1. Selected health indicators for Free State and a reflection on how they relate to the MDGs ’Maletela Tuoane-Nkhasi Statistics South Africa Symposium on evidenced based decision-making Bloemfontein, 10-11 October 2013

2. Contents of presentation  Government priorities on health  Data sources of health statistics  Selected health indicators for Free State o Infant mortality o Under-five mortality o Maternal mortality o Communicable diseases o Non-communicable diseases  Concluding remarks

3. Government priorities on health  Three Millennium Development Goals related to health  “A long and healthy life for all South Africans” o Increasing life expectancy o Decreasing maternal and child mortality o Combating HIV and AIDS and decreasing the burden of disease from tuberculosis  The National Development Plan – 2030 o Increase life expectancy at birth to 70 years o Progressively improve tuberculosis prevention and cure o Reduce maternal, infant and child mortality o Significantly reduce prevalence of non-communicable diseases o Reduce injury, accidents and violence by 50% from 2010 levels

4.  Censuses  Population-based surveys  Health facility records  Mortuary records  Demographic surveillance sites  Civil registration system Data sources on health statistics

5.  There is no dedicated health survey that is conducted by Stats SA  Limited/selected health statistics derived from the following sources: o Censuses / Surveys: – General Household Survey – Living Conditions Survey – Income and Expenditure Survey – Community Survey – Population censuses o Administrative source: – Death notification system Data sources on health statistics – Stats SA

6. Selected health indicators for Free State  MDG indicators o Infant mortality o Under-five mortality o Maternal mortality  Selected communicable diseases o Flu or acute respiratory tract infections o Diarrhoea o TB o HIV/AIDS  Selected non-communicable diseases o Asthma o Diabetes o Hypertension o Arthritis o Injuries

7. Analyses on MDG indicators  Data source o Mortality and causes of death data from South Africa’s civil registration system o This source was used for monitoring Goals 4 and 5 in the 2013 MDG report  Limitations with the data o Incomplete registration of death o Ill-defined causes of death o Misclassified causes of death  What is presented o Absolute number and percentage distribution to show trends o Methodology of adjusting for incomplete registration of death at provincial level under review

8. Infant mortality

9. Infant deaths by age: Free State, 1997-2010

10. Infant deaths by district: Free State, 1997-2010

11. 10 leading causes of death for infants: Free State, 2006 & 2010 Underlying cause of death 20062010 RankNo.%RankNo.% Influenza and pneumonia 1 1 25023,8259617,1 Intestinal infectious diseases 2 1 02019,4169820,1 Resp. & cardiovascular disorders specific to the perinatal period 3 63812,2352415,1 Disorders related to length of gestation and fetal growth 4 2414,661464,2 Malnutrition 5 1843,541624,7 Protozoal diseases 6 1222,3……… Other disorders originating in the perinatal period 7 1102,151554,5 Other acute lower respiratory infections 8 1021,98661,9 Infections specific to the perinatal period 9 991,971063,0 Certain disorders involving the immune mechanism10821,69611,8 Foetus & newborn affected by maternal factors & by complications of pregnancy, labour and delivery………10471,4

12. Causes of deathRank Fezile Dabi Rank Lejwe- leputs wa RankManga -ung RankThabo Mof. RankXha- riep Intestinal infectious diseases123,9123,4121,4117,0310,1 Respiratory and cardiovascular disorders specific to the perinatal period 216,3317,6314,749,9113,7 Influenza and pneumonia315,5220,9221,2213,5212,6 Malnutrition44,9… 45,855,054,2 Other disorders originating in the perinatal period 54,254,3… 36,046,1 Infections specific to the perinatal period … … 54,5… … Disorders related to length of gestation and fetal growth … 47,4… … … All deaths 1 107516936282636 5 leading causes of death for infant by district: Free State, 2010

