Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

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

Authors: Chodziwadziwa W. Kabudula, Brian Houle, Mark A. Collinson, Kathleen Kahn, Francesc Xavier Gómez-Olivé, Samuel J. Clark, Stephen Tollman

Published in: BMC Public Health | Issue 1/2017

Login to get access

Abstract

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 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.
Appendix
Available only for authorised users
Literature
1.
Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. The Milbank Memorial Fund Quarterly. 1971;49(4):509–38.CrossRefPubMed
2.
Rogers RG, Hackenberg R. Extending epidemiologic transition theory: a new stage. Soc Biol. 1987;34(3–4):234.PubMed
3.
Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. The Milbank Memorial Fund Quarterly. 1986;64:355–91.
4.
Caselli G, Mesle F, Vallin J. Epidemiologic transition theory exceptions. Genus. 2002;58(1):9–51.
5.
Frenk J, Bobadilla JL, Sepúlveda J, Cervantes ML. Health transition in middle-income countries: new challenges for health care. Health Policy Plan. 1989;4(1):29.CrossRef
6.
Kahn K, Garenne ML, Collinson MA, Tollman SM. Mortality trends in a new South Africa: hard to make a fresh start. Scand J Public Health. 2007;35(69 suppl):26.CrossRef
7.
Moser K, Shkolnikov V, Leon DA. World mortality 1950-2000: divergence replaces convergence from the late 1980s. Bull World Health Organ. 2005;83(3):202–9.PubMedPubMedCentral
8.
Omran A, R. The epidemiologic transition theory revisited thirty years later. World Health Statistics Quarterly. 1998;51(2/3/4):99–119.
9.
Masquelier B, Waltisperger D, Ralijaona O, Pison G, Ravélo A. The epidemiological transition in Antananarivo, Madagascar: an assessment based on death registers (1900-2012). Glob Health Action. 2014;7
10.
Agyei-Mensah S, Aikins AG. Epidemiological transition and the double burden of disease in Accra. Ghana J Urban Health. 2010;87(5):879–97.CrossRefPubMed
11.
Bawah A, Houle B, Alam N, Razzaque A, Streatfield PK, Debpuur C, et al. The evolving demographic and health transition in four low-and middle-income countries: evidence from four sites in the INDEPTH network of longitudinal health and demographic surveillance systems. PLoS One. 2016;11(6):e0157281.CrossRefPubMedPubMedCentral
12.
Engelaer FM, Koopman JJ, van Bodegom D, Eriksson UK, Westendorp RG. Determinants of epidemiologic transition in rural Africa: the role of socioeconomic status and drinking water source. Trans R Soc Trop Med Hyg. 2014;108(6):372–9.CrossRefPubMed
13.
Santosa A, Wall S, Fottrell E, Högberg U, Byass P. The development and experience of epidemiological transition theory over four decades: a systematic review. Glob Health Action. 2014;7
14.
Santosa A, Byass P. Diverse empirical evidence on epidemiological transition in low-and middle-income countries: population-based findings from INDEPTH network data. PLoS One. 2016;11(5):e0155753.CrossRefPubMedPubMedCentral
15.
Karim SSA, Churchyard GJ, Karim QA, Lawn SD. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet. 2009;374(9693):921–33.CrossRefPubMed
16.
United Nations DoE, Social Affairs PD. World Population Prospects: The 2010 Revision, Volume I: Comprehensive Tables. ST/ESA/SER.A/313.
17.
Bradshaw D, Laubscher R, Dorrington R, Bourne DE, Timaeus IM. Unabated rise in number of adult deaths in South Africa. SAMJ. 2004;94(4):278–9.PubMed
18.
Kabudula CW, Tollman S, Mee P, Ngobeni S, Silaule B, Gómez-Olivé FX, et al. Two decades of mortality change in rural northeast South Africa. Glob Health Action. 2014;7
19.
Zwang J, Garenne M, Kahn K, Collinson M, Tollman SM. Trends in mortality from pulmonary tuberculosis and HIV/AIDS co-infection in rural South Africa (Agincourt). Trans R Soc Trop Med Hyg. 2007;101(9):893–8.CrossRefPubMed
20.
Tollman SM, Kahna K, Garenne M, Gear JS. Reversal in mortality trends: evidence from the Agincourt field site, South Africa, 1992-1995. AIDS. 1999;13(9):1091–7.CrossRefPubMed
