Business Day, 22 November 2002, Report on causes of death backs MRC view

HIV/AIDS is a significant, and increasing, cause of death in SA, a long-awaited report by a Statistics SA-led team confirmed yesterday.

The report, released in Pretoria by statisticiangeneral Pali Lehohla, vindicates a study carried out last year by the Medical Research Council (MRC), which found that 40% of adult deaths were caused by HIV/AIDS.

Stats SA criticised the methodology of the report, while government said it would await the outcome of the Stats SA study.

Finally released yesterday, the report has important policy implications for government, adding impetus to moves to reflect the scale of the HIV/AIDS epidemic in the budget and intensifying debate on the need to make HIV/AIDS a notifiable disease.

The study lists the five main causes of death among South Africans as "unnatural causes", "ill-defined causes", tuberculosis (TB), HIV, and influenza and pneumonia.

The team, which included the health, home affairs and social development departments, the MRC and Stats SA, looked at death certificates between 1997 and last year, examining a 12% representative sample of registered deaths. It noted an increase in deaths resulting from TB and pneumonia.

"As these figures are some of the primary indicator conditions of HIV, this suggests that the burden of deaths due to HIV would be much larger than indicated by death notification forms on which HIV is stated, although it is not possible at this stage to give an accurate estimate of how much," the team said.

"In the view of the task team, the Stats SA report confirms the opinion that the number of HIV deaths is rising and that HIV has become one of the major underlying causes of death in SA."

David Bourne, a consultant with the MRC, said the organisation did not see any inconsistency between the two reports. "The MRC study last year essentially measured the effects of HIV/AIDS as an underlying cause of death, and what we reported on is reflected in the total mortality without having to go into the specific cause of death.

"The current study reports very precisely and without interpretation what is on the death certificate. We know the death certificate tends to emphasise the more immediate causes of death and de-emphasises the underlying causes, which in many cases is HIV/AIDS," he said.

The study showed that the highest prevalence of HIV-related deaths is among black females (13,5%), females aged 1529 (24,3%) and females aged 30-39 (20,5%), while the lowest is among white females (0,7%).

Males had a high prevalence of TB and unspecified unnatural causes, with three times as many males as females dying of the latter.

Health director-general Ayanda Ntsaluba said the findings made it clear that there was a need for government re-evaluate committing more resources to the fight against HIV/AIDS.

It would also have to strengthening its other social policy responses, such as the increasing number of orphans as a result of deaths from HIV/AIDS.