13. Under-five mortality

14. Under-five deaths by age: Free State, 1997-2010

15. Under-five deaths by district: Free State, 1997- 2010

16. 10 leading causes of death for children under-five years: Free State, 2006 & 2010 Underlying cause of death 20062010 RankNo.%RankNo.% Influenza and pneumonia 1 1 52822,5277716,8 Intestinal infectious diseases 2 1 45721,4196620,9 Respiratory and cardiovascular disorders specific to the perinatal period 3 6409,4352411,3 Malnutrition 4 3405,042856,2 Disorders related to length of gestation and fetal growth 5 2413,561473,2 Protozoal diseases 6 1412,1……… Certain disorders involving the immune mechanism 7 1241,881032,2 Other acute lower respiratory infections 8 1211,810831,9 Tuberculosis 9 1201,89891,9 Other disorders originating in the perinatal period10 1101,651563,4 Infections specific to the perinatal period ………71062,3

17. Causes of deathRank Fezile Dabi Rank Lejwe- leputs wa RankManga -ung RankThabo Mof. RankXha- riep Intestinal infectious diseases 124,8122,939,9125,4114,5 Influenza and pneumonia 219,6221,5112,2215,2213,1 Respiratory and cardiovascular disorders specific to the perinatal period 313,9311,1210,2312,137,5 Disorders related to length of gestation and fetal growth 45,8…………………… Malnutrition 54,646,346,146,746,4 Infections specific to the perinatal period ……53,4…………54,6 Other disorders originating in the perinatal period …………54,6………… Certain disorders involving the immune mechanism ……………………53,1 All deaths 6531 2488551 493373 5 leading causes of death for children under-five years by district: Free State, 2010

18. Maternal mortality

19. Maternal deaths: Free State, 1997-2010

20. Maternal deaths by district: Free State, 1997- 2010

21. Causes of maternal deaths: Free State, 2010 Causes of maternal deaths Number of deaths % Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium 3525,4 Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium 2719,6 Eclampsia107,3 Postpartum haemorrhage107,3 Obstetric embolism85,8 Complications of the puerperium, not elsewhere classified75,1 Gestational [pregnancy-induced] hypertension with significant proteinuria64,4 Puerperal sepsis64,4 Gestational [pregnancy-induced] hypertension without significant proteinuria53,6 Ectopic pregnancy32,2 Maternal care for other conditions predominantly related to pregnancy32,2 Obstetric death of unspecified cause32,2 Other maternal deaths1510,9 Total138100

22. Other health indicators  Data source o General household survey, 2012 o Flu, diarrhoea and TB – based on questions on whether individuals suffered from these illnesses in the month prior to the survey o Chronic conditions – if individuals were informed by a medical practitioner or nurse if they suffered from the conditions  Limitations with the data o Self-reported o Survey undertaken between July and September – affects seasonal conditions  What is presented o Percentage distributions by age and sex

23. Communicable diseases

24. Free State 46,9% Age group 48,3% 46,0%

25. Free State 3,4% Age group 3,6% 3,3%

26. Free State 2,4% 4,7% 1,0% Age group

27. Free State 3,0% 2,3% 3,6% Age group

28. Non-communicable diseases

29. Free State 1,5% 1,3% 1,6% Age group

30. Free State 5,4% 4,2% 6,5% Age group

31. Free State 19,7% 12,2% 26,3% Age group

32. Free State 5,1% 2,3% 7,5% Age group

33. Free State 0,3% 0,1% 0,4% Age group

34. Injuries

35. 0,33% of injuries 0,34% of injuries Percentage of people who suffered from specific injuries

36. Concluding remarks  Stats SA has some information available to monitor health indicators at provincial and sub-provisional level o Levels and trends o Data have limitation  Need to undertake a national health survey (Demographic and Health Survey) o Required to provide the much-needed health information in the country, especially at sub-national level  Monitoring health-related MDG indicators at province level requires concerted efforts by relevant stakeholders o Use of current information o Necessary adjustments on the data o Identification of other data sources to complement available information