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Burden of Disease

Current Projects

The Burden of Disease Research Unit is conducting a national study to investigate the cause-of-death information provided on death notifications.

After linking the data collected in the study with the cause-of-death data collected by Statistics South Africa, this project will produce correction factors for the national cause-of death profile. The correction factors will be applied to provincial and district mortality profiles. These are likely to be more accurate than COD profiles currently reported and can be used for planning and monitoring the burden of disease in each district and prioritizing the responses to such burden. Lessons in the use of verbal autopsy questionnaires will inform the possibility of using these for routine collection of cause-of-death statistics.

A high proportion of deaths are registered in South Africa due to its well-established Civil Registration and Vital Statistics System. However, the quality of the cause of death statistics generated from the death notification forms completed by medical doctors is poor, making it difficult to obtain a reliable cause of death profile.

Online training in medical certification of death for doctors

A free online course for medical students and doctors to learn to correctly complete a medical certificate of cause of death and when to refer to forensic pathology. The beta version can be found at:

Resource Materials - Medical Certification

The SMS project was developed to respond to a gap in the district health information system regarding access to timeous and accurate cause-of-death data during the COVID-19 epidemic. There were several sub-projects within the SMS described below.

Rapid assessment of cause-of-death data collection and public health use in South Africa 

The rapid assessment comprised a desktop review of reports and publications to identify strengths and the current understanding of challenges related to the collection, reporting and public health use of cause-of-death statistics in South Africa, and an analysis of the cause-of-death data from the period 2000 – 2017 to assess the quality of cause-of-death data. The report was shared with Civil Registration and Vital Statistics stakeholders and followed by collecting information about the perceptions of challenges and plans to improve the reporting of deaths that are already underway.  Key findings indicate that in many respects, the cause of death statistics in South Africa are good, and that there have been improvements in areas such as the completeness of death registration. However, the quality of the COD information is still suboptimal and timely access to the information provided on death notifications is needed to enable public health responses. View the complete Rapid assessment of cause-of-death data collection and public health use in South Africa Report.

TeleVA pilot

This study aimed to assess whether conducting telephonic verbal autopsies (TeleVA) to gather information about the causes of deaths that occurred outside health facilities, would be feasible and acceptable for families and interviewers. A rapid qualitative approach was used to collect information about the experiences and perceptions of both interviewees and interviewers. A successful workshop to brainstorm potential sources of next-of-kin data, how to strengthen the Western Cape Mortality surveillance system and potential opportunities for verbal autopsies was conducted in November 2021 with stakeholders. A report on the findings of the workshop  have been published.

Online capture of the medical certificate of cause of death – Scoping study for South Africa

The COVID-19 pandemic highlighted that cause of death information in South Africa does not serve public health needs due to the delays in processing resulting from a lack of digital data collection.  Furthermore, cause of death information from Civil Registration and Vital Statistics (CRVS) has been identified as being of low quality which has limited determining the full burden of HIV and TB. This has highlighted the urgent need for the country to assess the role and scope of Electronic Death Registration System (EDRS), particularly online medical certification of cause of death (MCCD) to overcome these deficiencies. This scoping study aims to assist the country to draw on international best practice and identify local requirements, opportunities and barriers towards developing EDRS. A multi-disciplinary protocol has been developed by researchers in BODRU in collaboration with Jembi, Swiss Tropical and Public Health Institute and the CDC to gather preparatory information that would inform the country about implementing electronic death registration. This scoping study aims to assist the country to draw on international best practice and identify local requirements, opportunities and barriers towards developing an electronic death registration system.

