Abstract
ABSTRACT Background: NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries. Objective: The aims were:develop methods to provide integrated biosocial accounts of NCD mortality; and explore the practical utility of extended mortality data for the primary health care system. Methods: We drew on data from research programmes in the study area. Data were analysed in three steps: [a]analysis of levels, causes and circumstances of NCD mortality [n = 4,166] from routine census updates including Verbal Autopsy and of qualitative data on lived experiences of NCDs in rural villages from participatory research; [b] identifying areas of convergence and divergence between the analyses; and [c]exploration of the practical relevance of the data drawing on engagements with health systems stakeholders. Results: NCDs constituted a significant proportion of mortality in this setting [36%]. VA data revealed multiple barriers to access in end-of-life care. Many deaths were attributed to problems with resources and health systems [21%;19% respectively]. The qualitative research provided rich complementary detail on the processes through which risk originates, accumulates and is expressed in access to end-of-life care, related to chronic poverty and perceptions of poor quality care in clinics. The exploration of practical relevance revealed chronic under-funding for NCD services, and an acute need for robust, timely data on the NCD burden. Conclusions: VA data allowed a significant burden of NCD mortality to be quantified and revealed barriers to access at and around the time of death. Qualitative research contextualised these barriers, providing explanations of how and why they exist and persist. Health systems analysis revealed shortages of resources allocated to NCDs and a need for robust research to provide locally relevant evidence to organise and deliver care. Pragmatic interdisciplinary and mixed method analysis provides relevant renditions of complex problems to inform more effective responses.
Highlights
non-communicable dis eases (NCDs) are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries
We drew on data from the PHEVA (Public Health Evaluation and Verbal Autopsy) and VAPAR (Verbal Autopsy with Participatory Action Research) pro grammes [8,30,31] in the Medical Research Council (MRC)/Wits Rural Public Health and Health Transitions Research Unit which operates the Agincourt Health and Socio-Demographic Surveillance System (HDSS) in rural northeast South Africa (Figure 1)
Data were analysed in three stages: (a) analysis of levels, causes and circumstances of NCD mortality from VA data in the Agincourt HDSS, and of qualitative data on lived experi ences of NCDs in rural villages drawn from participatory research; (b) analytical integration, identifying areas of convergence and divergence between the quantitative and qualitative analyses; and (c) district health systems appraisal of new data and data systems
Summary
NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries. NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries. 87% of premature mor tality and morbidity is borne in low- and middleincome countries (LMICs) and 40% is preventable [1]. NCDs account for around 40 million deaths per annum, having increased by seven million since 2008 [1]. These shifts have been linked to increasingly effective infectious disease control, decreasing fertility and increased life expectancy [2,3,4,5]. NCDs, seriously challenge and compromise weak and under funded health systems in resource constrained set tings [2,3,6]
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