21.
Herbst AJ, Cooke GS, Bärnighausen T, KanyKany A, Tanser F, Newell ML. Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal. South Africa Bull World Health Organ. 2009;87(10):754–62.CrossRefPubMed
22.
Herbst AJ, Mafojane T, Newell ML, others. Verbal autopsy-based cause-specific mortality trends in rural KwaZulu-Natal, South Africa, 2000–2009. Popul Health Metr. 2011;9(1):47.
23.
Bradshaw D, Groenewald P, Laubscher R, Nannan N, Nojilana B, Norman R, et al. Initial burden of disease estimates for South Africa, 2000. SAMJ. 2003;93(9):682–8.PubMed
24.
Bradshaw D, Nannan N, Groenewald P, Joubert J, Laubscher R, Nijilana B, et al. Provincial mortality in South Africa, 2000-priority-setting for now and benchmark for the future. SAMJ. 2005;95(7):496–503.PubMed
25.
Groenewald P, Bradshaw D, Daniels J, Zinyakatira N, Matzopoulos R, Bourne D, et al. Local-level mortality surveillance in resource-limited settings: a case study of cape town highlights disparities in health. Bull World Health Organ. 2010;88(6):444–51.CrossRefPubMedPubMedCentral
26.
Hosegood V, Vanneste AM, Timæus IM. Levels and causes of adult mortality in rural South Africa: the impact of AIDS. AIDS. 2004;18(4):663.CrossRefPubMed
27.
Tollman SM, Kahn K, Sartorius B, Collinson MA, Clark SJ, Garenne ML. Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study. Lancet. 2008;372(9642):893–901.CrossRefPubMedPubMedCentral
28.
Houle B, Clark SJ, Gómez-Olivé FX, Kahn K, Tollman SM. The unfolding counter-transition in rural South Africa: mortality and cause of death, 1994--2009. PLoS One 2014;9(6):e100420.
29.
Bradshaw D, Schneider M, Dorrington R, Bourne DE, Laubscher R. South African cause-of-death profile in transition-1996 and future trends. SAMJ. 2002;92:618–23.PubMed
30.
Kahn K, Tollman SM, Garenne M, Gear JSS. Who dies from what? Determining cause of death in South Africa's rural north-east. Tropical Med Int Health. 1999;4(6):433–41.CrossRef
31.
Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, et al. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global burden of disease study 2013. Lancet. 2015;385(9963):117–71.CrossRef
32.
Kahn K, Collinson MA, Gómez-Olivé FX, Mokoena O, Twine R, Mee P, et al. Profile: Agincourt health and socio-demographic surveillance system. Int J Epidemiol. 2012;41(4):988–1001.CrossRefPubMedPubMedCentral
33.
Kahn K, Tollman SM, Collinson MA, Clark SJ, Twine R, Clark BD, et al. Research into health, population and social transitions in rural South Africa: data and methods of the Agincourt health and demographic surveillance system. Scand J Public Health. 2007;35(69 suppl):8–20.CrossRef
34.
Kabudula CW, Houle B, Collinson MA, Kahn K, Tollman S, Clark S. Assessing Changes in Household Socioeconomic Status in Rural South Africa, 2001--2013: A distributional analysis using household asset indicators. Soc Indic Res1--27.
35.
Kahn K, Tollman SM, Garenne M, Gear JSS. Validation and application of verbal autopsies in a rural area of South Africa. Tropical Med Int Health. 2000;5(11):824–31.CrossRef
36.
Kahn K. Dying to make a fresh start: mortality and health transition in a new South Africa: Umea University; 2006.
37.
Byass P, Chandramohan D, Clark SJ, D'Ambruoso L, Fottrell E, Graham WJ, et al. Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool. Glob Health Action. 2012;5
38.
Byass P, Kahn K, Fottrell E, Mee P, Collinson MA, Tollman SM. Using verbal autopsy to track epidemic dynamics: the case of HIV-related mortality in South Africa. Popul Health Metr. 2011;9:46.CrossRefPubMedPubMedCentral
39.
Clark SJ, Collinson MA, Kahn K, Drullinger K, Tollman SM. Returning home to die: circular labour migration and mortality in South Africa 1. Scand J Public Health. 2007;35(Suppl 69):35–44.CrossRef
40.
Allison PD. Event history analysis: regression for longitudinal event data. Thousand Oaks, CA: Sage; 1984.CrossRef
41.
Allison PD. Discrete-time methods for the analysis of event histories. Sociol Methodol. 1982;13(1):61–98.CrossRef
