Burden of mortality linked to community-nominated priorities in rural South Africa
Date
2021-11-26
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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.
Description
Keywords
Community participation; Participatory action research; Verbal Autopsy; Global Burden of Disease