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Stats SA to distil mortality trends
Pali Lehohla
2005-02-04

Administrative data can reveal trends in causes of death.

In recent years, much effort has gone into improving South Africa's system of death registration. This included the redesign of the death notification form, which was first introduced in 1998. Internationally, statistical agencies compile data from administrative records. The compilation of data on deaths is an example of this. Information on disease (morbidity) and death, including the causes of death, can usefully be used to inform public health and related social policy. Later this month, Statistics SA will release a report on causes of death between 1997 and 2003, based on death notification forms.

There has been some controversy in the run-up to this release, with at least one newspaper hinting at possible political interference in the results of this exercise. However, there is nothing intrinsically controversial in the project undertaken. The information is effectively an aggregation of individual forms. Each form is a unit record captured in a massive data base. Any attempt to manipulate or change details could be identified and established by any competent researcher with access to the dataset - and that dataset will be freely available. The only limit on this is that the identity of the deceased, recorded on the forms, is protected for confidentiality. The title of the report to be released says it all: Mortality and Causes of Death in South Africa, 1997-2003. Findings from death notification. The department of home affairs was able to supply Stats SA with over 3 million death notification forms for the period involved.

After removing duplicate forms, and excluding forms that recorded deaths outside the reference period, just over 2.87 million forms remained. Information on these forms has now been captured, and some analysis of these death records undertaken. The data will provide information on trends and patterns regarding deaths in South Africa - at what age people are dying and what the reported causes of death are. The release will be particularly useful to specialist epidemiologists and demographers, enabling them to undertake more detailed investigation into mortality patterns and the causes of death in South Africa. However, data compiled from these forms have their limits: they cannot alone give death rates or infant mortality rates and other demographic data need to be used in conjunction with this study to determine such rates. Because of a lack of standardization of place names, information can be provided only at provincial and national levels, and this limits a detailed understanding of the spread of epidemics.

The data cannot provide the number of deaths due to HIV/AIDS. It does, however, provide information on the number of cases where HIV/AIDS is directly recorded on the form as the cause of death. This large data capturing project was necessarily limited to what was recorded on the forms. Incomplete forms (for example, in large numbers of cases, population group is not recorded) impacted on the comprehensiveness of the data.The causes of death are sometimes not recorded and for some, the cause of death had to be listed as ill-defined. The reported causes of death were coded using the international statistical classification of diseases and related health problems (generally referred to as ICD-10). Tables of numbers of deaths by year, numbers and proportions for groupings according to province of death, age group, and sex were then compiled. The numbers of deaths attributed to particular causes have also been tabulated and ranked in terms of frequency.

In order to establish the underlying cause of death, rules defined in terms of ICD-10 were applied. These rules are used in most countries. Support was provided by the World Health Organization and the Centre for Disease Control (CDC) in using the software system, ACME, and results obtained were verified by the CDC. Those who anticipate that they will be able to find complex derivations indicating, for example, the prevalence of HIV among the population, or anything more than AIDS mortality as recorded on the forms, are destined for disappointment.
   
 
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