Objectives & Study Design
  1. A literature review of published material of international practice in EDRS was done to identify lessons from international initiatives as well as documentation of current global EDRS initiatives that have been identified by the WHO Family of International Classifications (WHO-FIC).  
  2. A technical review utilized systems, software and process analysis methods, as well as requirements analysis and key stakeholder interviews, to understand the enterprise architecture of the CRVS system in South Africa
  3. A participatory workshop was held to identify the requirements for an online system for certification of the medical cause of death in South Africa through a review of systems in selected countries.
  4. The acceptability and feasibility of implementing EDRS in South Africa explored the perception of users (doctors, funeral practitioners, government officials) by conducting key informant interviews, followed by a descriptive survey of attitudes and barriers among users. 
  5. A review of current legislation was conducted to identify any legal barriers to or opportunities for online medical certification of cause of death, with an emphasis on sharing identifiable information at time of death registration as well as including the manner of death for external causes.

South African Medical Research Counci

  1. Pamela Groenewald (Principal Investigator)
    Provide overall management to the project team to ensure that the objectives of the research project are achieved. Manage the overall workplan, timelines, budget, project design and survey implementation. Provide oversight for data collection and data analysis. Lead the reporting, and dissemination of research findings.
  2. Nadine Nannan (Co-Principal Investigator)
    Support PI with overall management of project.
  3. Debbie Bradshaw (Co-Principal Investigator)
    Support PI with overall management of project.
  4. Oluwatoyin Awotiwon (Co-Investigator)
    Lead objective 1.

Centres for Disease Control and Prevention Co-investigators 

  1. Dr Erin Nichols (SEV #13740)*
    Epidemiologist at the International Statistics Program, National Center for Health Statistics, CDC, Hyattsville, Maryland, USA. Provides technical advice regarding conceptualization, protocol development, and data analysis. Contributes to write up of results.
  2. Dr Diane Morof (MD, MSc) (SEV #4764)*
    Associate Director for Science CDC South Africa, Pretoria, SA.  Provides technical advice on project data analysis, interpretation, and dissemination of results, particularly in the area of maternal mortality.

Jembi and SAMRC Jembi Collaborating Centre for Digital Health Innovation

  1. Chris Seebregts (PhD)Co-Investigator
    Dr Chris Seebregts is a biomedical scientist and founder of Jembi Health Systems, a South African non-profit company and honorary research associate in the School of Public Health at the University of Cape Town. He has extensive knowledge and experience in digital health and data science research and developing medical records, health information exchange and CRVS systems in Africa.

Swiss Tropical and Public Health Institute

  1.  Daniel Cobos (MD, PhD) Co-Investigator
    Dr. Daniel Cobos Muñoz is a Medical Doctor who specialized in Family and Community Medicine, with a Master’s Degree in Public Health in Developing Countries, and a PhD in Public Health. He is a health system researcher with a focus on the application of systems thinking tools and methods to unpack the inherent complexity of public health challenges.
  2. Carmen Sant Fruchtman (Msc) Co-Investigator
    Carmen Santfruchtmanis a scientific collaborator at the health systems research group. She has a master of International Health from the Swiss Tropical and Public Health Institute (SwissTPH), in which she specialized in how to scale up sustainable digital health solutions.

Section 27

  1. Sasha Stevenson Co-Investigator
    Advocate and head of Section 27. Lead legal review for project. 
  2. Jonathan Berger Technical Advisor
    Advocate. Provide legal opinion to project.

Vital Wave

  1. Pierre Dane (MPH) -Technical Advisor
    Mr. Dane is a digital health expert with an MPH Epidemiology. Over the past 20 years he has worked across large public and private technology enterprises as a software and database engineer a technology lead and director, and as a public health professional, with a focus on health information interoperability and public health data.
  2. Amy Paul (PhD) Technical Advisor  
    Ms. Paul is a global development professional with a PhD in health policy and management. She has over a decade of experience that spans global health, health policy, digital development, emerging technologies, interdisciplinary research, and applied bioethics.
  3. Derek Treatman
  • President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) Cooperative Agreement SAMRC-CDC Cooperative Agreement AG CDC-RFA-GH19-1911-03CONT21/ 1NU2GGH002193-03-01/
  • South African Medical Research Council
Study Outputs

Funded by the South African Medical Research Council and the UK Government’s Newton Fund through the UK Medical Research Council, the ERICA-SA project will utilise lifestyle data and biological samples collected by the Johannesburg Cancer Study (JCS) from 20,000 African cancer patients to investigate the causes of cancer and to enhance scientific research capacity in South Africa.

