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