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Road fatalities were labelled a pandemic as early as 1973 (BMJ 1973). The number of road fatalities reached 1.35 million in 2016. Currently over 3 500 people perish every day on the world's roads. South Africa has one of the highest road fatality rates in the world, with a fatality rate of 25.9 deaths per 100 000 population (WHO 2018). In order to understand and improve the road safety situation of a region, effective road safety assessments must be carried out. This paper presents a comparison of four different road safety assessment approaches, both traditional and novel, and serves as a proof of concept for the 'road safety desert' methodology, a new technique adapted from the 'transit desert' concept. This new approach to road safety assessment explores the possibility of geo-coded supply and demand comparisons to identify 'road safety deserts' - areas that have a comparatively higher road safety risk. This paper shows that there are several unique and effective ways to assess road safety, and that each approach incorporates different characteristics within their methodologies. It is recommended that road safety analysis is conducted using a multitude of methods, so as to improve understanding and intervention selection. [ABSTRACT FROM AUTHOR]

In spite of the fact that the road traffic crash fatality rate in South Africa is significantly higher than the global average, the characteristics and causes of road traffic crashes are still not well understood. Without a clear understanding of the characteristics and causes, intelligence-led countermeasures to reduce crashes cannot be developed or applied. The analysis of local South African road crash data is of particular importance in identifying the underlying problems responsible for the high crash rates across the country. While descriptive analyses can be used to present a snapshot of the crash problem, they are largely inadequate when it comes to throwing light on the underlying patterns and relationships between the contributing factors and causes of the crashes themselves. This paper presents a study of the use of Association Rule Analysis (ARA) on data related to crashes on the N4 between Pretoria and the Mozambican border, between 2015 and 2019, to see what added value ARA may offer to standard descriptive analyses of crash data. Apriori Association Rule algorithm was employed on the dataset to identify what contributory factors were not initially evident in the occurrence of serious and fatal crashes. ARA revealed that pedestrians, negligent driving, overtaking and single-vehicle crashes are common factors likely to be present in a serious crash. However, this study found that descriptive statistical analysis and ARA methods are not mutually exclusive, but rather complementary. Where descriptive statistical analysis focuses on summarising and describing data, ARA focuses on identifying relationships and patterns within the data. [ABSTRACT FROM AUTHOR]

The eruption of the novel virus brought to the global scene the prediction that Africa would be worse hit by the pandemic. This prediction was partly built on the widely recognized fact that Africa is the continent with the weakest public health care system and the lowest budgetary allocations to health. However, contrary to this prediction, the COVID-19 death rate in Africa has been low compared to in other continents. Debates on Africa's low COVID-19 death rate have generated mixed reactions, the majority of which have centred on beliefs and superstition about hot weather and Africa's youth-dominated society. Little or none of these reactions have attributed the low COVID-19 death rate to swift and prudent budgetary adjustment, which partly aided a swift response from some African governments. Indeed, not many studies have examined the swiftness in the response of some African governments and prudent budgetary adjustment in tackling the spread of COVID-19. This paper, through secondary data, advances knowledge on how budget revision aided government response to the COVID-19 pandemic in South Africa and Nigeria. It found that both countries adjusted their budgetary allocations in response to COVID-19. It further indicates that South Africa, through budgetary revision, allocated more funds to government agencies in charge of COVID-19 and various relief packages than Nigeria. Moreover, it indicates that the swift budgetary adjustment by both countries partly aided a quick government response that progressively flattened the curve and, in the long run, partly contributed to fiscal impulse and deferrals. [ABSTRACT FROM AUTHOR]

The coronavirus disease-2019 (COVID-19) has been spreading rapidly in South Africa (SA) since its first case on 5 March 2020. In total, 674,339 confirmed cases and 16,734 mortality cases were reported by 30 September 2020, and this pandemic has made severe impacts on economy and life. In this paper, analysis and long-term prediction of the epidemic dynamics of SA are made, which could assist the government and public in assessing the past Infection Prevention and Control Measures and designing the future ones to contain the epidemic more effectively. A Susceptible–Infectious–Recovered model is adopted to analyse epidemic dynamics. The model parameters are estimated over different phases with the SA data. They indicate variations in the transmissibility of COVID-19 under different phases and thus reveal weakness of the past Infection Prevention and Control Measures in SA. The model also shows that transient behaviours of the daily growth rate and the cumulative removal rate exhibit periodic oscillations. Such dynamics indicates that the underlying signals are not stationary and conventional linear and nonlinear models would fail for long-term prediction. Therefore, a large class of mappings with rich functions and operations is chosen as the model class and the evolutionary algorithm is utilized to obtain the optimal model for long term prediction. The resulting models on the daily growth rate, the cumulative removal rate and the cumulative mortality rate predict that the peak and inflection point will occur on November 4, 2020 and October 15, 2020, respectively; the virus shall cease spreading on April 28, 2021; and the ultimate numbers of the COVID-19 cases and mortality cases will be 785,529 and 17,072, respectively. The approach is also benchmarked against other methods and shows better accuracy of long-term prediction. [ABSTRACT FROM AUTHOR]

