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5. Older Adults and the Health Transition in Agincourt, Rural South Africa: New Understanding, Growing Complexity
Pages 166-188

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From page 166...
... Such change in population age structure shifts the mortality profile from one dominated by the infectious diseases more common in children, toward one dominated by the noncommunicable diseases that affect older adults and the elderly. Despite the relatively young distribution of African mortality compared with other less developed regions, the number of deaths in Africa has increased more at the older ages; this reflects both 166
From page 167...
... . Almost half the South African population resides in rural and semirural settings, comprising the majority of the country's poor.
From page 168...
... We contend that the early conceptions of epidemiological transition theory are inadequate to explain the changes observed, and we locate the empirical findings in a more contemporary analysis of the health transition. Finally, we raise some implications of the transition for the provision of health care.
From page 169...
... points out that while epidemiological transition theory emphasizes the role of social, economic, ecobiological, and environmental change, it understates the contributions of scientific discovery, medical technology, and public health interventions, such as water purification, sewage disposal, and immunization. Defining just three stages of the epidemiological transition is thought too restrictive, a limitation identified by Omran and others in the 1980s who have added a subsequent stage dealing with the reduction of age-specific death rates due to degenerative diseases (Beaglehole and Bonita, 2004; Olshansky and Ault, 1986; Omran, 1982)
From page 170...
... OLDER ADULTS AND THE HEALTH TRANSITION IN AGINCOURT: A CASE STUDY The Agincourt Study Site Geographic, Social, and Economic Characteristics of Agincourt The Agincourt subdistrict site covers 390 sq km of the Bushbuckridge district of Mpumalanga Province, lying just south of Limpopo Province, adjacent to Mozambique's western boundary (separated by the Kruger National Park)
From page 171...
... South Africa has a system of statesupported social welfare unique in sub-Saharan Africa, which includes an old-age pension payable to women from age 60 and men from age 65. Population Growth and Age Structure, 1992-2000 The foundation of the work in the Agincourt study site is a Health and Demographic Surveillance System (HDSS)
From page 172...
... During ages 65-74, female mortality remained stable while male mortality increased. These changes were
From page 173...
... TABLE 5-1 Change in Mortality Rates by Age and Sex, Agincourt 1992-2000 Period Change Gender and Age Group 1992-1994 1998-2000 1992-1994 / 1998-2000 P-value Significance Men 0-4 0.03169 0.05637 2.21 0.0000 – 5-14 0.00911 0.00766 0.56 0.5849 NS 15-29 0.02920 0.03464 1.15 0.4059 NS 30-49 0.11893 0.20565 2.36 0.0001 * 50-64 0.25108 0.19948 0.65 0.1649 NS 65-74 0.28233 0.34651 1.18 0.1672 NS 75-84 0.58817 0.58540 1.06 0.9797 NS Women 0-4 0.03179 0.05335 1.97 0.0002 – 5-14 0.00616 0.00532 0.55 0.7063 NS 15-29 0.01766 0.04413 3.12 0.0000 – 30-49 0.06728 0.12356 2.50 0.0002 – 50-64 0.09537 0.15114 2.29 0.0227 – 65-74 0.20834 0.20700 0.98 0.9653 NS 75-84 0.42415 0.32092 0.65 0.1603 NS *
From page 174...
... Why women appear to be losing their survival advantage in this population is a critical question. Verbal autopsy data indicate that women are bearing the brunt of emerging noncommunicable diseases: for all ages, female mortality from stroke, diabetes, and hypertension combined increased significantly over the 1992-2000 period (Figure 5-1)
From page 175...
... 175 OLDER ADULTS AND THE HEALTH TRANSITION IN AGINCOURT 0.0004 Female Male 0.0003 0.0003 Death Rate 0.0002 0.0002 0.0001 0.0001 0.0000 1992-1994 1995-1997 1998-2000 Period FIGURE 5-2 Trends in overall death rates from diabetes, Agincourt 1992-2000. 0.0008 0.0007 0.0006 0.0005 Death Rate 0.0004 0.0003 0.0002 Female Male 0.0001 0.0000 1992-1994 1995-1997 1998-2000 Period FIGURE 5-3 Trends in overall death rates from stroke, Agincourt 1992-2000.
From page 176...
... Emerging Noncommunicable Diseases: The Case of Stroke As populations undergo health and economic transitions, their disease patterns change, with cardiovascular disease (stroke, ischemic heart disease, and peripheral vascular disease) increasing.
From page 177...
... The project aims to measure the current burden of stroke, to investigate the causes and social context of stroke, and to lay the groundwork for a program of intervention research. Between 2001 and 2003, the project employed multiple methods to quantify the community impact of stroke, understand the social setting of stroke, understand the nature of stroke and its risk factors in hospitalized patients and in stroke survivors in the community, and identify problems related to the prevention, diagnosis, and management of stroke (SASPI Project Team, 2003)
From page 178...
... , suggesting that rural South Africans are in the early transition stage. Evidence of atherosclerosis and myocardial infarction, which typically appear later in the transition, was absent (SASPI Project Team, 2004a)
From page 179...
... . IMPLICATIONS OF CHANGING ADULT HEALTH FOR PROVISION OF HEALTH CARE During this early transitional stage of rural South African communities, what role does the health service currently play in hypertension control and
From page 180...
... In Agincourt, barriers to secondary prevention of stroke include cost of treatment, reluctance to use pills, difficulties with access to drugs, and lack of equipment to measure blood pressure (SASPI Project Team, 2004b) , while problems with staff knowledge, attitudes, and practices have been identified in public-sector facilities providing primary care for diabetes in South Africa (Goodman, Zwarenstein, Robinson, and Levitt, 1996; Levitt et al., 1996)
From page 181...
... There is need to effectively prevent and control the increasing burden of noncommunicable diseases, address HIV/AIDS transmission and treatment and provide home-based care for the terminally ill, while simultaneously maintaining and improving on gains in child and maternal health. Agincourt adults and other Southern African populations are subject to extensive temporary labor migration, with consequent high mobility, making the provision of chronic, ongoing care especially challenging.
From page 182...
... Greater emphasis needs to be placed on noncommunicable disease diagnosis and management and on the detection of complications. An understanding of risk factors, including hypertension, obesity, and such lifestyle factors as smoking and alcohol consumption, as well as methods of reducing them, is needed.
From page 183...
... In settings in which people tend to access plural health care, encouraging earlier consultation and regular follow-up at Western primary care services may be an important part of developing patient literacy around noncommunicable diseases and their management. Treatment of hypertension in sub-Saharan Africa, despite the cost and difficulties, is a priority.
From page 184...
... The coexistence of communicable and noncommunicable diseases poses multiple challenges for households, policy makers, and health system planners and managers. Efforts to project the prevalence of chronic diseases for purposes of health budgeting and planning need to take into account the impact of HIV/AIDS; fewer infected people will survive to middle and older ages at which noncommunicable diseases reach their peak age-specific prevalence, resulting in lower chronic disease prevalence rates (Panz and Joffe, 1999)
From page 185...
... South African Medical Journal, 90(1)
From page 186...
... South African Medical Journal, 87(3)
From page 187...
... . The prevalence of cardiovascular risk factors in a rural South African population: Evidence of the impending cardiovascular epidemic from the Southern Africa stroke prevention ini tiative (SASPI)
From page 188...
... . Global burden of cardiovascular diseases Part I: General considerations, the epidemiologic transitions, risk factors, and the impact of urbanization.


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