National Cause of Death Validation Reveals HIV/AIDS Still a Leading Cause of Death in South Africa
A large nationwide study led by the South African Medical Research Council (SAMRC) has assessed the accuracy of cause-of-death data collected through South Africa's Civil Registration and Vital Statistics (CRVS) system. The study compared official death records with data gathered from medical records, forensic reports, and verbal autopsy interviews for a sample of deaths.
The study found poor agreement between the underlying cause of death identified by researchers and the official recorded cause of death data, with only 36.9% agreement for over 15,000 linked deaths. It also revealed significant underreporting of HIV/AIDS deaths and misclassification of injury-related deaths, particularly suicides.
The revised cause-of-death profile showed that HIV/AIDS remains the leading cause of death, accounting for 23.3% of all deaths. A strong link between TB and HIV was also observed, with TB responsible for 45.7% of deaths among people with HIV and 63.0% of TB deaths occurring in individuals with HIV. Additionally, cardiometabolic diseases, injuries, and lower respiratory infections ranked among the top ten causes of death.
The study further found that homicides and road traffic accidents featured prominently among the top causes of death for males but not for females. For the first time in a national study, verbal autopsies were used, providing valuable population-level mortality data.
Professor Debbie Bradshaw, Chief Specialist Scientist at the SAMRC Burden of Disease Research Unit, emphasised the significance of the findings. “Accurate mortality data are essential for informed public health policies and targeted interventions; however, this study highlights critical gaps in our cause-of-death data, particularly in the underreporting of HIV/AIDS and suicides” she stated. She further noted that “the strong association between TB and HIV reinforces the need to strengthen healthcare strategies that address both conditions.”
“The study recommends strengthening case finding, follow-up, prevention, and treatment for HIV, AIDS and TB to reduce mortality rates, and underlines the importance of Government’s rapid response to counter the recent abrupt withdrawal of Pepfar funding,” continues Professor Bradshaw.
It also highlights the importance of interpreting official cause-of-death data carefully and using multiple data sources for public health planning and the need to improve the quality of the national statistics. Amending the South African death notification form to include the manner of death would align it with international standards and improve the information about causes of injury deaths. Training doctors in medical certification of cause of death, systematically reviewing the quality of medical certificates, and improving medical record-keeping are also suggested measures to improve the quality of information.
“Implementing an electronic death certification system could provide timely access to cause-of-death information and allow for better quality monitoring,” says Professor Bradshaw. She further stressed that “in the meanwhile, doctors, medical students, and interns are urged to review online self-training materials that provide a public health perspective on accurately certifying causes of death (Death certification training).”
Top 10 Causes of Death in South Africa in 2017/18:
- HIV/AIDS: 23.3%
- Stroke: 7.7%
- Tuberculosis (TB): 6.3%
- Hypertensive heart disease: 6.3%
- Diabetes mellitus: 4.6%
- Other cancers: 4.5%
- Homicide: 3.8%
- Road traffic injuries: 3.6%
- Lower respiratory infections: 3.6%
- Ischaemic heart disease: 3.5%
Links to National Cause of Death Validation Study outputs:
- Report 3 |Agreement and corrected cause specific profiles based on data linkage
- Report 1 | Methodology and Description of a National Sample of Verbal Autopsies
- Report 2 | Underlying cause of death based on a sample of Medical Records from Public Sector Hospitals and Forensic Pathology Service Mortuaries
- Online self-training for medical doctors and students | Death certification training
For more information, please contact:
Ms Yolanda Phakela
SAMRC Public Relations Manager
e-mail: yolanda.phakela@mrc.ac.za
Tel: 021 938 0339