Background: Studies on the barriers migrant women face when trying to access healthcare services in South Africa have emphasized economic factors, fear of deportation, lack of documentation, language barriers, xenophobia, and discrimination in society and in healthcare institutions as factors explaining migrants' reluctance to seek healthcare. Our study aims to visualize some of the outcome effects of these barriers by analyzing data on maternal death and comparing the local population and black African migrant women from the South African Development Countries (SADC) living in South Africa. The heightened maternal mortality of black migrant women in South Africa can be associated with the hidden costs of barriers migrants face, including xenophobic attitudes experienced at public healthcare institutions. Methods: Our analysis is based on data on reported causes of death (COD) from the South African Department of Home Affairs (DHA). Statistics South Africa (Stats SA) processed the data further and coded the cause of death (COD) according to the WHO classification of disease, ICD10. The dataset is available on the StatsSA website (http://nesstar.statssa.gov.za:8282/webview/) for research and statistical purposes. The entire dataset consists of over 10 million records and about 50 variables of registered deaths that occurred in the country between 1997 and 2018. For our analysis, we have used data from 2002 to 2015, the years for which information on citizenship is reliably included on the death certificate. Corresponding benchmark data, in which nationality is recorded, exists only for a 10% sample from the population and housing census of 2011. Mid-year population estimates (MYPE) also exist but are not disaggregated by nationality. For this reason, certain estimates of death proportions by nationality will be relative and will not correspond to crude death rates. Results: The total number of female deaths recorded from the years 2002 to 2015 in the country was 3740.761. Of these, 99.09% (n = 3,707,003) were deaths of South Africans and 0.91% (n = 33,758) were deaths of SADC women citizens. For maternal mortality, we considered the total number of deaths recorded for women between the ages of 15 and 49years of age and were 1,530,495 deaths. Of these, deaths due to pregnancy-related causes contributed to approximately 1% of deaths. South African women contributed to 17,228 maternal deaths and SADC women to 467 maternal deaths during the period under study. The odds ratio for this comparison was 2.02. In other words, our findings show the odds of a black migrant woman from a SADC country dying of a maternal death were more than twice that of a South African woman. This result is statistically significant as this odds ratio, 2.02, falls within the 95% confidence interval (1.82-2.22). Conclusion: The study is the first to examine and compare maternal death among two groups of women, women from SADC countries and South Africa, based on Stats SA data available for the years 2002-2015. This analysis allows for a better understanding of the differential impact that social determinants of health have on mortality among black migrant women in South Africa and considers access to healthcare as a determinant of health. As we examined maternal death, we inferred that the heightened mortality among black migrant women in South Africa was associated with various determinants of health, such as xenophobic attitudes of healthcare workers toward foreigners during the study period. The negative attitudes of healthcare workers toward migrants have been reported in the literature and the media. Yet, until now, its long-term impact on the health of the foreign population has not been gaged. While a direct association between the heightened death of migrant populations and xenophobia cannot be established in this study, we hope to offer evidence that supports the need to focus on the heightened vulnerability of black migrant women in South Africa. As we argued here, the heightened maternal mortality among migrant women can be considered hidden barriers in which health inequality and the pervasive effects of xenophobia perpetuate the health disparity of SADC migrants in South Africa. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) and COVID-19 co-infection poses a significant global health challenge with increased fatality rates and adverse outcomes. However, the existing evidence on the epidemiology and treatment of TB-COVID co-infection remains limited. Methods: This updated systematic review aimed to investigate the prevalence, fatality rates, and treatment outcomes of TB-COVID co-infection. A comprehensive search across six electronic databases spanning November 1, 2019, to January 24, 2023, was conducted. The Joanna Briggs Institute Critical Appraisal Checklist assessed risk of bias of included studies, and meta-analysis estimated co-infection fatality rates and relative risk. Results: From 5,095 studies screened, 17 were included. TB-COVID co-infection prevalence was reported in 38 countries or regions, spanning both high and low TB prevalence areas. Prevalence estimates were approximately 0.06% in West Cape Province, South Africa, and 0.02% in California, USA. Treatment approaches for TB-COVID co-infection displayed minimal evolution since 2021. Converging findings from diverse studies underscored increased hospitalization risks, extended recovery periods, and accelerated mortality compared to single COVID-19 cases. The pooled fatality rate among co-infected patients was 7.1% (95%CI: 4.0% ~ 10.8%), slightly lower than previous estimates. In-hospital co-infected patients faced a mean fatality rate of 11.4% (95%CI: 5.6% ~ 18.8%). The pooled relative risk of in-hospital fatality was 0.8 (95% CI, 0.18–3.68) for TB-COVID patients versus single COVID patients. Conclusion: TB-COVID co-infection is increasingly prevalent worldwide, with fatality rates gradually declining but remaining higher than COVID-19 alone. This underscores the urgency of continued research to understand and address the challenges posed by TB-COVID co-infection. Author summary: Tuberculosis (TB) and COVID-19, both highly infectious diseases, have posed significant global health challenges, particularly in low/middle-income countries (LMICs) with limited medical resources. Our research highlights that TB-COVID co-infection remains a substantial concern, impacting regions with varying TB burdens. The predominant treatment approach for TB-COVID co-infection has not notably evolved since our earlier study in 2021. It typically involves a combination of the recommended TB regimen and standard COVID-19 treatment. Our analysis consistently shows that individuals with TB-COVID co-infection are at heightened risk of hospitalization, protracted recovery periods, and accelerated mortality compared to those with sole COVID-19 infections. Remarkably, we found limited information on the post-COVID-19 condition of co-infected patients. One study indicated a higher prevalence of anxiety symptoms, highlighting the potential psychological toll of TB-COVID co-infection. Although the fatality rate has gradually decreased, it remains notably higher than that of COVID-19 alone. Our findings underscore the urgent need for global collaboration to address the complex challenges posed by TB-COVID co-infection, particularly in countries with limited medical resources. [ABSTRACT FROM AUTHOR]

