Mortality trends at Benedictine Hospital, Nongoma, KwaZulu-Natal 1995- 2001.

Thesis (M.Med.)-University of Natal, Durban, 2003.This epidemiological study is a longitudinal descriptive review of the mortuary register at Benedictine Hospital, with an analysis of the trends which emerge. The descriptive component describes mortality at Benedictine Hospital during the years 1995- 2001. It describes both the actual numbers of deaths which occurred according to each sex and age group, and the causes of death as recorded in the mortuary register. The purpose of this study was twofold. First it was desired to raise AIDS awareness in the district by examining the effects of the AIDS epidemic on mortality. Second as the new district health system was being established, it was desired to develop a baseline of mortality information to be utilized for management in the Nongoma Local Municipality. In the trend analysis component of the study, first, it is assumed that most of the deaths occurred at Benedictine Hospital as it is the only health facility which handles severe illness in the Nongoma Local Municipality; therefore the number of deaths within the hospital and the population of Nongoma were used to calculate Age Specific (ASMRs) and Cause Specific Mortality Rates (CSMRs). Secondly an analysis of the age and sex distribution of deaths, ASMRs, the distribution of causes of death, and CSMRs was done. Two research questions were posed. The first research question was, has there been any change in the age distribution of death? It was demonstrated that while there was an 80% increase in the number of deaths, and although deaths increased in every age group except for the neonatal group, 80% of the increase was in the young adult ages particularly in the 20 through 39 years old age groups. By 2001 these groups were recording the largest number of deaths, 179 male deaths and 133 female deaths in the 30 through 39 years old group. Also the ASMRs of young adults had increased three to four times. The second research question was, has there been any change in the distribution of causes of death? It was demonstrated that the infectious diseases which caused the largest numbers of deaths, pulmonary tuberculosis caused 353 deaths, pneumonia 250, gastroenteritis acute and chronic 203, retro-viral disease 66, and meningitis 59, were six of the top seven causes of death in 2001. Chronic gastroenteritis, retro-viral disease, and meningitis had strengthened their position moving from the second ten into the top seven. Only trauma which was in the top five was not an infectious disease. Infectious diseases increased their share of the burden of disease from 36% in 1995 to 57% in 2001. While CSMRs for trauma and the type II non-communicable diseases were basically stable or falling, those of the infectious diseases increased three to four times. It is estimated that because the mortality pattern is similar to that of AIDS deaths in South Africa and Zimbabwe, that because it is young adult mortality that has increased and that it is infectious diseases which have increased that about 50% of mortality in Nongoma is due to AIDS. Recommendations are put forward as to how to disseminate this information and also how to institute a system to carry on monitoring mortality in Nongoma