More young adults, children under five, babies and women in childbirth are dying now than a few years back, both as a result of HIV/AIDS and the deterioration of health services.
In addition, chronic diseases associated with poor diet, smoking, excessive drinking and lack of exercise are on the increase, as more South Africans adopt westernised lifestyles.
This is according to the 2003/4 South African Health Review (SAHR), an annual report on the state of the nation’s health produced by the non-governmental organisation Health Systems Trust (HST), which was launched last night (28 July).
The average South African isn’t looking too healthy, although SAHR editors Petrida Ijumba, Candy Day and Antoinette Ntuli warn that the lack of accurate data makes monitoring difficult,.
We are most likely to die of HIV/AIDS, which was responsible for 39 percent of all deaths in 2000. If we don’t die of AIDS, we may fall victim to homicide and violence, which is our second biggest killer overall (7,5 percent), followed by tuberculosis (5 percent) and road accidents (4,1 percent).
But our increasingly westernised, sedentary lifestyles are also killing us. When all categories of non-communicable diseases ‘ chronic non-infectious diseases usually associated with lifestyle ‘ are combined, these kill almost as many people as HIV/AIDS does (responsible for around 37 percent of deaths).
The biggest chronic killer is heart disease, followed by strokes, cancer, chronic obstructive pulmonary disease and diabetes.
‘Chronic diseases are largely preventable if intervention is targeted at risk factors and determinants,’ says researcher Priscilla Reddy.
Risk factors and determinants include smoking, excessive alcohol consumption, poor diet, lack of exercise, obesity, high blood pressure and high cholesterol.
Changes in diet have been particularly striking in South Africa over the past few years, particularly with the growth of the fast food industry, notes Reddy.
‘Traditional plant-based foods (are) being replaced by high fat, high sugar, energy dense, low fibre foods’ that promote the development of chronic diseases.
More mothers dying
More than one in three (35 percent) of our sisters will have had a child by the age of 19, particularly if they live in rural areas. Significantly, the vast majority of pregnant women (94 percent) get antenatal care and the majority of all births (84 percent) will be supervised by a skilled person.
If you give birth in Limpopo you have only a 13.7 percent chance of being attended to by a doctor.
In private health, you have a 37 percent chance of being given a Caesarean. This is in contrast to the international norm of 5-15 percent Caesareans for all births, which indicates significant ‘over-medicalisation’.
Your newborn baby is most likely to die within a week if born in the North West and Free State. But babies over a week but under a month old are mostly likely to die in the Eastern Cape.
In Gauteng, there was a 15 percent increase in babies dying within the first week between 1999 and 2002. This was almost entirely due to the 50 percent increase in the stillbirth rate (viable babies born dead).
The risk of a baby being stillborn is increased fourfold if its mother is HIV positive, notes researcher Robert Pattinson. But, he adds, ‘as the stillbirth rate reflects the quality of antenatal care, this difference may indicate deteriorating antenatal care’.
This is borne out by a survey that found the deaths of 63 percent of babies who died of suffocation in the womb or birth trauma were avoidable in metropolitan areas.
The chances of women dying in, or as a result of, childbirth (maternal deaths) is also increasing. In 1998 in Gauteng public health, 67 women died in childbirth per 100 000 births but by 2002, the number was 112.
‘This deterioration cannot be explained by the increasing HIV epidemic alone,’ says Pattinson. ‘The implication is that there has been a steady deterioration of maternal health services over the past few years.’
In fact, in 1998 ‘avoidable factors, missed opportunities and substandard care’ relating to the conduct of healthcare workers were noted in 56,8 percent of maternal deaths assessed. Although a slightly different calculation was made to get the 1999-2001 figures, at primary care level such mistakes were made in 73,3 percent of cases.
If you want to terminate your pregnancy, your options remain limited. A third of the designated termination of pregnancy (TOP) facilities were not offering the service in 2003. This is particularly the case in KwaZulu-Natal (KZN). Despite being having the largest population, only 21 of the 69 facilities that were supposed to be offering TOP actually performed them.
More children under five dying
More of our children under the age of five are dying, with the death rate of this age group worse in 2000 (95 per 1000 births) than it was in 1975 (89 per 1000).
AIDS-related illnesses were responsible for 40,3 percent of deaths of our children under five, followed by low birth weight (11,2 percent) and diarrhoea (10.2 percent).
The HIV/AIDS epidemic has effectively reversed the health gains made in child health as, by 1998, the death rate for the under fives had been reduced to 59,4 per 1000.
As most children get HIV from their mothers, a well-run and massive prevention of mother-to-child HIV transmission programme is the best way to improve the death rate of our children and babies, urges the review.
By the age of nine, your child has a one in five chance of being stunted as a result of sustained lack of nutrition. This is particularly the case if your child lives in a rural area such as the Free State and Northern Cape.
By the time our children get to their teens, they are vulnerable to injury-related death (the cause of 22 percent of deaths of those aged 15-24).
Homicide and violence are by far the biggest killers in this category (61 percent), followed by road accidents (21 percent) and suicide (10 percent).
A quarter of teens said they had felt hopeless and sad for more than two weeks in the previous six months. This was worst in Gauteng, where over a third of pupils had such feelings, according to a school survey of teens from grades 8 to 11.
About 41 percent of these pupils reported being sexually active, with the greatest percentage in Gauteng. Less than half (44 percent) of the sexually active had ever used condoms, although this was the most popular method of birth control. A fifth of the sexually active girls had fallen pregnant.
One in 10 young people under the age of 24 is living with HIV, and 77 percent of these are female.
But HIV prevalence among the 15-19 year olds appears to be decreasing in high prevalence areas such as KZN and Mpumalanga.
The nutritional patterns of the pupils show the two extremes of South Africa. About one in five children, mainly African, were either underweight or stunted whereas one in three, mainly Indian and white, were either overweight or obese.
Double the number of African teens as whites were stunted. Some 27 percent of Indian teens were overweight in comparison to 17 percent of African teens.
More of us getting older
By adulthood, sexually transmitted infections (STIs) pose a serious health problem. About 8.4 million people were infected with STIs in 2002, according to the country’s first comprehensive STI survey.
Yet only half of all professional nurses were trained in the STI management method recommended by the health department, called syndromic management, and less than half the facilities provided the correct treatment for vaginal discharge.
Sexually active women in the Western Cape were most likely to use contraception (73,7 percent) while those in Mpumalanga were least likely (53,2 percent).
Screening for cervical cancer, which resulted in the loss of 50 027 years of life in 2000, is inadequate with about two thirds of primary health care facilities offering pap smears.
South Africa has one of the most rapidly ageing populations in Africa, with 7,3 percent of the population over the age of 60.
Our grandparents are most likely to live in the Eastern Cape and Limpopo, which have both the highest proportion of older people and children under the age of 15.
Many elderly pensioners reported that they were struggling to support children and grandchildren on their pensions, a situation which has worsened as the AIDS epidemic has matured.
For our grandparents over 60, strokes and heart attacks pose the greatest health risks. Excess weight was a risk factor, with 43 percent of men and 60 percent of women over 65 either being overweight or obese.
Only 13 percent of those over 65 have a medical aid, but half this age group were taking two or three prescription drugs.
About 6 percent of South Africans are disabled, with the Eastern Cape and KZN having the highest disability rates. Visual impairment was the most commonly reported disability, but psychiatric disability was generally poorly documented.
E-mail Kerry Cullinan