Background: Covid-19 epidemics raged around the world in years 2020–2022. The dynamics of the epidemics and their mortality varied by country depending on prevention, treatments, vaccination and health status of the population. Objective: The study compares Covid-19 morbidity and mortality in South-Africa and in France, two countries with similar population size and with reliable reporting systems, in order to better understand the dynamics and impacts of the epidemics and the effects of health policies and programs. Data and methods: Data on cases, deaths, hospitalizations, vaccinations were drawn from national statistics. Published data on cases and deaths were corrected for undercount. Results: Results show a different epidemiology in the two countries in the first three years of the epidemic (2020–2022). Incidence was higher in South Africa, and some 44% more people were infected by December 2022 than in France. Mortality and case-fatality were also higher in South Africa despite a favourable age structure. The age pattern of mortality showed higher values in South Africa among the young adults. Young women appeared somewhat disadvantaged in South Africa. Lastly, vaccination appeared to have had no effect on incidence, but a large effect on case-fatality in France. Conclusions: Despite about the same population size and the same crude death rate at baseline, South Africa exhibited more cases and more deaths from Covid-19 over the 2020–2022 period. Prevention strategies (lockdown and vaccination) appear to have had large impacts on morbidity and mortality. [ABSTRACT FROM AUTHOR]

Emergomyces africanus is a recently identified thermally-dimorphic fungal pathogen that causes disseminated infection in people living with advanced HIV disease. Known as emergomycosis, this disseminated disease is associated with very high case fatality rates. Over the last decade, improved diagnostics and fungal identification in South Africa resulted in a dramatic increase in the number of reported cases. Although the true burden of disease is still unknown, emergomycosis is among the most frequently diagnosed dimorphic fungal infections in Southern Africa; and additional species in the genus have been identified on four continents. Little is known about the pathogenesis and the host's immune response to this emerging pathogen. Therefore, we established a murine model of pulmonary infection using a clinical isolate, E. africanus (CBS 136260). Both conidia and yeast forms caused pulmonary and disseminated infection in mice with organisms isolated in culture from lung, spleen, liver, and kidney. Wild-type C57BL/6 mice demonstrated a drop in body weight at two weeks post-infection, corresponding to a peak in fungal burden in the lung, spleen, liver, and kidney. An increase in pro-inflammatory cytokine production was detected in homogenized lung supernatants including IFN-γ, IL-1β, IL-6, IL12-p40 and IL-17 at three- and four-weeks post-infection. No significant differences in TNF, IL-12p70 and IL-10 were observed in wild-type mice between one and four-weeks post-infection. Rag-1-deficient mice, lacking mature T-and B-cells, had an increased fungal burden associated with reduced IFN-γ production. Together our data support a protective T-helper type-1 immune response to E. africanus infection. This may provide a possible explanation for the susceptibility of only a subset of people living with advanced HIV disease despite hypothesized widespread environmental exposure. In summary, we have established a novel murine model of E. africanus disease providing critical insights into the host immune components required for eliminating the infection. Author summary: Emergomyces africanus is a thermally-dimorphic fungus that was recently described as the cause of disseminated infections in persons living with advanced HIV disease in South Africa, where emergomycosis is among the most frequently diagnosed dimorphic fungal diseases. Four additional Emergomyces species have been described causing serious infections around the world, and the infection has a high case fatality rate. Despite the seriousness of this infection, the pathophysiology, immunology, diagnosis, and optimal management of emergomycosis remain largely unknown, hampered by the absence of an animal model. Here, we established a mouse model of pulmonary and disseminated emergomycosis using a clinical isolate of E. africanus with the aim of investigating the host immune response. We found that infection spread from the lungs to other organs within two weeks. We describe the effector immune responses in immune-competent mice aiding in controlled infection. We also highlight the immune-modulating components lacking in immunocompromised mice that promote susceptibilty to infection. Our study provides new insights into the components of the host immune response required for controlling Emergomyces spp. infection. [ABSTRACT FROM AUTHOR]

Background: This study explores the determinants impacting the mortality risk of COVID-19 patients following hospitalisation within South Africa's Limpopo province. Methods: Utilising a dataset comprising 388 patients, the investigation employs a frailty regression model to evaluate the influence of diverse characteristics on mortality outcomes, contrasting its performance against other parametric models based on loglikelihood measures. Results: The findings underscore diabetes and hypertension as notable contributors to heightened mortality rates, underscoring the urgency of effectively managing these comorbidities to optimise patient well-being. Additionally, regional discrepancies come to the fore, with the Capricorn district demonstrating elevated mortality risks, thereby accentuating the necessity for precisely targeted interventions. Medical interventions, particularly ventilation, emerge as pivotal factors in mitigating mortality risk. Gender-based distinctions in mortality patterns also underscore the need for bespoke patient care strategies. Conclusions: Collectively, these outcomes supply practical insights with implications for healthcare interventions, policy formulation, and clinical strategies aimed at ameliorating COVID-19 mortality risk among individuals discharged from hospitals within South Africa's Limpopo province. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB), caused by Mycobacterium tuberculosis (M. tb), remains a significant global health issue, with high morbidity and mortality rates. The emergence of drug-resistant strains, particularly multidrug-resistant TB (MDR-TB), poses difficult challenges to TB control efforts. This comprehensive review and meta-analysis investigated the prevalence of and molecular insights into isoniazid (INH) and rifampicin (RIF) resistance-conferring mutations in M. tb isolates from South Africa. Through systematic search and analysis of 11 relevant studies, we determined the prevalence of gene mutations associated with RIF and INH resistance, such as rpoB, katG, and inhA. The findings demonstrated a high prevalence of specific mutations, including S450L in rpoB, and S315T, which are linked to resistance against RIF and INH, respectively. These results contribute to the understanding of drug resistance mechanisms and provide valuable insights for the development of targeted interventions against drug-resistant TB. [ABSTRACT FROM AUTHOR]

