Abstract
BackgroundVirtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population.MethodsWe estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993–2013.ResultsFrom the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males.ConclusionsThis typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact on continued progress in reducing preventable mortality and improving health across the life course. Integrated healthcare planning and program delivery is required to improve access and adherence for HIV and non-communicable disease treatment. These findings from a local, rural setting over an extended period contribute to the evidence needed to inform further refinement and advancement of epidemiological transition theory.
Highlights
All low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries
Observed changes in mortality and disease patterns in most low- and middleincome countries including those in sub-Saharan Africa reveal transitions that are characterized by reversals, partial changes and simultaneous occurrence of different types of diseases [4,5,6,7,8,9,10,11,12,13,14]
This paper has assessed the progress of the epidemiological transition in a rural population in South Africa undergoing profound health and social changes, using mortality and cause of death data collected over two decades through a robust health and socio-demographic surveillance system
Summary
All low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Mortality and disease patterns in human populations transition from very high and fluctuating mortality concentrated at younger ages and largely caused by infectious diseases and nutritional deficiencies to relatively stable low mortality concentrated at older ages and largely caused by non-communicable diseases and injuries – the ‘epidemiological transition’ [1]. Highincome countries experienced this transition in an orderly way along a unidirectional path during the first half of the twentieth century [1]. Observed changes in mortality and disease patterns in most low- and middleincome countries including those in sub-Saharan Africa reveal transitions that are characterized by reversals, partial changes and simultaneous occurrence of different types of diseases [4,5,6,7,8,9,10,11,12,13,14]
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