Statistical reports show a decline in mortality in South Africa since 2007.
The number of deaths reported in 2011 by Statistics South Africa in their 2011 Mortality and Causes of Death report (most recent publication) and the Medical Research Council's (MRC) 2011 Rapid Mortality Surveillance report are slightly different, but both reports agree that there’s a declining trend.
|Natural Deaths||Non Natural Deaths||Total|
|Stats SA||459 813||45 990||505 803|
|MRC||442 291||42 732||485 023|
2011 Mortality figures for the total recorded deaths reported by Stats SA and the MRC.
While a decline in mortality is promising, the MRC says ‘it’s important to investigate whether there are any indications of system failure.’ The 2011 Rapid Mortality Surveillance (RMS) report (1) indicates that ‘subtle changes in completeness of recording are quite difficult to detect’ and ‘extensive investigation did not identify any’.
According to the 2011 RMS report, one of the reasons for a decline in mortality is the ‘greater than expected’ rapid roll out of antiretrovirals (1). Due to time constraints, Stats SA couldn’t release child mortality figures, but the 2011 RMS report says that life expectancy improvements occurred due to improvements in under five and child mortality (1).
RMS versus Stats SA reports
Both the 2011 RMS and the Stats SA Mortality and Causes of Death report use data from the Department of Home Affairs (DHA) National Population Register (NPR). However, the RMS includes information that shows mortality based only on SA citizens whose birth and death are recorded in the NPR database system and permanent SA residents. In contrast, Stats SA retrieves its data from the actual death notification form, which includes ‘deaths for non-South African citizens and South African citizens whose births weren’t registered on the NPR’. This could explain the differences in the total number of deaths.
Stats SA published the 2011 Mortality and Causes of Death report (2) on 18 March 2014, whereas the MRC published the 2011 RMS in August 2012 (1) and the 2012 RMS report (3) in February/March 2014. ‘It is possible to provide information on key health indicators in a timely fashion,’ the 2011 RMS says, ‘By adjusting for known bias in the RMS data, it is possible to provide information about the key indicators two years sooner than the published vital registration data.’
It must be noted that the two reports both report on key health indicators, but have slightly different outputs. The Stats SA report outlines population mortality, sex, marital status, geographic differentials, classification of deaths by age and morbidity while the RMS focuses on life expectancy and an overview of adult, child and maternal mortality.
Stats SA 2011 Mortality and Causes of Death report
Stats SA found a decrease in population mortality from 547 724 deaths in 2010 to 505 803 in 2011, indicating a 7.7% decrease. Crude death rates and median ages of death support the DHA data. Decreasing mortality is linked to the rise of median ages and showed that mortality occurred later in life.
Out of all deaths, 51.7% were among males and 48.3% among females. The average age of male deaths was 49 years and 52.5 for females. And never married people constituted approximately half of all registered deaths in 2011.
Significant population group differences in mortality showed up that two thirds of the deaths were from the black African population group (340 728), coloured deaths came second (39 037), followed by white (26 724), Indian/Asian (7 924), other (891) and unknown or unspecified (90 499). This is largely in line with the race distribution in the Census 2011.
The provinces with the highest number of deaths correlated with the provinces with the highest populations; 20.7% of deaths occurred in KwaZulu-Natal, 19.9% in Gauteng, 14.4% in Eastern Cape.
Leading causes of death per age group for 2011 were as follows: 0-14 years - intestinal infectious diseases, 15-64 years - tuberculosis (TB), and 65 and older - cerebrovascular diseases. The majority of deaths in 2011 were in the infectious and parasitic deaths group (23.1%) and the diseases of the circulatory system (16.2%). Non-natural deaths amounted to 9.1%. The age group 15-19 years experienced the highest percentage of non-natural causes of death. The most unnatural deaths occurred in the Western Cape followed by Gauteng.
Dominant causes of death in 2011 were TB (10.7% of all deaths), influenza and pneumonia (6.6%) and cerebrovascular diseases (5.1%). In 2011, intestinal infectious diseases ranked sixth place for leading causes of death (3.8%) compared to 2009 and 2010 where it ranked third place. On the contrary, cerebrovascular disease moved up to third leading cause of death in 2011 from fifth place in 2010 and 2009. HIV came in at seventh, followed by hypertensive diseases at eighth place.
The maternal mortality ratio - trends in the vital registration data article (4) by Rob Dorrington and Debbie Bradshaw – co-authors of the 2011 RMS - signposts challenges with regard to HIV ranking seventh in a country with a tremendous HIV epidemic. The article considers that ‘epidemiological models suggest nearly 40% of deaths are due to HIV’ compared to the 2-2.5% of registered deaths that are actually attributed to HIV. In addition, ‘Studies have highlighted high levels of misattribution of HIV/AIDS as well as cardiovascular causes,’ say Dorrington and Bradshaw.
MRC Rapid Mortality Surveillance reports
According to the 2011 RMS report (1), the number of under 5 year old deaths declined. In 2011 it was 21 554 from 34 006 in 2006. Furthermore, based on the 2011 RMS’s limited report on the maternal mortality (MM) key indicator, MM seems to be worsening. In 2008 a baseline of 310 deaths was set for maternal mortality ratio (MMR) per 100 000 live births, due to the lag in available data from Stats SA cause of death data. In 2009 the MMR was 333.
The 2011 and 2012 RMS report (1,3) showed an increasing life expectancy from 2005 to present thus the government’s National Service Delivery Agreement has prematurely reached it's target of 59.1 for 2014. Compared to 2010 where life expectancy for males was 55.3 years and 60.3 for females, the 2011 RMS showed an increase in life expectancy in 2011: males - 56.9 years and females - 62.4.
|Rapid Mortality Surveillance Key Indicator-Life Expectancy|
|Life expectancy at birth||57.1||58.5||60.5||61.3||61|
Table modified from the 2012 RMS Life expectancy at birth report (3).
In spite of the vital registration system challenges, South Africans, it appears, are living longer.
By Megan Harker, honours degree in Health Journalism, undergraduate in Communication Science and Philosophy. More work by this author can be found at: framewrite.blogspot.com, gardeniagardenescapades.wordpress.com, portfoliobymeganharkerat.wordpress.com
- Bradshaw D, Dorrington RE, Laubscher R. Rapid mortality surveillance report 2011. Cape Town: South African Medical Research Council; 2012. Link to report
- Statistics South Africa. Mortality and Causes of Death in South Africa 2011. Pretoria: Statistics South Africa; 2014. Link to report
- Dorrington RE, Bradshaw D, Laubscher R. Rapid mortality surveillance report 2012. Cape Town: South African Medical Research Council; 2014. Link to report
- Bradshaw D, Dorrington RE. Maternal mortality ratio-trends in the vital registration data. South African Journal of Obstetrics and Gynaecology. 2012;18(2):38-42. Link to article