South Africa’s burden of disease consists of maternal, newborn and child health, HIV/AIDS and TB, non-communicable diseases, and interpersonal violence (South African Medical Research Council, 2022). Disability Adjusted Years, also called DALYs, is able to quantify the premature mortality and morbidity that these burdens of diseases cause in South Africa. DALYs means one lost year of "healthy" life. When DALYs for a population or burden of disease are added it puts into perspective the difference between the ideal standard for the health of the population, e.g. living to old age, without disease and disability, and the current health status of the population or affect that the burden of disease is having. Disability adjected years can be calculated with the following equation:
DALY=YLL+YLD
Where:
DALY- Disability adjusted years.
YLL- years of life lost
YLD- years lived with disability.
South Africa had HIV/AIDS, diarrheal disease, and interpersonal violence, as the top causes of Disability adjusted years in 2010. This illustrated the link between the burden of diseases and the decreased quality of life or life span of an individual. Globally there was a general trend of declining communicable, maternal, neonatal, and nutritional causes for DALYs, while non-communicable disease and injuries have continued to increase. We can now look at each quadruple burden of disease individually.
Communicable diseases:
These are illnesses which are the result of biological agents or their products and can easily be transmitted from one person to another. There are two types of communicable diseases, acute and chronic communicable diseases. HIV/AIDS and TB both fall under chronic communicable diseases.
HIV/AIDS
Management of HIV/AIDS:
Critical issues in the management of HIV:
HIV/AIDS relation to ongoing burdening of the Health Care System:
Tuberculosis
Management of TB:
Critical issues in the management of TB:
TB relation to ongoing burdening of the Health Care System:
Non-communicable diseases:
Those diseases or illnesses that cannot be transmitted from an infected person to a susceptible, healthy one. Several, or even many, factors may contribute to the development of a given non-communicable health condition. The contributing factors may be genetic, environmental, or behavioural in nature. Globally, non-communicable diseases are the leading cause of death in 1st world, killing more than 36 million people yearly. In low- & middle-income countries 80% deaths can be attributed to non-communicable diseases.
There are four groups of diseases that account for around 80% of all NCD deaths. Cardiovascular disease, Diabetes, Cancer, and Chronic respiratory disease.
These four conditions share four main risk factors: Tobacco use, physical inactivity, harmful use of alcohol, and Unhealthy diets.
FACTORS TO CONSIDER IN SA
The burden of non-communicable diseases is rising in rural communities, and it disproportionately affects poor people living in urban settings, and is resulting in an increase in the demand for care for chronic diseases.
As with CDs, NCDs are also associated with underdevelopment
Trends show that exposure to risk factors for NCDs has been increasing.
The rising demand for chronic care for communicable and non-communicable diseases needs an integrated model of care at all levels of the health system, supported by a robust surveillance system.
Management of Non-communicable diseases:
Non-communicable diseases relation to ongoing burdening of the Health Care System:
Maternal, newborn and child health:
Maternal, newborn and child health refers to the health outcomes of mothers and babies within the first 28 days of life. As well as children under the age of 5. Over the past two decades, there has been a remarkable decline in child mortality rates. The most recent data indicates that the number of children who died before their fifth birthday reached an all-time low of 4.9 million in 2022. This positive trend reflects significant progress in healthcare and child well-being (UNICEF, 2022).
Management of Maternal, newborn and child health:
Maternal, newborn and child health relation to ongoing burdening of the Health Care System:
Interpersonal violence:
Mercy et al. (2017) defines interpersonal violence as, "Interpersonal violence involves the intentional use of physical force or power against other persons by an individual or small group of individuals. Interpersonal violence may be physical, sexual, or psychological (also called emotional violence), and it may involve deprivation and neglect."
In South Africa Interpersonal violence is the second highest burden of diseases. Additionally, most of the interpersonal violence is aimed at women (Gordon, 2016).
Management of Interpersonal violence:
Interpersonal violence relation to ongoing burdening of the Health Care System:
Reference list:
South African Medical Research Council (2022). South African Medical Research Council. [online] South African Medical Research Council. Available at: https://www.samrc.ac.za/ [Accessed 5 Jun. 2024].
Allinder, S.M. and Fleischman, J. (2019). The World’s Largest HIV Epidemic in Crisis: HIV in South Africa. [online] Csis.org. Available at: https://www.csis.org/analysis/worlds-largest-hiv-epidemic-crisis-hiv-south-africa [Accessed 7 Jun. 2024].
Gordon, C. (2016). Intimate partner violence is everyone’s problem, but how should we approach it in a clinical setting? South African Medical Journal, [online] 106(10), p.962. doi:https://doi.org/10.7196/samj.2016.v106i10.11408.
Mercy, J.A., Hillis, S.D., Butchart, A., Bellis, M.A., Ward, C.L., Fang, X. and Rosenberg, M.L. (2017). Interpersonal Violence: Global Impact and Paths to Prevention. 3rd ed. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK525208/#:~:text=Interpersonal%20violence%20involves%20the%20intentional [Accessed 10 Jun. 2024].
Murdoch, J., Curran, R., van Rensburg, A.J., Awotiwon, A., Dube, A., Bachmann, M., Petersen, I. and Fairall, L. (2021). Identifying contextual determinants of problems in tuberculosis care provision in South Africa: a theory-generating case study. Infectious Diseases of Poverty, [online] 10(1). doi:https://doi.org/10.1186/s40249-021-00840-5.
South African National Department of Health (2021). The First National TB Prevalence Survey - South Africa 2018 | Department of Health Knowledge Hub. [online] knowledgehub.health.gov.za. National Department of Health. Available at: https://knowledgehub.health.gov.za/elibrary/first-national-tb-prevalence-survey-south-africa-2018 [Accessed 11 Jun. 2024].
UNICEF (2022). Maternal, Newborn and Child Survival. [online] Unicef.org. Available at: https://www.unicef.org/health/maternal-newborn-and-child-survival [Accessed 10 Jun. 2024].
WHO TEAM Global HIV, Hepatitis and STIs Programmes (HHS), Global Tuberculosis Programme (GTB), Guidelines Review Committee (2016). Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd ed. [online] www.ncbi.nlm.nih.gov. World Health Organization. Available at: https://www.ncbi.nlm.nih.gov/books/NBK374293/ [Accessed 7 Jun. 2024].
World Health Organization (2018). Tuberculosis (TB). [online] WHO | Regional Office for Africa. Available at: https://www.afro.who.int/health-topics/tuberculosis-tb [Accessed 10 Jun. 2024].