15 Eastern Cape Province - hst.org.za

276

Section B: National and District Profiles

276

Section B: Profile Eastern Cape Province

15 Eastern Cape Province

Buffalo City Metropolitan Municipality (BUF) Naomi Massyn and Pamela Groenewald

Buffalo City is situated on the east coast of the Eastern Cape Province and has a population of 757 267, with a population density of 299 people per km2. The district falls into socio-economic Quintile 4, which is among the wealthier districts.

Population distribution, sub-district boundaries and health facility locations: Buffalo City (BUF)

Broad age.. Female Male

<5 years

5-14

15-24

25-64

65+

Total 55.4%25.4%13.8%

24.4%

16.6%

15.6%

30.1%

18.7%

43.5%

82.7%

11.6%

21.0%

48.0%

38.9%

64.1%

24.5%

16.7%

12.3%

17.2%47.6%23.8%

42.9%

71.2%

17.5%

16.1%

25.8%

12.6%

40.2%

80.0%

15.3%

33.6%

64.8%

16.0%

9.5%9.6%

EC, Buffalo City: BUF

Broad age.. 2008-10 2011-13

<5 years

5-14

15-24

25-64

65+

30.7%

46.3%

11.9%

13.0%

30.9%

14.1%

39.9%

81.4%

11.5%

18.5%

28.1%

36.3%

67.0%

19.9%

11.6%

11.9%

8.5%

40.5%

49.0%

12.2%

20.8%

23.4%

16.8%

44.0%

81.7%

16.7%

25.1%

35.5%

60.2%

19.3%

9.1%

Rank.. 2008-10 2011-13

<5 y

ears

12345678910

5-14

12345678910

15-2

4

12345678910

25-6

4

12345678910

65+

12345678910

Protein-energy malnutrition (3.9%)Birth asphyxia (2.8%)

Fires, hot substances (2.6%)

Preterm birth complications (4.8%)

Accidental threats to breathing (2.7%)

Meningitis/encephalitis (2.1%)

Diarrhoeal diseases (24.3%)Lower respiratory infections (24.4%)

HIV/AIDS (7.3%)

Tuberculosis (4.4%)

Sepsis/other newborn infectious (3.1%)


Other respiratory (2.6%)




HIV/AIDS (6.2%)

Tuberculosis (2.9%)

Other neurological conditions (4.2%)

Drowning (12.1%)

Epilepsy (3.5%)Fires, hot substances (3.7%)

Accidental threats to breathing (4.4%)Road injuries (5.7%)Diarrhoeal diseases (6.9%)

Lower respiratory infections (4.2%)

HIV/AIDS (8.6%)Tuberculosis (11.1%)

Drowning (20.5%)


Accidental threats to breathing (5.0%)Meningitis/encephalitis (6.1%)

Road injuries (12.6%)

Diarrhoeal diseases (4.9%)



Drowning (2.2%)


Interpersonal violence (20.0%)

Mechanical forces (5.0%)



Road injuries (3.7%)Lower respiratory infections (3.6%)

HIV/AIDS (8.1%)

Tuberculosis (20.5%)

Drowning (2.8%)

Epilepsy (1.8%)



Mechanical forces (6.4%)Accidental threats to breathing (8.4%)




Oesophagus (2.4%)


COPD (2.6%)Diabetes mellitus (2.6%)

Ischaemic heart disease (2.6%)Diarrhoeal diseases (3.2%)

Cerebrovascular disease (4.0%)Lower respiratory infections (4.5%)




COPD (2.9%)

Nephritis/nephrosis (2.8%)

Diabetes mellitus (3.0%)

Ischaemic heart disease (2.9%)



Oesophagus (4.8%)

Trachea/bronchi/lung (2.6%)Cardiomyopathy (3.8%)

COPD (6.4%)


Hypertensive heart disease (7.5%)Ischaemic heart disease (8.8%)

Cerebrovascular disease (13.7%)


Tuberculosis (6.5%)

Oesophagus (4.6%)

Cardiomyopathy (2.7%)

COPD (6.7%)






Tuberculosis (6.1%)

Prov, DistrictEC, Buffalo City: BUF

Show History

BroadcauseInjury

NCD

HIV and TB

Comm_mat_peri_nut

Percentage ofdeaths by broadcause and leadingcauses, 2008-2013


277


277

Burden of disease profile

Percentage of deaths by broad cause and leading causes, 2008-2013: Buffalo City (BUF)

278


278


Broad cause groups by age and gender

In the under-5-year age group, communicable diseases together with maternal, perinatal and nutritional conditions accounted for almost 65% of deaths. HIV and TB mortality was about 11.6% among females and 9.6% among males, and injuries accounted for around 9% of deaths.

In the 5–14-year age group there were bigger differences in the proportions of broad causes between females and males. Injuries accounted for 24.4% of deaths among females versus 42.9% of deaths among males; communicable diseases and maternal, perinatal and nutritional conditions accounted for 24.5% of deaths among females versus 16.0% among males; and HIV and TB accounted for 21.0% of deaths among females versus 15.3% among males.

