Burden of mortality linked to community-nominated priorities in rural South Africa

Abstract

Background Community knowledge is a critical input for relevant health programmes and strategies. How community perceptions of risk reflect the burden of mortality is poorly understood. Objective To determine the burden of mortality reflecting community-nominated health risk factors in rural South Africa, where a complex health transition is underway. Methods Three discussion groups (total 48 participants) representing a cross-section of the community nominated health priorities through a Participatory Action Research process. A secondary analysis of Verbal Autopsy (VA) data was performed for deaths in the same community from 1993 to 2015 (n = 14,430). Using population attributable fractions (PAFs) extracted from Global Burden of Disease data for South Africa, deaths were categorised as ‘attributable at least in part’ to community-nominated risk factors if the PAF of the risk factor to the cause of death was >0. We also calculated ‘reducible mortality fractions’ (RMFs), defined as the proportions of each and all community-nominated risk factor(s) relative to all possible risk factors for deaths in the population . Results Three risk factors were nominated as the most important health concerns locally: alcohol abuse , drug abuse , and lack of safe water . Of all causes of deaths 1993–2015, over 77% (n = 11,143) were attributable at least in part to at least one community-nominated risk factor. Causes of attributable deaths, at least in part, to alcohol abuse were most common (52.6%, n = 7,591), followed by drug abuse (29.3%, n = 4,223), and lack of safe water (11.4%, n = 1,652). In terms of the RMF, alcohol use contributed the largest percentage of all possible risk factors leading to death (13.6%), then lack of safe water (7.0%), and drug abuse (1.3%) . Conclusion A substantial proportion of deaths are linked to community-nominated risk factors. Community knowledge is a critical input to understand local health risks.

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“…On water, repeated and prolonged periods without piped water documented, as were unreliable and unavailable infrastructure, inadequate service delivery, unregulated sources, empty reservoirs, and poor supply exacerbated by droughts [ 67 ]. We supplemented community intelligence with statistical data on the extent of the burden and its social and circumstantial drivers [ 70 , 71 ].…”

“…The elements outlined above—pilot work [ 65 ], Cycle 1 community-based process [ 66 – 68 ], multisectoral engagement [ 69 ], VA [ 70 , 71 ], reflective/adaptive element [ 72 ], Cycle 2 redesign [ 73 , 74 ] and Cycle 3 CHW training [ 75 ]—are reported elsewhere.…”

Strategic leadership and change management imperatives in a volatile era: a case study of Prince Mshiyeni Memorial Hospital.

“…SA have demonstrated the vulnerability of diseases in their variety, from HIV and TB to noncommunicable diseases such as hypertension, diabetes, cardiovascular disease, high maternal, neonatal, and child morbidity, and high levels of trauma and violence (Govender, et al, 2018;Harrichandparsad & Mahomed, 2021;Mattila, et al, 2022). In KZN alone, it was reported that "94% of people living with HIV know their status, and 85% of those people are on HIV treatment" (Ritshidze, 2021, p. 5).…”