12 Dec 2007

SA face quadruple burden

South Africa is suffering from a "quadruple burden of disease" - HIV/Aids, underdevelopment, chronic diseases related to unhealthy lifestyles, and injuries, the Medical Research Council said on Wednesday.

Data in a report titled Dietary changes and the health transition in SA: implications for health policy, showed that the prevalence of HIV among pregnant women attending public clinics has increased from 0.8 percent in 1990 to 27.3 percent in 2003, "reflecting the remarkable spread of the epidemic".

It is estimated that in 2004 about 12 percent of the total population was infected with the virus and that by the year 2000, HIV/Aids had become the single biggest cause of death in South Africa.

HIV infection rate to peak in 2013
Under the chapter on communicable disease burden, authors of the report said allowing for the impact of government's treatment intervention, the number of infected persons was projected to peak in 2013 and then decrease slowly, "while the number of Aids-sick persons increases slowly".

It was also predicted that in 2015 the number of Aids-sick persons would be about three quarters of a million, with a projected 5.4 million HIV-positive persons.

"Currently, about 10 percent of HIV-positive persons are Aids-sick and this will rise to just under about 13 percent."

TB still taking toll
Turning to tuberculosis, the report said despite national treatment programmes, TB has been among the leading causes of death, accounting for more than five percent of all deaths in 2000.

This has been exacerbated by the HIV/Aids epidemic with TB being the common opportunistic infection among people who are HIV-positive.

In 2002, it was estimated that there were 243 000 cases of TB in the country, making South Africa the country with the seventh highest prevalence rate.

The number of TB cases, as well as the number of new "smear cases" has almost doubled between 1996 and 2002, with the real increase in the number of cases attributed to the rising prevalence of HIV.

HIV infection was now the main single risk factor for TB, and in 2003/04 more than half the smear-positive TB patients were HIV-positive.

Malaria being kept in check
Malaria affected only the northern and north-eastern regions of the country, with good access to treatment and systematic control efforts keeping the disease in check.

And, unlike most other countries in sub-Saharan Africa, malaria was not a major cause of death.

For the period 1976 to 1995, reported malaria cases ranged from 2 000 to 13 000 a year. In 1996, there were just over 27 000 cases reported, which rose to more than 60 000 during 2000.

The malaria mosquitoes' resistance to existing pesticides, and anti-malarial drug resistance, in part caused the "dramatic" increase in the number of cases and deaths from malaria.

"Changes to the drugs and insecticide used contributed to the subsequent significant decrease in malaria morbidity and mortality in SA in the subsequent years," read the report.

Diarrhoea caused 3% of deaths
The national burden-of-disease study found diarrhoea causes nearly three percent of all deaths in the country in 2000. However, death rates for diarrhoeal disease varied by province, ranging from 12 per 100 000 in the Western Cape to more than 60 in Limpopo province.

The average rate for the country is about 42 per 100 000 for males and slightly lower for females.

"Clearly, in some provinces, death from diarrhoea still makes a significant contribution, particularly affecting infants and children and the elderly."

Wednesday's report said serious cholera outbreaks have occurred in recent years, affecting areas where there were poor water supplies and no sanitation.

However, the fatality rates during these outbreaks have been "remarkably low". – (Sapa)