Skip navigation
Skip navigation

Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993-2013

Kabudula, Chodziwadziwa; Houle, Brian; Collinson, Mark; Kahn, Kathleen; Gómez-Olivé, Francesc; Clark, Samuel J.; Tollman, Stephen M.

Description

Background: Virtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently...[Show more]

dc.contributor.authorKabudula, Chodziwadziwa
dc.contributor.authorHoule, Brian
dc.contributor.authorCollinson, Mark
dc.contributor.authorKahn, Kathleen
dc.contributor.authorGómez-Olivé, Francesc
dc.contributor.authorClark, Samuel J.
dc.contributor.authorTollman, Stephen M.
dc.date.accessioned2021-09-06T00:51:21Z
dc.date.available2021-09-06T00:51:21Z
dc.identifier.issn1471-2458
dc.identifier.urihttp://hdl.handle.net/1885/247363
dc.description.abstractBackground: Virtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population. Methods: We estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993–2013. Results: From the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males. Conclusions: This typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact on continued progress in reducing preventable mortality and improving health across the life course. Integrated healthcare planning and program delivery is required to improve access and adherence for HIV and non-communicable disease treatment. These findings from a local, rural setting over an extended period contribute to the evidence needed to inform further refinement and advancement of epidemiological transition theory.
dc.description.sponsorshipThe MRC/Wits Rural Public Health and Health Transitions Research Unit which runs the Agincourt Health and socio-Demographic Surveillance System has been supported by the Wellcome Trust, UK (grants 058893/Z/99/A, 069683/Z/ 02/Z, 085477/Z/08/Z, and 085477/B/08/Z); the South African Medical Research Council; and University of the Witwatersrand, South Africa. PRICELESS-SA (Priority Cost-effective Lessons Systems Strengthening) provided support through a grant from the South African Medical Research Council (D1305910–01).
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherBioMed Central Ltd.
dc.rights© The Author(s). 2017
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceBMC Public Health
dc.subjectSouth Africa
dc.subjectAgincourt
dc.subjectRural
dc.subjectMortality
dc.subjectHIV/Aids
dc.subjectCause composition
dc.subjectVerbal autopsy
dc.subjectInterVA
dc.subjectNoncommunicable diseases
dc.subjectepidemiological transition
dc.titleProgression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993-2013
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume17
dc.date.issued2017
local.identifier.absfor160304 - Mortality
local.identifier.absfor160305 - Population Trends and Policies
local.identifier.ariespublicationu8403255xPUB3
local.publisher.urlhttp://www.biomedcentral.com/
local.type.statusPublished Version
local.contributor.affiliationKabudula, Chodziwadziwa, University of the Witwatersrand
local.contributor.affiliationHoule, Brian, College of Arts and Social Sciences, ANU
local.contributor.affiliationCollinson, Mark, University of the Witwatersrand
local.contributor.affiliationKahn, Kathleen, University of the Witwatersrand
local.contributor.affiliationGómez-Olivé, Francesc, University of the Witwatersrand, Johannesburg, South Africa
local.contributor.affiliationClark, Samuel J., Ohio State University
local.contributor.affiliationTollman, Stephen M., University of the Witwatersrand
local.bibliographicCitation.issue424
local.identifier.doi10.1186/s12889-017-4312-x
local.identifier.absseo920506 - Rural Health
dc.date.updated2020-11-23T10:59:17Z
local.identifier.scopusID2-s2.0-85019047618
local.identifier.thomsonID000400820800003
dcterms.accessRightsOpen Access
dc.provenanceThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
dc.rights.licenseCreative Commons License (Attribution 4.0 International)
CollectionsANU Research Publications

Download

File Description SizeFormat Image
01_Kabudula_Progression_of_the_2017.pdf687.07 kBAdobe PDFThumbnail


This item is licensed under a Creative Commons License Creative Commons

Updated:  19 May 2020/ Responsible Officer:  University Librarian/ Page Contact:  Library Systems & Web Coordinator