More boys than girls are typically born; however, women live longer than men. As a result, most societies experience a crossover point where the number of women in society surpasses the number of men. This crossover point provides valuable information on how gender proportions in a society change in relation to mortality patterns and marital behaviour. The evolution of the crossover point has recently been studied in different countries across the world except in Africa. The objective of this study is to examine the crossover point in South Africa between 1904 and 2011. Due to the lack of availability of long-term mortality tables by race, the study applies descriptive analysis from data collected from censuses. Unlike other countries, the findings suggest that South Africa has a low crossover point and a decreasing trend throughout the twentieth century among all race groups. The explanation for this surprisingly low crossover point can be found in the lower sex ratios at birth and the higher rates of mortality compared to other countries. The findings of this study imply a higher proportion of women in the marriage market, which may have historically been linked to the low rate of singlehood and the persistence of polygamous marriages. [ABSTRACT FROM AUTHOR]

Bactrocera dorsalis (Hendel) is a new fruit fly pest of some fruit types in the north and north eastern areas of South Africa. In order to determine whether existing cold disinfestation treatment schedules for an indigenous fruit fly pest: Ceratitis capitata (Wiedemann) would be effective for B. dorsalis, cold tolerances of four immature stages of the two species were compared. Studies were done in an artificial carrot-based larval diet. The developmental rates of the immature stages of the two species in the carrot-based larval diet were first determined at a constant temperature of 26°C. The developmental times for eggs and three larval stages were found to be similar for the two species. Incubation times of both species after egg inoculation were determined to be 0, 3, 4, and 6 d for obtaining egg, first larval, second larval, and third larval stages respectively for the cold treatment. At a test temperature of –0.6°C, mortality rates of C. capitata eggs, first instars, second instars, and third instars were lower than those of B. dorsalis. These results demonstrate that the current cold treatment schedules for disinfestation of C. capitata can be used as equally or more efficacious treatments for B. dorsalis. [ABSTRACT FROM AUTHOR]

The emergence of the global COVID-19 pandemic has continued to cause havoc and untold suffering worldwide. The pandemic's pattern of spreading has varied between continents and indeed within countries. Studies looking at the factors affecting the dynamics of COVID-19 in African countries are limited. In this study we attempt to assess and understand the differential spread of COVID-19 in Africa by looking at South Africa (Southern Africa), Senegal (West Africa), Egypt and Morocco (North Africa), Rwanda (Central Africa) and Kenya (East Africa). We observed a high prevalence of COVID-19 in South Africa, Morocco and Egypt. Furthermore, South Africa ranks first in the number of reported confirmed COVID-19 cases and related hospitalisations and deaths in Africa. Senegal (Western Africa) shows lower confirmed cases and death rates. Based on the findings, it is crucial for these countries' governments and health authorities to be vigilant in mobilising effective medical resources and to continue educating their citizens in order to curb the spread of the coronavirus. [ABSTRACT FROM AUTHOR]

This paper explores how housing modifies the temperature–mortality relationship in the Eastern and Western Cape provinces of South Africa. We estimate dose–response relationships for residents living in each of the five common types of South African housing by combining linear-threshold models for Cape Town with concurrent data on the city's housing composition and expert estimates of how well different types of housing protect against heat and cold. We then apply temperature data to determine provincial-level dose–response relationships, relative risks, attributable fractions and mortality burdens for heat and cold under seven housing scenarios – three past, three future and a scenario of maximum protection. We find that future mortality burdens would be lower under a policy scenario that prioritizes the replacement of informal housing compared to one that prioritizes the replacement of traditional dwellings. In a maximum protection scenario, where everyone lived in houses characteristic of the wealthy, temperature-related mortality could be reduced by over 50% (approximately 5000 deaths annually) in the two provinces combined. These results have relevance to current housing policy but also reinforce the importance of the built environment in mitigating adverse effects of future climate change. [Copyright &y& Elsevier]

Inadequate nutrition limits small-scale livestock production by smallholder farmers in South Africa but can be addressed by the introduction of woody fodder species. Cutting woody plants to harvest fodder affects their productivity and thus it is necessary to determine the optimum cutting height. Cutting affects the productivity and survival of woody plants because it alters concentrations of non-structural carbohydrates, which are used to support their recovery. Since pigeon pea (Cajanus cajan (L.) Millsp.) is not widely grown in South Africa and is not managed as a pruned hedgerow, there was a need to investigate the effect of cutting height under local conditions, especially in areas that experience frost. The trial was established in November 2016, ran over two growing seasons (2016/2017 and 2017/2018) and concluded in August 2018. The treatments comprised three silvopastoral systems with Panicum maximum planted between pigeon pea hedgerows that were cut at 60 cm and 90 cm above the ground, or left uncut and sole P. maximum. Over the two year period, the pigeon pea plants cut at 90 cm above ground produced significantly more leaf, twig and total biomass than the plants cut at 60 cm. Cutting height also had a significant effect on the percentage twig, with pigeon pea plants cut at 90 cm having significantly higher percentage twig than those cut at 60 cm (P < 0.05). There was a significant effect of cutting height on stem sugar concentration and sugar: starch ratio but not for starch and total non-structural carbohydrate concentration (P > 0.05). In July 2018 there were a number of days with temperatures below 0 °C. Prior to this no mortalities had been observed, but the frost events resulted in die-off. The mortality rates were determined in August 2018 when it was clear which of the shrubs had clearly died. The shrub mortality rates were higher for pruned relative to unpruned shrubs, but the effect was not significant (P > 0.05). It was concluded that the choice of cutting height is important for maximising browse production. Future research should consider the effect of pruning on non-structural carbohydrate concentration and total pool in the roots to better understand the reasons for reduced production and shrub mortalities. [ABSTRACT FROM AUTHOR]

