Life and death without trace: examining population dynamics and trends in mortality in rural South Africa

Abstract

Population-based demographic and health information is essential to informed public health planning and the setting of research priorities. In the absence of functioning vital registration, a longitudinal community study was initiated in 1992 in the Agincourt subdistrict of Bushbuckridge, part of South Africa’s Northern Province. The study aimed to provide valid baseline data on the health and demographic characteristics of a defined rural population, and to facilitate comparison of key population variables between the Agincourt area and sub-Saharan African countries. Following the baseline census, an indepth study of mortality trends and patterns was undertaken. This included retrospective analysis of mortality based on history of maternal survival, and prospective study over the period 1992-1995, with verbal autopsies being conducted on almost all of the deaths in the subdistrict (n=T001). Although the Agincourt area displays many of the demographic features of low-income African settings, there is evidence that the area has progressed considerably further along the demographic transition. This notwithstanding, overall mortality in the area appears to be v/orsening. A reversal in the previously declining mortality among women of reproductive age was documented, with AIDS and related diseases most probably responsible. Findings from both the demographic and mortality studies highlight vulnerable sub-groups, in particular rural women, male migrants and adolescents. The findings also carry implications for South Africa’s decentralising health system.