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» 18.11.2010 - Longer life in SA may reflect AIDS victory
» 07.12.2009 - SA urged to improve health care for migrants
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» 23.10.2007 - South African scientists will rise to Gates' challenge
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» 16.03.2007 - "Alarming" HIV rise in young South African women
» 28.05.2004 - Brain drain: "Europe poaching African healthcare workers"

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South African mortality crisis overcome

afrol News, 5 November - Mortality rates, which have been increasing in South Africa since the 1990s, are on their way back down, reflecting a downturn of the AIDS epidemic and signalling longer lifespans for South Africans, statistics published today reveal.

Statistics South Africa, the country's official statistics provider, today published its first-ever detailed report on mortality and causes of death in South Africa. Detailed data cover the 1997-2007 periods, coinciding with the peak of mortality rates in the AIDS-struck country.

While the situation is not back to the bright early 1990s, data clearly show that South Africa is on its way out of the mortality crisis. From the 1990s, mortality rates rose and life expectancy declined rapidly, depriving the average South African from a whole decade of expected lifespan. The AIDS pandemic has been seen as the main responsible.

Numbers show that the crisis peaked around 2004. At that stage, the medium age at death had declined to only 42.5 years for the population at large.

For South African women, the mortality crisis had become extreme. While the average age of death was around 60 years in the mid-1990s, it had dropped to only 41.4 years in 2004. Females on average even died two years younger than males that year, which is very uncommon all around the world.

Since 2004, however, the medium age of death is slowly increasing again. Also, South African women have started filling the gap to the average male age of dead, thus slowly heading towards the demographic normality. By 2007, the male medium age of death was at 44.4 years, and the female average at 43.6 years.

Also crude death rates reached their peak in 2004-05, Statistics South Africa has shown. Crude death rates measures deaths as a percentage of the population. In 2007, the rate showed a strong tendency downwards, signalling a healthier population.

South African death rates during the peak years showed very uncommon age and sex ratios. While other countries - most being much poorer than South Africa - with similar life expectancies have very high infant mortality rate, there was a very high mortality rate among middle age groups in South Africa. This can indicate an epidemic.

During the last few years, however, one can observe that the age peak in mortality slowly is moving into older groups. This is also true for the smaller mortality peak for children, which is moving into elder children. If the HIV epidemic is to be interpreted as the main source of these abnormal age mortality peaks, the new trend may be an effect of a wider use of life-prolonging antiretroviral medicines.

But AIDS-related deaths play a surprisingly small role in official statistics. Both in 2006 and 2007, it was only the ninth leading cause of death in South Africa, according to official death certificates. While the agency's report does not discuss these figures, others have speculated in gross underreporting of HIV-related deaths due to social stigma. Indeed, poorly defined tuberculosis diagnoses - TB being a typical side effect of HIV infection - are the most common cause of death in South Africa, reaching over 12 percent.

Nevertheless, AIDS is measured to be on the decline as a cause of death. From 2006 to 2007, indeed, the most significant decrease was for HIV disease, which declined by 9,5 percent, according to the statistics agency. In 2006, 14,935 persons or 2.4 percent of South African deaths were attributed HIV. In 2007, this had dropped to 13,521 persons or 2.2 percent.

The expected relation between South African mortality crisis and the HIV pandemic is further underlined by the gender difference in death causes. A much higher percentage of female deaths were attributed to HIV than of male deaths, which in turn can explain the abnormal mortality ratios distributed by sex. Finally, HIV-related deaths are almost exclusively found in the 15-49 age group, the same that is peaking abnormally in mortality.

Another surprising revelation in the Statistics South Africa report is the distribution of natural and non-natural causes of death over time. Public opinion has it that crime and murder rates have exploded in South Africa over the last decade. This is not in any way supported by national statistics.

Total number of non-natural deaths have remained almost constant from 1997 to 2007, at between 50,000 and 55,000. But at the same time, the population has increased. Therefore, the percentage of non-natural deaths - or the risk of getting killed - has strongly declined since 1997. In 1997, some 17 percent of deaths were by non-natural causes. By 2007, this had dropped to 9 percent.

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