disorders related to length of gestation and fetal growth … 4 7,4 … … …
All deaths 1 107 516 936 282 636
5 leading causes of death for infant by district: Free State, 2010
Under-five mortality
Under-five deaths by age: Free State, 1997-2010
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
0 1 2 3 4
Year of death
Num
ber o
f dea
ths
Under-five deaths by district: Free State, 1997-2010
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
500
1 000
1 500
2 000
2 500
Fezile Dabi Lejweleputswa Mangaung Metro Thabo Mofutsanyane Xhariep
Year of death by district municipality
Num
ber
of d
eath
s
10 leading causes of death for children under-five years: Free State, 2006 & 2010
Underlying cause of death2006 2010
Rank No. % Rank No. %
Influenza and pneumonia 1 1 528 22,5 2 777 16,8
Intestinal infectious diseases 2 1 457 21,4 1 966 20,9
Respiratory and cardiovascular disorders specific to the perinatal period 3 640 9,4 3 524 11,3
Malnutrition 4 340 5,0 4 285 6,2
Disorders related to length of gestation and fetal growth 5 241 3,5 6 147 3,2
Protozoal diseases 6 141 2,1 … … …
Certain disorders involving the immune mechanism 7 124 1,8 8 103 2,2
Other acute lower respiratory infections 8 121 1,8 10 83 1,9
Tuberculosis 9 120 1,8 9 89 1,9
Other disorders originating in the perinatal period 10 110 1,6 5 156 3,4
Infections specific to the perinatal period … … … 7 106 2,3
Causes of death Rank Fezile Dabi
Rank Lejwe-leputs
waRank Manga
-ungRank Thabo
Mof.Rank Xha-
riep
Intestinal infectious diseases 1 24,8 1 22,9 3 9,9 1 25,4 1 14,5
Influenza and pneumonia 2 19,6 2 21,5 1 12,2 2 15,2 2 13,1
Respiratory and cardiovascular disorders specific to the perinatal period 3 13,9 3 11,1 2 10,2 3 12,1 3 7,5
Disorders related to length of gestation and fetal growth 4 5,8 … … … … … … … …
Malnutrition 5 4,6 4 6,3 4 6,1 4 6,7 4 6,4
Infections specific to the perinatal period … … 5 3,4 … … … … 5 4,6
Other disorders originating in the perinatal period … … … … 5 4,6 … … … …
Certain disorders involving the immune mechanism … … … … … … … … 5 3,1
All deaths 653 1 248 855 1 493 373
5 leading causes of death for children under-five years by district: Free State, 2010
Maternal mortality
Maternal deaths: Free State, 1997-2010
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Maternal Deaths
69 55 55 65 83 72 87 128 138 120 167 162 165 138
10
30
50
70
90
110
130
150
170
Year of death
Num
ber
of m
ater
nal d
eath
s
Maternal deaths by district: Free State, 1997-2010
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
10
20
30
40
50
60
70
Fezile Dabi Lejweleputswa Mangaung MetroThabo Mofutsanyane Xhariep
Year of death
Num
ber o
f mat
erna
l dea
ths
Causes of maternal deaths: Free State, 2010Causes of maternal deaths Number of
deaths %
Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium 35 25,4
Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium 27 19,6
Eclampsia 10 7,3Postpartum haemorrhage 10 7,3Obstetric embolism 8 5,8Complications of the puerperium, not elsewhere classified 7 5,1Gestational [pregnancy-induced] hypertension with significant proteinuria 6 4,4Puerperal sepsis 6 4,4
Gestational [pregnancy-induced] hypertension without significant proteinuria 5 3,6
Ectopic pregnancy 3 2,2Maternal care for other conditions predominantly related to pregnancy 3 2,2Obstetric death of unspecified cause 3 2,2Other maternal deaths 15 10,9Total 138 100
Other health indicators
Data sourceo General household survey, 2012o Flu, diarrhoea and TB – based on questions on whether individuals suffered from
these illnesses in the month prior to the surveyo Chronic conditions – if individuals were informed by a medical practitioner or nurse
if they suffered from the conditions
Limitations with the datao Self-reportedo Survey undertaken between July and September – affects seasonal conditions
What is presentedo Percentage distributions by age and sex
Communicable diseases
Free State46,9% Age group
48,3%
46,0%
Free State3,4% Age group
3,6%
3,3%
Free State2,4%
4,7%1,0%
Age group
Free State3,0%
2,3%
3,6%
Age group
Non-communicable diseases
Free State1,5%
1,3%
1,6%
Age group
Free State5,4%
4,2%
6,5%
Age group
Free State19,7%
12,2%
26,3%
Age group
Free State5,1%
2,3%
7,5%
Age group
Free State0,3%
0,1%
0,4%
Age group
Injuries
0,33% of injuries
0,34% of injuries
Percentage of people who suffered from specific injuries
Concluding remarks
Stats SA has some information available to monitor health indicators at provincial and sub-provisional levelo Levels and trendso Data have limitation
Need to undertake a national health survey (Demographic and Health Survey)o Required to provide the much-needed health information in the country, especially
at sub-national level
Monitoring health-related MDG indicators at province level requires concerted efforts by relevant stakeholderso Use of current informationo Necessary adjustments on the datao Identification of other data sources to complement available information