Although the death rate caused by the COVID-19 pandemic in South Africa has thus far been much lower than initially feared, the economic and social impact has been severe. The country's Jewish community, constituting 0.1% of the population with a median age of 45 years, has not escaped its effects. Organizations and individuals have nonetheless been able to mobilize a rapid and wide-reaching series of responses directed towards those most in need both inside and outside the community. The uniquely coordinated, energetic, and multipronged nature of these responses are attributed to robust communal infrastructure, strong community social capital, and the history of the Jewish community's positioning in post-apartheid South Africa, alongside the perceived importance of health to collective well-being. [ABSTRACT FROM AUTHOR]

Background: South Africa (SA) has experienced a rapid transition in the Human Development Index (HDI) over the past decade, which had an effect on the incidence and mortality rates of colorectal cancer (CRC). This study aims to provide CRC incidence and mortality trends by population group and sex in SA from 2002 to 2014.Methods: Incidence data were extracted from the South African National Cancer Registry and mortality data obtained from Statistics South Africa (STATS SA), for the period 2002 to 2014. Age-standardised incidence rates (ASIR) and age-standardised mortality rates (ASMR) were calculated using the STATS SA mid-year population as the denominator and the Segi world standard population data for standardisation. A Joinpoint regression analysis was computed for the CRC ASIR and ASMR by population group and sex.Results: A total of 33,232 incident CRC cases and 26,836 CRC deaths were reported during the study period. Of the CRC cases reported, 54% were males and 46% were females, and among deaths reported, 47% were males and 53% were females. Overall, there was a 2.5% annual average percentage change (AAPC) increase in ASIR from 2002 to 2014 (95% CI: 0.6-4.5, p-value < 0.001). For ASMR overall, there was 1.3% increase from 2002 to 2014 (95% CI: 0.1-2.6, p-value < 0.001). The ASIR and ASMR among population groups were stable, with the exception of the Black population group. The ASIR increased consistently at 4.3% for black males (95% CI: 1.9-6.7, p-value < 0.001) and 3.4% for black females (95% CI: 1.5-5.3, p-value < 0.001) from 2002 to 2014, respectively. Similarly, ASMR for black males and females increased by 4.2% (95% CI: 2.0-6.5, p-value < 0.001) and 3.4% (, 95%CI: 2.0-4.8, p-value < 0.01) from 2002 to 2014, respectively.Conclusions: The disparities in the CRC incidence and mortality trends may reflect socioeconomic inequalities across different population groups in SA. The rapid increase in CRC trends among the Black population group is concerning and requires further investigation and increased efforts for cancer prevention, early screening and diagnosis, as well as better access to cancer treatment. [ABSTRACT FROM AUTHOR]

Background: Local villages in the Vhembe district of South Africa have experienced high malaria infection rates and a high variability of malaria case mortality rates over the past 20 years. This research project sets out to determine if specific socioeconomic factors have influence on the varying malaria case mortality rates.Methods: The study used existing malaria records of all reported malaria cases in the Vhembe district between 1998 and 2017. The data set was sampled using maximum variation sampling combined with a stratified sampling approach to select the source locations with the highest reported variations in malaria case mortality. The number of medical facilities used, distances to the medical facilities, and proximity to significant water sources were subsequently spatially and statistically analysed for potential correlations between these factors and the malaria case fatality rates of the source locations.Results: Within the period of study, a total of 57,974 malaria infections were reported from 850 source locations across the villages and neighbourhoods. The result of the sampling methods gave 30 source locations with highest reported variations in malaria case mortality. The statistical analysis indicated a significant negative correlation between the case mortality rates and the number of medical facilities used, the number of infections reported, and the maximum and mean distances travelled to the medical facilities used. In addition, the analysis indicated a positive correlation between the minimum distances travelled to the medical facilities used and the case mortality rates. The spatial analysis supported the majority of the findings from the statistical analysis. Proximity to significant water bodies was not found to have any significant impact on case mortality rates.Conclusion: The results suggested that malaria patients from larger communities, those who had financial or other means to consult more advanced facilities, or those with a larger variety of services had a significantly lower risk of mortality. The findings of this study could assist societies and authorities in mitigating the negative effects of malaria infections on human life expectancies through improved socioeconomic development. [ABSTRACT FROM AUTHOR]

Cost-effectiveness thresholds are important decision rules that determine whether health interventions represent good value for money. In low- and middle-income countries, the World Health Organization (WHO) one to three times per capita gross domestic product (GDP) per disability-adjusted life years (DALYs) averted has been the most widely used threshold for informing resource allocation decisions. However, in 2016, the WHO withdrew recommendations for using this threshold, creating a significant vacuum in South Africa and many countries that rely on results of cost-effectiveness analyses for making resource allocation decisions. This study estimates a cost-effectiveness threshold that reflects the health opportunity cost of health spending in South Africa using a three-step approach. First, marginal returns to health spending was estimated as health spending elasticity for crude death rates using a fixed effect estimation approach. Second, the opportunity cost of health spending was estimated as DALYs averted. Finally, a cost per DALY averted threshold was estimated as the inverse of the marginal product of health spending. We show that 1% of total health spending in 2015 (equivalent to approximately ZAR 1.54 billion/USD 120.7 million) averted 1050 deaths, 34 180 years of life lost, 5880 years lived with disability and 40 055 DALYs. The cost-effectiveness threshold was estimated at approximately ZAR 38 500 (USD 3015) per DALY averted, ∼53% of South Africa's per capita GDP in 2015 (ZAR 72 700/USD 5700) and lower than the previously recommended one to three times per capita GDP. As South Africa moves towards implementing universal health coverage reforms through National Health Insurance by 2025, the adoption of a threshold that reflects health opportunity costs will be crucial for ensuring efficiency in the allocation of scarce resources. This study provides useful insight into the magnitude of the health opportunity cost of health spending in South Africa and highlights the need for further research. [ABSTRACT FROM AUTHOR]

