Burden of mortality linked to community-nominated priorities in rural South Africa

• Main Authors: Pyry Mattila (Author), Justine Davies (Author), Denny Mabetha (Author), Stephen Tollman (Author), Lucia D'Ambruoso (Author)
• Format: Book
• Published: Taylor & Francis Group, 2022-12-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1654-9880; 10.1080/16549716.2021.2013599
• Keywords: community participation; participatory action research; verbal autopsy; global burden of disease; Public aspects of medicine; RA1-1270
• Source: Global Health Action, Vol 15, Iss 1 (2022)

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.