This will be the largest study of its kind in Africa and will support PhD students to work with an international team of geneticists, infectious disease specialists and epidemiologists from the SAMRC, the NHLS National Cancer Registry, the Sydney Brenner Institute for Molecular Bioscience (SBIMB) at WITS, King’s College London, the University of Cambridge, the German Cancer Research Center (DKFZ) in Germany, the MRC AIDS Virus Research Centre in Uganda, and the University of Sydney, Australia.

  • South African Demographic and Health Survey
  • Local level mortality surveillance system
  • Population based cancer register in Eastern Cape
  • Evaluation of alcohol policy on violence in Khayelitsha and Nyanga
  • Rapid mortality surveillance


  • Evaluation of health information systems for National Health Insurance
  • Evaluation of the District Health Information System for PMTCT

Co-Principal Investigators: Dr Megan Prinsloo (BODRU) & Dr Petal Petersen Williams (ATODRU)

Co-Investigators: Prof Sithombo Maqungo (UCT), Prof Richard Matzopoulos (BODRU), Ms Shibe Mhlongo (Gender & Health Research Unit), Dr Ian Neethling (BODRU), Prof Charles Parry (ATODRU) & Dr Margie Peden (The George Institute for Global Health, UK)

The AVIRT study is a SAMRC funded Flagship study where the aim is:

  • To validate alcohol diagnostics for injury-related trauma and assess its utility for improving national health practice and policy.

This will be a mixed methods study comprising qualitative and quantitative research methods across the following work packages:

Work Package 1.1 (WP 1.1)- Prioritization of methods for assessing alcohol

Focus Group Discussions (FGDs) will be conducted with key stakeholders (across clinical, academic, policy and operational expertise) to determine what type of alcohol information will be useful for different stakeholders in the trauma and injury prevention sectors.

Work Package 1.2 (WP 1.2)- Validation of alcohol diagnostic tools in a clinical trauma setting

This will focus on validating a list of alcohol diagnostic tools (clinical assessment, breath alcohol analysis, finger-prick blood) against a blood concentration analysis, using enzyme immunoassay -considered as the gold standard for the purpose of this study, in a public health trauma facility in the Western Cape Province. Information related to the cause and intent of the injury for adult patients presenting for first time treatment will be recorded.

Work Package 2 (WP 2)- Field testing of selected alcohol diagnostic tools at a District hospital

The selected alcohol diagnostic tools will be tested for routine use in a trauma setting and it’s utility assessed, for recommended national scale-up. Epidemiological information on injury severity, intent, cause and nature of injury-related trauma will be reported.

Work Package 3 (WP 3)- Community engagement and Capacity development

FGDs will be conducted with hospital staff from WP1.2 and WP2. Alcohol and health policy stakeholders will be invited to a feedback workshop to discuss the study recommendations for national scale-up to other trauma facilities.

BoDRU, in collaboration with the Gender and Health Research Unit; Alcohol, Tobacco and other Drug Research Unit; and Biostatistics unit, recently conducted a nationally representative survey of mortuaries for the period 1 April 2020 – 31 March 2021. Data were collected for 32 962 non-natural deaths from 65 sampled mortuaries in 8 of the 9 provinces. This was complemented by data from the Forensic Pathology Services’ electronic database for all 16 mortuaries in the Western Cape province, to provide a complete national sample of 81 mortuaries.

The purpose of the study was to:

  • describe the incidence of fatal injury rates in South Africa by age, sex and cause for 2020/2021
  • compare the provincial injury mortality rates for fatal injuries
  • determine whether there is a shift in the manner of death for 2017 and the 2020/21 Covid-19 lockdown period.

A Technical report is currently being drafted. The 2009 and 2017 IMS reports are available below.

Please view the key findings and the full report here:  The 2nd Injury Mortality Survey: A national study of injury mortality levels and causes in South Africa in 2017

Please click to view the previous Injury Mortality Survey 2009 report.