Background: South Africa's maternal mortality ratio remains high although it has substantially declined in the past few years. Numerous studies undertaken in South Africa on maternal mortality have not paid much attention to how the causes are distributed in different socio-demographic groups. This study assesses and analyses the causes of maternal mortality according to sociodemographic factors in South Africa.Methods: The causes of maternal deaths were assessed with respect to age, province, place of death, occupation, education and marital status. Data were obtained from the vital registration database of Statistics South Africa. About 14,892 maternal deaths of women from 9 to 55 years of age were analysed using frequency tables, cross-tabulations and logistic regression. Maternal mortality ratio (MMR), by year, age group, and province for the years 2007-2015 was calculated.Results: The 2007-2015 MMR was 139.3 deaths per 100,000 live births (10,687,687 total live births). The year 2009 had the highest MMR during this period. Specific province MMR for three triennia (2007-2009; 2010-2012; 2013-2015) shows that the Free State province had the highest MMR (297.9/100000 live births; 214.6/100000 live births; 159/100000 live births) throughout this period. MMR increased with age. Although the contribution of the direct causes of death (10603) was more than double the contribution of indirect causes (4289) maternal mortality showed a steady decline during this period.Conclusions: The study shows evidence of variations in the causes of death among different socio-demographic subgroups. These variations indicate that more attention has to be given to the role played by socio-demographic factors in maternal mortality. [ABSTRACT FROM AUTHOR]

The census is the traditional source of population figures at various levels. Census figures however are technically outdated immediately they are released because planners require figures for the present and possibly for future dates. In an attempt to meet this demand different organisations and researchers produce population estimates and projections. These estimates however are usually at higher geographical levels and often do not meet the planning needs of administrators at lower geographical levels. This study extends a top-down estimation method to an African country by estimating the mid-2014 population at ward level in South Africa. The study used the 2011 South Africa Census to estimate current levels of fertility, mortality as well as current trends in net migration at a higher geographical level. Historical trends in fertility and mortality were based on the 1996 Census, 1997 and 1998 October Household Surveys as well as the 2007 Community Survey data. The results indicate that that 20 of the largest wards as at mid-2014 were located in South Africa's metropolitan areas. Nineteen of the 20 largest wards are currently growing at a rate of over 4% per annum and if this trend continues, eighteen of these wards will double their current population size in less than 15 years. [ABSTRACT FROM AUTHOR]

Background. Information on the mortality burden associated with seasonal and pandemic influenza virus infection among pregnant women is scarce in most settings, particularly in sub-Saharan Africa where pregnancy and maternal mortality rates as well as human immunodeficiency virus (HIV) prevalence are elevated. Methods. We used an ecological study design to estimate the seasonal and A(H1N1)pdm09 influenza-associated mortality among pregnant and nonpregnant women of childbearing age (15-49 years) by HIV serostatus during 1999-2009 in South Africa. Mortality rates were expressed per 100 000 person-years. Results. During 1999-2009, the estimated mean annual seasonal influenza-associated mortality rates were 12.6 (123 deaths) and 7.3 (914 deaths) among pregnant and nonpregnant women, respectively. Among pregnant women, the estimated mean annual seasonal influenza-associated mortality rates were 74.9 (109 deaths) among HIVinfected and 1.5 (14 deaths) among HIV-uninfected individuals. Among nonpregnant women, the estimated mean annual seasonal influenza-associated mortality rate was 41.2 (824 deaths) among HIV-infected and 0.9 (90 deaths) among HIV-uninfected individuals. Pregnant women experienced an increased risk of seasonal influenza- associated mortality compared with nonpregnant women (relative risk [RR], 2.8; 95% confidence interval [CI], 1.7-3.9). In 2009, the estimated influenza A(H1N1)pdm09-associated mortality rates were 19.3 (181 deaths) and 9.4 (1189 deaths) among pregnant and nonpregnant women, respectively (RR, 3.2; 95% CI, 2.3-4.1). Conclusions. Among women of childbearing age, the majority of estimated seasonal influenza-associated deaths occurred in HIV-infected individuals. Pregnant women experienced an increased risk of death associated with seasonal and A(H1N1)pdm09 influenza infection compared with nonpregnant women. [ABSTRACT FROM AUTHOR]