In the 15–24-year age group, injury accounted for 71.2% of deaths among males compared with only 16.6% of deaths among females, while HIV and TB accounted for 48.0% of deaths among females.

In the 25–64-year age group, non-communicable diseases accounted for the largest proportion of deaths (43.5% among females and 40.2% among males). Injuries accounted for a smaller proportion of deaths in this age group, with the percentage being much higher among males (17.5%) than females (5.3%).

In the 65-years-and-older age group, non-communicable diseases accounted for the highest proportion of deaths (82.7% among females and 80.0% among males). HIV and TB deaths were higher among males than females.

Trends in broad cause groups by age

Among children under 5 years, there was a decline in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions and HIV and TB, with a corresponding increase in deaths due to non-communicable diseases, and a slight increase in injury-related deaths. In the 5–14-year age group, there was a slight decrease in HIV and TB mortality, a bigger decrease in non-communicable disease mortality, and a marked increase in injury-related deaths (30.7% to 40.5%). In the 15–24, 25–64 and 65-years-and-older age groups there were no significant changes in the broad cause groups over the period.

Trends in leading causes of death by age

Under 5 years

Deaths due to lower respiratory infection, diarrhoea, and HIV and AIDS declined over this period but remained the leading causes. Tuberculosis also declined over this period, with prematurity and birth asphyxia increasing, and sepsis/other newborn infections moving into the top 10 causes of death. HIV-related mortality accounted for between 40% and 50% of mortality in this age group.

5–14 years

Drowning, road injuries, TB, and HIV and AIDS remained in the top four causes of death in this age group, with the proportion of road injuries and drowning increasing markedly. Diarrhoea and lower respiratory infections moved down in the ranking. Accidental threats to breathing, fires and epilepsy were also among the top 10 causes of death.

15–24 years

Interpersonal violence, TB, HIV and AIDS and accidental threats to breathing remained the top four causes of death over this period, with TB decreasing and moving down to second place in the ranking. Road injuries, fires, drowning and lower respiratory infections were also among the top 10 causes of death.

25–64 years

Tuberculosis, HIV and AIDS, cerebrovascular disease, lower respiratory infections and interpersonal violence remained the top five causes of death over the whole period. Diabetes mellitus, chronic obstructive pulmonary disease and ischaemic heart disease also appeared in the top 10 causes in both periods.

65 years and older

Cerebrovascular disease, hypertensive heart disease, ischaemic heart disease, chronic obstructive pulmonary disease and TB remained the leading causes of death in this age group over the whole period. Diabetes mellitus, oesophageal cancer, lower respiratory infections and cardiomyopathy remained in the top 10, with nephritis/nephrosis replacing tracheal/bronchial/lung cancer in the latter period.


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279

Indicator performance: Buffalo City (BUF)

District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target

Category Indicator 2012/13 2013/14 2014/15 2014/15 2014/15 2014/15 2015/16 2014/15 2014/15 2015/16Management PHC

PHC supervisor visit rate (fixed clinic/CHC/CDC) [Percentage]

75.0 65.7 82.5 19 77.6 91.0 73.5

Management Inpatients

Average length of stay (district hospitals) [Days]

6.3 5.6 4.9 11 5.3 4.9 4.6

Expenditure per patient day equivalent (district hospitals) [Rand (real 2014/15 prices)]

2 099.5 2 042.8 2 066.6 9 2 005.9 2 136.4

Inpatient bed utilisation rate (district hospitals) [Percentage]

68.2 64.9 56.6 42 59.0 65.0 65.8

OPD new client not referred rate (district hospitals) [Percentage]

63.4 43.0 47.8 19 64.3 60.7

Mortality Inpatients

Child under 5 years diarrhoea case fatality rate [Percentage]

2.8 2.6 2.2 16 5.2 5.8 5.6 3.3 3.5 3.0

Child under 5 years pneumonia case fatality rate [Percentage]

1.4 2.1 2.4 21 4.2 6.0 4.0 2.9

Child under 5 years severe acute malnutrition case fatality rate [Percentage]

10.7 12.9 9.5 20 11.8 12.0 10.0 11.6 8.0 7.0

Inpatient crude death rate [Percentage]

6.9 6.4 5.8 31 6.3 5.2

Delivery Delivery by Caesarean section rate (district hospitals) [Percentage]

21.3 23.7 25.0 20.6 22.7

Delivery in facility under 18 years rate [Percentage]

6.4 6.1 5.9 8 9.6 10.3 7.4

Inpatient early neonatal death rate [per 1 000 live births]

14.0 12.8 13.1 43 13.3 12.0 10.1 0

Maternal mortality in facility ratio [per 100 000 live births]

196.9 133.3 206.7 43 148.3 114.0 112.0 132.5 100 80.0

Mother postnatal visit within 6 days rate [Percentage]

66.9 66.6 69.1 27 58.0 55.0 74.3 80.0 85.0

Stillbirth in facility rate [per 1 000 births]

22.1 23.2 21.3 27 19.6 20.7

PMTCT Antenatal 1st visit before 20 weeks rate [Percentage]

38.8 39.3 47.4 46 48.8 42.0 50.0 53.9 65.0 70.0

Antenatal client initiated on ART rate [Percentage]

