Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May 10;17(1):424.
doi: 10.1186/s12889-017-4312-x.

Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993-2013

Chodziwadziwa W Kabudula  1   2 , Brian Houle  3   4   5 , Mark A Collinson  3   6   7 , Kathleen Kahn  3   6   7 , Francesc Xavier Gómez-Olivé  3   6 , Samuel J Clark  3   5   6   8 , Stephen Tollman  3   6   7
Affiliations

Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993-2013

Chodziwadziwa W Kabudula et al. BMC Public Health. .

Abstract

Background: Virtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population.

Methods: We estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993-2013.

Results: From the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males.

Conclusions: This typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact on continued progress in reducing preventable mortality and improving health across the life course. Integrated healthcare planning and program delivery is required to improve access and adherence for HIV and non-communicable disease treatment. These findings from a local, rural setting over an extended period contribute to the evidence needed to inform further refinement and advancement of epidemiological transition theory.

Keywords: Agincourt; Cause composition; HIV/Aids; InterVA; Mortality; Non-communicable diseases, epidemiological transition; Rural; South Africa; Verbal autopsy.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Trends in selected mortality and cause of death indicators, Agincourt, South Africa, 1993–2013. a All-Cause Mortality. b Adult Mortality. c Life Expectancy at Birth. d Cause Specific Mortality
Fig. 2
Fig. 2
Trends in annual probability of dying by cause of death, Agincourt, South Africa, 1993–2013. a HIV/AIDS and TB. b Other Communicable. c Non-Communicable. d Injuries
Fig. 3
Fig. 3
Trends in annual probability of dying by age, sex and cause of death, Agincourt, South Africa, 1993–2013
Fig. 4
Fig. 4
Age-specific marginal linear predictions of dying from selected causes of death in subsequent time periods relative to 1993–1997 for males, Agincourt, South Africa, 1993–2013
Fig. 5
Fig. 5
Age-specific marginal linear predictions of dying from selected causes of death in subsequent time periods relative to 1993–1997 for females, Agincourt, South Africa, 1993–2013
Fig. 6
Fig. 6
Shifts in mortality and cause of death patterns for males, Agincourt, South Africa, 1993–2013
Fig. 7
Fig. 7
Shifts in mortality and cause of death patterns for females, Agincourt, South Africa, 1993–2013
See this image and copyright information in PMC

References

    1. Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. The Milbank Memorial Fund Quarterly. 1971;49(4):509–538. doi: 10.2307/3349375. - DOI - PubMed
    1. Rogers RG, Hackenberg R. Extending epidemiologic transition theory: a new stage. Soc Biol. 1987;34(3–4):234. - PubMed
    1. Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. The Milbank Memorial Fund Quarterly. 1986;64:355–391. - PubMed
    1. Caselli G, Mesle F, Vallin J. Epidemiologic transition theory exceptions. Genus. 2002;58(1):9–51.
    1. Frenk J, Bobadilla JL, Sepúlveda J, Cervantes ML. Health transition in middle-income countries: new challenges for health care. Health Policy Plan. 1989;4(1):29. doi: 10.1093/heapol/4.1.29. - DOI

MeSH terms