Background: Two World Health Organization comparative assessments rated the quality of South Africa’s 1996 mortality data as low. Since then, focussed initiatives were introduced to improve civil registration and vital statistics. Furthermore, South African cause-of-death data are widely used by research and international development agencies as the basis for making estimates of cause-specific mortality in many African countries. It is hence important to assess the quality of more recent South African data. Methods: We employed nine criteria to evaluate the quality of civil registration mortality data. Four criteria were assessed by analysing 5.38 million deaths that occurred nationally from 1997–2007. For the remaining five criteria, we reviewed relevant legislation, data repositories, and reports to highlight developments which shaped the current status of these criteria. Findings: National mortality statistics from civil registration were rated satisfactory for coverage and completeness of death registration, temporal consistency, age/sex classification, timeliness, and sub-national availability. Epidemiological consistency could not be assessed conclusively as the model lacks the discriminatory power to enable an assessment for South Africa. Selected studies and the extent of ill-defined/non-specific codes suggest substantial shortcomings with single-cause data. The latter criterion and content validity were rated unsatisfactory. Conclusion: In a region marred by mortality data absences and deficiencies, this analysis signifies optimism by revealing considerable progress from a dysfunctional mortality data system to one that offers all-cause mortality data that can be adjusted for demographic and health analysis. Additionally, timely and disaggregated single-cause data are available, certified and coded according to international standards. However, without skillfully estimating adjustments for biases, a considerable confidence gap remains for single-cause data to inform local health planning, or to fill gaps in sparse-data countries on the continent. Improving the accuracy of single-cause data will be a critical contribution to the epidemiologic and population health evidence base in Africa. [ABSTRACT FROM AUTHOR]

Background: Measurement of the level and composition of maternal mortality depends on the definition used, with inconsistencies leading to inflated rates and invalid comparisons across settings. This study investigates the differences in risk of death for women in their reproductive years during and outside the maternal risk period (pregnancy, delivery, puerperium), focusing on specific causes of infectious, non-communicable and external causes of death after separating out direct obstetrical causes. Methods: Data on all deaths of women aged 15–49 years that occurred in the Agincourt sub-district between 1992 and 2010 were obtained from the Agincourt health and socio-demographic surveillance system (HDSS) located in rural South Africa. Causes of death were assessed using a validated verbal autopsy instrument. Analysis included 2170 deaths, of which 137 occurred during the maternal risk period. Findings: Overall, women had significantly lower mortality during the maternal risk period than outside it (age-standardized RR = 0.75; 95% CI = 0.63–0.89). This was true in most age groups with the exception of adolescents aged 15–19 years where the risk of death was higher. Mortality from most causes, other than obstetric causes, was lower during the maternal risk period except for malaria, cardiovascular diseases and violence where there were no differences. Lower mortality was significant for HIV/AIDS (RR = 0.29, P<0.0001), cancers (RR = 0.10, P<0.023), and accidents (RR = 0, P<0.0001). Interpretation: In this rural setting typical of much of Southern Africa, pregnancy was largely protective against the risk of death, most likely because of a strong selection effect amongst those women who conceived successfully. The concept of indirect cause of maternal death needs to be re-examined. [ABSTRACT FROM AUTHOR]

Objectives: Mortality in patients starting antiretroviral therapy (ART) is higher in Malawi and Zambia than in South Africa. We examined whether different monitoring of ART (viral load [VL] in South Africa and CD4 count in Malawi and Zambia) could explain this mortality difference. Design:: Mathematical modelling study based on data from ART programmes. Methods: We used a stochastic simulation model to study the effect of VL monitoring on mortality over 5 years. In baseline scenario A all parameters were identical between strategies except for more timely and complete detection of treatment failure with VL monitoring. Additional scenarios introduced delays in switching to second-line ART (scenario B) or higher virologic failure rates (due to worse adherence) when monitoring was based on CD4 counts only (scenario C). Results are presented as relative risks (RR) with 95% prediction intervals and percent of observed mortality difference explained. Results: RRs comparing VL with CD4 cell count monitoring were 0.94 (0.74–1.03) in scenario A, 0.94 (0.77–1.02) with delayed switching (scenario B) and 0.80 (0.44–1.07) when assuming a 3-times higher rate of failure (scenario C). The observed mortality at 3 years was 10.9% in Malawi and Zambia and 8.6% in South Africa (absolute difference 2.3%). The percentage of the mortality difference explained by VL monitoring ranged from 4% (scenario A) to 32% (scenarios B and C combined, assuming a 3-times higher failure rate). Eleven percent was explained by non-HIV related mortality. Conclusions: VL monitoring reduces mortality moderately when assuming improved adherence and decreased failure rates. [ABSTRACT FROM AUTHOR]

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Background: Mortality data are frequently presented at the overall population level, possibly obscuring small-scale variations over time and space and between different population sub-groups. Objective: Analysis of mortality data from the Dikgale Health and Demographic Surveillance System, in rural South Africa, over the period 1996-2007, to identify local clustering of mortality among the eight villages in the observed population. Design: Mortality data and person-time of observation were collected annually in an open-cohort population of approximately 8,000 people over 12 years. Poisson regression modelling and space-time clustering analyses were used to identify possible clustering of mortality. Results: Similar patterns of mortality clustering emerged from Poisson regression and space-time clustering analyses after allowing for age and sex. There was no appreciable clustering of mortality among children under 15 years of age nor in adults 50 years and over. For adults aged 15-49 years, there were substantial clustering effects both in time and in space, with mortality increasing during the period observed and particularly so in some locations, which were nearer to local conurbations. Mortality was relatively lower in the vicinity of the local health centre. Conclusions: Although cause-specific mortality data were not available, the rise in mortality in the 15-49-year age group over time and in areas closer to conurbations strongly suggests that the clustering observed was due to the development of HIV/AIDS-related mortality, as seen similarly elsewhere in South Africa. The HIV/ AIDS services offered by the local health centre may have contributed to lower relative mortality around that location. [ABSTRACT FROM AUTHOR]

