African women still bear the brunt of virtually all the major health problems in the country, and over half can expect to die by the age of 60 in comparison to only 15% of white women.
This is according to a wide range of health indicators that are analysed by the SA Health Review.
The huge discrepancies between private and public sector services are best illustrated by the caesarean rates. A shocking 62% of births were by caesareans in the private sector in 2005 in comparison to 17.7% in public hospitals. Countries such as the UK, US and Australia have a rate of slightly more than 20%.
Mental health remains the neglected Cinderella of our health services. Almost a third (30.3%) of South Africans reported a psychiatric disorder with 16.5% reporting that it occurred within the past 12 months, according to the country’s first nationally representative mental health survey.
Anxiety and mood disorders and substance abuse were the most common problems. Access to treatment was very poor with almost three-quarters (72.4%) receiving no treatment in the past year. Perhaps this is not surprising as there are only 419 psychologists in the public sector in comparison to the 6 310 registered with the Health Professions Council of SA. There is an average of only one psychologist per 100 000 people in the public sector.
HIV/AIDS continues to cut a swathe through the population, and the number of women dying between the ages of 20 and 39 in 2004 tripled over an eight year period.
The death rate for men between the ages of 30 and 44 doubled over the same period.
The HIV rate among Africans was at least double that of whites and Indians, with an estimated 16% of Africans aged 15 to 49 living with HIV, in comparison to 5.6% of whites and 2.7% of Indians.
By February this year, slightly more than a third of those in need of antiretroviral medicine were actually on the treatment. Children in need of ARVs were particularly underserved.
KwaZulu-Natal continues to be worst affected by HIV, with close on 40% of pregnant women testing HIV positive in 2006. The worst affected districts are Amajuba (Newcastle area) Umgungundlovu (Pietermaritzburg) and Ethekwini (Durban), where HIV prevalence among pregnant women was over 40%.
However, while the Western Cape’s HIV prevalence rate is relatively low, there are huge differences in the same health districts. For example, in the Cape Town metro, 32.6% of pregnant women in Khayelitsha were HIV positive in comparison to only 5.1% of Mitchell’s Plain women.
Between 2001 and 2005, the rate of children whose mothers have died doubled. There are now an estimated 1,2-million maternal orphans, with African children in KwaZulu-Natal being worst affected. Some 8.3% of African children in KZN under 14 and 6% nationally are motherless. Nationally, 16% (almost two out of every ten??)of children have lost either their mother or father.
The child mortality rate is increasing, mainly as a result of HIV. Four out of five children under the age of 5 who died in hospitals in 2005 were linked to HIV. The previous year, three out of five deaths were HIV-related.
The Eastern Cape had by far the worst infant mortality rate (68.3 deaths per 1000 births) in 2003, and while this had improved to 60 per 1000 three years later, it remains the worst in the country.
Tuberculosis continues to have a serious effect on South Africans, with South Africa having the 7th worst TB rate in the world. TB is the most common opportunistic infection associated with HIV.
Although the Department of Health has been treating TB using the Directly Observed Treatment (DOT) system, research showed that there was ‘no assurance’ that taking treatment in front of someone in DOTS was better than self-administered treatment.
KwaZulu-Natal has by far the highest TB rate in 2006 with 88 271 reported cases ‘ almost double the number of the next highest province, the Western Cape, with 43 155 cases.
While HIV affects women more than men, men are far more at risk of dying in homicides than women.
The homicide death rate for men in 2004 ‘ 96 deaths per 100 000 ‘ was the second highest in the world, after Colombia.
According to 2000 statistics, South Africa is one of the most violent societies on earth with nine times the global average for violent deaths of young men aged 15 to 29. Assault rates are worst in the Northern and Eastern Cape.
Road accident fatalities are also climbing, with 32.5 deaths per 100 000 people last year (as opposed to 26.8 in 2003).
Maternal deaths ‘ women who die as a result of childbearing ‘ more than doubled between 1997 and 2004. By 2005, there were 1 258 maternal deaths.
Teen pregnancy continues to be a problem, with at least 15% of teenage girls having fallen pregnant. The Kaiser national survey of 4 000 South Africans aged 15-24 found that 57% of sexually active young women had fallen pregnant ‘ and 61% described their pregnancies as being ‘unwanted’.
Obesity is a growing problem, with South Africa following trends in the US of increased levels of obesity in children and women particularly. In 2003, over a quarter (28.4%) of African women were obese while over a fifth of white men were also obese. In contrast, more than one in 10 African men were underweight.
A host of health problems are associated with obesity, the most prevalent in South Africa being hypertension (high blood pressure) and diabetes.
The prevalence of hypertension is very high for women, with over 40% of women aged 55 and over suffering from it. Women were also disproportionally affected by diabetes, with a prevalence rate of over 12% in women over 55.
However, indicators are never fool proof and the need for caution is perhaps best illustrated by the malaria statistics. While the Department of Health statistics claim that only 64 people died of malaria in 2005, StatsSA records 756 deaths in the same period.