National Health Insurance
Evidence of the Prevalence of Chronic Disease in South Africa
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A useful source of data on chronic disease prevalence for South Africa as a whole is that collated from several sources by Candy Day and Andy Gray for Health Systems Trust and reported annually in the South African Health Review. Included in the report are tables by province and sometimes by ethnic group, but only a few of the CDL diseases are covered.
The 2007 version of the publication contained a comparison of the medical scheme prevalence data described in the section above to the national prevalence for hypertension, hyperlipidaemia, asthma and diabetes mellitus (type 2). The comparison for one disease is shown below, while the others are part of the slides for this policy brief on the IMSA web-site.
Figure 3: Comparison of Rates of Diabetes Mellitus Type 2 in Medical Schemes and the South Africa Demographic and Health Survey 2003
Day & Gray found that “although the age group, time period and measurement methods from the two sources are quite different, some interesting broad correlations and deviations can be seen.” The national prevalence was the self-reported prevalence in the preliminary report from the South Africa Demographic and Health Survey of 2003 (SADHS 2003). SADHS 2003 was based on a survey of 7,756 households. The prevalence of chronic disease is reported as the percentage of respondents age 15 and above who were told by a doctor nurse or health worker at a clinic or hospital that they have this condition.
Reviewing the full report a year later, Day & Gray found that10 “apart from the obvious difference in time period, caution should also be exercised in comparing these two sources, as the methods used are very different. The SADHS data are based on self-reported diagnoses and some measurements (blood pressure and peak flow, for example) and the full report indicates substantial quality concerns regarding the measurement of blood pressure.” Nevertheless, this is the first comparison of the medical scheme prevalence data to that for South Africa as a whole, using age and gender.
The Burden of Disease Research Unit at the Medical Research Council of South Africa produces valuable reports on the total burden of disease in South Africa. The work includes measuring the burden of disease by mortality, years of life lost (YLLs), years lived with disability (YLDs) and disability adjusted life years (DALYs). The first burden of disease report for South Africa was released in 2003. .
The authors, lead by Dr Debbie Bradshaw,said: “Although the South African epidemiological database has improved, there remains a paucity of reliable morbidity information. The notification data for tuberculosis, malaria and sexually transmitted diseases are incomplete. The National Cancer Registry provides incidence data on a number of cancers but the limitation here is that submissions are based on the histologically confirmed cases and therefore rates must be interpreted cautiously. Some morbidity data have been collected in surveys such as the 1998 Demographic and Health Survey. These include respiratory diseases, self-reported work-related illness and injury. These fragmented data do not provide the detail required to accurately estimate the YLDs”.
In 2006 the Medical Research Council Chronic Diseases of Lifestyle Unit produced a comprehensive technical report “A Perspective on Dealing with Chronic Diseases of Lifestyle in South Africa”. Specific chapters on hypertension, hyperlipidaemia, diabetes mellitus and respiratory diseases provide information on what is known about the epidemiology of each condition in South Africa.
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