Background: Detailed information regarding the spatial and/or spatial-temporal distribution of mortality is required for the efficient implementation and targeting of public health interventions. Objectives: Identify high risk clusters of mortality within the Agincourt subdistrict for targeting of public health interventions, and highlight areas for further research. Design: Mortality data were extracted from the Agincourt health and socio-demographic surveillance system (HDSS) for the period 1992-2007. Mortality rates by age group and time were calculated assuming a Poisson distribution and using precise person-time contribution estimates. A spatial scan statistic (Kulldorff) was used to test for clusters of age group specific all-cause and cause-specific mortality both in space and time. Results: Many statistically significant clusters of higher all-cause and cause-specific mortality were identified both in space and time. Specific areas were consistently identified as high risk areas; namely, the east/southeast and upper east central regions. This corresponds to areas with higher mortality due to communicable causes (especially HIV/TB and diarrheal disease) and indicates a non-random element to the distribution of potential underlying causative factors e.g. settlements comprising former Mozambican refugees in east/southeast of the site, corresponding higher poverty areas, South African villages with higher HIV prevalence, etc. Clusters of older adult mortality were also observed indicating potential non-random distribution of noncommunicable disease mortality. Conclusion: This study has highlighted distinct clusters of all-cause and cause-specific mortality within the Agincourt subdistrict. It is a first step in prioritizing areas for further, more detailed research as well as for future public health follow-on efforts such as targeting of vertical prevention of HIV/TB and antiretroviral rollout in significant child and adult mortality clusters; and assessment and provision of adequate water and sanitation in the child mortality clusters particularly in the south-east where diarrheal mortality appears high. Underlying causative factors need to be identified and accurately quantified. Other questions for more detailed research are discussed. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe mortality of women from intimate partner violence (IPV) in South Africa using a retrospective national study in a proportionate random sample of 25 mortuaries. Homicides identified from mortuary, autopsy, and police records. There were 3,797 female homicides, of which 50.3% were from IPV. The mortality rate from IPV was 8.8 per 100,000 women. Mortality from IPV were elevated among those 14 to 44 years and women of color. Blunt force injuries were more common, while strangulation or asphyxiation were less common. The national IPV mortality rate was more than twice that found in the United States. The study highlights the value of collecting reliable data across the globe to develop interventions for advocacy of which gender equity is critical. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Only 33% of eligible human immunodeficiency virus (HIV)-infected patients in South Africa receive antiretroviral therapy (ART). We sought to estimate the impact of alternative ART scale-up scenarios on patient outcomes from 2007-2012. Methods. Using a simulation model of HIV infection with South African data, we projected HIV-associated mortality with and without effective ART for an adult cohort in need of therapy (2007) and for adults who became eligible for treatment (2008 -2012). We compared 5 scale-up scenarios: (1) zero growth, with a total of 100,000 new treatment slots; (2) constant growth, with 600,000; (3) moderate growth, with 2.1 million; (4) rapid growth, with 2.4 million); and (5) full capacity, with 3.2 million. Results. Our projections showed that by 2011, the rapid growth scenario fully met the South African need for ART; by 2012, the moderate scenario met 97% of the need, but the zero and constant growth scenarios met only 28% and 52% of the need, respectively. The latter scenarios resulted in 364,000 and 831,000 people alive and on ART in 2012. From 2007 to 2012, cumulative deaths in South Africa ranged from 2.5 million under the zero growth scenario to 1.2 million under the rapid growth scenario. Conclusions. Alternative ART scale-up scenarios in South Africa will lead to differences in the death rate that amount to more than 1.2 million deaths by 2012. More rapid scale-up remains critically important. [ABSTRACT FROM AUTHOR]

Background: In mid 1998, a question "Was the deceased a smoker five years ago?" was introduced on the newly revised South African death notification form. Design: A total of 16 230 new death notification forms from 1998 have been coded, and comparison of the prevalence of smoking among those who died of different causes was used to estimate, by case-control comparisons, tobacco attributed mortality in South Africa. Cases comprised deaths from causes known (from other studies) to be causally associated with smoking, and controls comprised deaths from medical conditions expected to be unrelated to smoking. Those who died from external causes, and from diseases strongly related to alcohol consumption, were excluded. Subjects: Reports were available from 5340 deceased adults (age 25+), whose smoking status was given by a family member. Results: Significantly increased risks were found for deaths from tuberculosis (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.23 to 2.11), chronic obstructive pulmonary disease (COPD) (OR 2.5, 95% CI 1.9 to 3.4), lung cancer (OR 4.8, 95% CI 2.9 to 8.0), other upper aerodigestive cancer (OR 3.0, 95% CI 1.9 to 4.9) and ischaemic heart disease (OR 1.7, 95% CI 1.2 to 2.3). Conclusion: If smokers had the same death rate as non-smokers, 58% of lung cancer deaths, 37% of COPD deaths, 20% of tuberculosis deaths, and 23% of vascular deaths would have been avoided. About 8% of all adult deaths in South Africa (more than 20 000 deaths a year) were caused by smoking. [ABSTRACT FROM AUTHOR]

Since early 2020, the COVID-19 pandemic has caused an excess in morbidity and mortality rates worldwide. Containment strategies rely firstly on rapid and sensitive laboratory diagnosis, with molecular detection of the viral genome in respiratory samples being the gold standard. The reliability of diagnostic protocols could be affected by SARS-CoV-2 genetic variability. In fact, mutations occurring during SARS-CoV-2 genomic evolution can involve the regions targeted by the diagnostic probes. Following a review of the literature and an in silico analysis of the most recently described virus variants (including the UK B 1.1.7 and the South Africa 501Y.V2 variants), we conclude that the described genetic variability should have minimal or no effect on the sensitivity of existing diagnostic protocols for SARS-CoV-2 genome detection. However, given the continuous emergence of new variants, the situation should be monitored in the future, and protocols including multiple targets should be preferred. [ABSTRACT FROM AUTHOR]