42.
Allison PD. Survival analysis using SAS: a practical guide: SAS Institute; 2010.
43.
Efron B. Logistic regression, survival analysis, and the Kaplan-Meier curve. J Amer Stat Assoc. 1988;83(402):414–25.CrossRef
44.
Van Hook J, Altman CE. Using discrete-time event history fertility models to simulate total fertility rates and other fertility measures. Popul Res Policy Rev. 2013;32(4):585–610.CrossRefPubMedPubMedCentral
45.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747–57.CrossRefPubMed
46.
Salomon JA, Murray CJL. The epidemiologic transition revisited: compositional models for causes of death by age and sex. Popul Develop Rev. 2002;28(2):205–28.CrossRef
47.
Mee P, Collinson MA, Madhavan S, Root ED, Tollman SM, Byass P, et al. Evidence for localised HIV related micro-epidemics associated with the decentralised provision of antiretroviral treatment in rural South Africa: a spatio-temporal analysis of changing mortality patterns (2007-2010). J Global Health. 2014;4(1):010403.CrossRef
48.
Byass P, Kabudula CW, Mee P, Ngobeni S, Silaule B, Gómez-Olivé FX, et al. A successful failure: missing the MDG4 target for under-five mortality in South Africa. PLoS Med. 2015;12(12):e1001926.CrossRefPubMedPubMedCentral
49.
Bärnighausen T, Tanser F, Herbst K, Mutevedzi T, Mossong J, Newell M-L. Structural barriers to antiretroviral treatment: a study using population-based CD4 cell count and linked antiretroviral treatment programme data. Lancet. 2013;382:S5.CrossRef
50.
Bassett IV, Regan S, Luthuli P, Mbonambi H, Bearnot B, Pendleton A, et al. Linkage to care following community-based mobile HIV testing compared with clinic-based testing in Umlazi township, Durban. South Africa HIV Med. 2014;15(6):367–72.PubMed
51.
Lessells RJ, Mutevedzi PC, Cooke GS, Newell M-L. Retention in HIV care for individuals not yet eligible for antiretroviral therapy: rural KwaZulu-Natal. South Africa JAIDS. 2011;56(3):e79.PubMed
52.
Mugglin C, Estill J, Wandeler G, Bender N, Egger M, Gsponer T, et al. Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis. Tropical Med Int Health. 2012;17(12):1509–20.CrossRef
53.
Gómez-Olivé FX, Angotti N, Houle B, Klipstein-Grobusch K, Kabudula C, Menken J, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care. 2013;25(9):112–8.CrossRef
54.
Clark SJ, Gómez-Olivé FX, Houle B, Thorogood M, Klipstein-Grobusch K, Angotti N, et al. Cardiometabolic disease risk and HIV status in rural South Africa: establishing a baseline. BMC Public Health. 2015;15(1):1.CrossRef
55.
Collinson MA, White MJ, Bocquier P, McGarvey ST, Afolabi SA, Clark SJ, et al. Migration and the epidemiological transition: insights from the Agincourt sub-district of northeast South Africa. Glob Health Action. 2014;7
Metadata
Title
Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993–2013
Authors
Chodziwadziwa W. Kabudula
Brian Houle
Mark A. Collinson
Kathleen Kahn
Francesc Xavier Gómez-Olivé
Samuel J. Clark
Stephen Tollman
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4312-x

Other articles of this Issue 1/2017

BMC Public Health 1/2017 Go to the issue

Research article

Promoting active travel to school: a systematic review (2010–2016)

Research article

Factors associated with infant mortality in Nepal: a comparative analysis of Nepal demographic and health surveys (NDHS) 2006 and 2011

Research article

In the interest of food safety: a qualitative study investigating communication and trust between food regulators and food industry in the UK, Australia and New Zealand

Research article

Effect of exclusive breastfeeding on selected adverse health and nutritional outcomes: a nationally representative study

Research article

Changes in prevalence, awareness, treatment and control of hypertension from 2004 to 2014 among 25-74-year-old citizens in the Yangon Region, Myanmar

Research article

Male suicide among construction workers in Australia: a qualitative analysis of the major stressors precipitating death