Burden of Mortality Linked to Community-nominated Priorities in Rural South Africa

Pyry Mattila* (Corresponding Author), Justine Davies, Denny Mabetha, Stephen Tollman, Lucia D'Ambruoso

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Community knowledge is a critical input for relevant health programmes and strategies. How community perceptions of risk reflect the burden of mortality is poorly understood.

Objective
To determine the burden of mortality reflecting community-nominated health risk factors in rural South Africa, where a complex health transition is underway.

Methods
Three discussion groups (total 48 participants) representing a cross-section of the community nominated health priorities through a Participatory Action Research process. A secondary analysis of Verbal Autopsy (VA) data was performed for deaths in the same community from 1993 to 2015 (n = 14,430). Using population attributable fractions (PAFs) extracted from Global Burden of Disease data for South Africa, deaths were categorised as ‘attributable at least in part’ to community-nominated risk factors if the PAF of the risk factor to the cause of death was >0. We also calculated ‘reducible mortality fractions’ (RMFs), defined as the proportions of each and all community-nominated risk factor(s) relative to all possible risk factors for deaths in the population .

Results
Three risk factors were nominated as the most important health concerns locally: alcohol abuse, drug abuse, and lack of safe water. Of all causes of deaths 1993–2015, over 77% (n = 11,143) were attributable at least in part to at least one community-nominated risk factor. Causes of attributable deaths, at least in part, to alcohol abuse were most common (52.6%, n = 7,591), followed by drug abuse (29.3%, n = 4,223), and lack of safe water (11.4%, n = 1,652). In terms of the RMF, alcohol use contributed the largest percentage of all possible risk factors leading to death (13.6%), then lack of safe water (7.0%), and drug abuse (1.3%) .

Conclusion
A substantial proportion of deaths are linked to community-nominated risk factors. Community knowledge is a critical input to understand local health risks.
Original languageEnglish
Article number2013599
Number of pages13
JournalGlobal Health Action
Volume15
Issue number1
Early online date21 Jan 2022
DOIs
Publication statusPublished - 2022

Keywords

  • Community participation
  • Participatory action research
  • Verbal Autopsy
  • Global Burden of Disease

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