69.3 79.6 98.2 5 91.7 90.0 91.2 93.0 96.0

Infant 1st PCR test around 6 weeks uptake rate [Percentage]

70.7 74.6 74.6 51 95.2 100.6

Infant 1st PCR test positive around 6 weeks rate [Percentage]

2.3 1.6 1.5 23 1.7 2.8 1.5 1.5 1.8 2.0

Child Health School Grade 1 screening coverage [Percentage]

13.2 8.0 48 13.4 70.0 27.4 23.2 30.0 35.0

Vitamin A dose 12-59 months coverage [Percentage]

32.1 33.5 41.7 49 53.0 55.0 55.0 52.2 55.0

Immunisation Immunisation coverage under 1 year [Percentage]

98.7 93.4 96.4 10 80.9 90.0 90.0 89.8 95.0 91.0

Measles 2nd dose coverage [Percentage]

73.8 72.7 79.8 25 73.6 95.0 90.0 82.8 85.0 85.0

Reproductive health

Cervical cancer screening coverage ([Percentage]

31.3 49.3 65.2 15 56.3 42.0 44.0 54.5 60.0 64.0

Couple year protection rate [Percentage]

26.7 30.6 45.2 28 39.4 60.0 46.8 55.0

TB case finding TB Rifampicin resistance confirmed client rate [Percentage]

9.8 7.9 7.9 43 6.0 6.4

HIVNon-communicable diseases

HIV testing coverage (including ANC)

24.8 31.6 35 36.0 32.1

Male condom distribution coverage

10.9 12.9 41.7 17 33.6 38.0 38.4

Hypertension incidence [per 1 000]

17.8 22.7 17.2 15.7 3.5 13.9

Mental health admission rate [Percentage]

0.3 0.4 1.3 1.2

Human Resources

PHC doctor clinical workload [Clients per doctor per day]

18.0 11.5 14.7 44 23.8 26.9

PHC professional nurse clinical workload [Clients per nurse per day]

21.4 21.4 22.5 33 33.7 29.4

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280


District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target

Category Indicator 2011 2012 2013 2014 2013 2013 2013 2014 2013 2013 2014TB case finding

Incidence (diagnosed cases) of TB - all types [Cases per 100 000 population]

903.8 791.4 822.7 38 792.3 592.5

TB treatment outcomes

TB cure rate (new smear positive) [Percentage]

55.4 55.1 65.1 47 70.5 76.8

TB death rate (all TB) [Percentage] 9.7 8.4 6.4 13 9.3 5.9 7.4 6.0 5.0TB defaulter rate (new smear positive) [Percentage]

11.7 11.6 11.3 52 7.7 7.06.8

5.8 6.05.5

TB treatment success rate (all TB) [Percentage]

70.5 71.7 77.7 27 77.0 78.982.0

77.9 82.083.0

HIV Percentage of TB cases with known HIV status (ETR.Net) [Percentage]

86.2 87.0 90.7 40 92.3 92.8

TB/HIV co-infected client on ART rate (ETR.Net) [Percentage]

61.8 92.0 85.1 18 89.1 78.9

NCDs Hypertension prevalence rate (crude) [Percentage]

48.3 50 36.3 31.8

Burden of disease

Percentage of deaths garbage codes [Percentage]

17.3 17.3 16.8 45 13.5 14.5

Percentage of deaths ill-defined [Percentage]

6.5 7.8 8.4 17 20.7 14.0

Percentage of YLLs due to communicable, maternal, perinatal, nutrition causes [Percentage]

13.5 11.9 11.1 7 16.1 22.1

Percentage of YLLs due to HIV and TB [Percentage]

29.6 29.8 28.6 28 32.6 27.9

Percentage of YLLs due to injuries [Percentage]

15.7 13.5 15.7 44 14.2 13.1

Percentage of YLLs due to non-communicable diseases [Percentage]

41.3 44.7 44.6 43 37.1 36.9

Value in red – improvement strategies are urgently needed

Value highlighted in yellow – performance is ranked among the 10 best in the country

Value highlighted in red – performance is ranked among the 10 worst in the country

The district performed very well with regard to some indicators, which ranked among the 10 best in the country in the last reporting period. These indicators were:

✦ Expenditure per patient day equivalent (district hospitals)

✦ Delivery in facility under 18 years rate

✦ Antenatal client initiated on ART rate

✦ Immunisation coverage under 1 year

✦ Percentage of years of life lost (YLLs) due to communicable, maternal, perinatal, nutrition causes

However, the performance of some indicators ranked among the 10 worst in the country. These indicators were:

✦ Inpatient early neonatal death rate

✦ Maternal mortality in facility ratio

✦ Antenatal 1st visit before 20 weeks rate

✦ Infant 1st PCR test around 6 weeks uptake rate (second lowest in the country)

✦ School Grade 1 screening coverage

✦ Vitamin A dose 12–59 months coverage

✦ TB Rifampicin resistance confirmed client rate

✦ TB cure rate (new smear positive)

✦ TB defaulter rate (new smear positive)

✦ PHC doctor clinical workload

✦ Hypertension prevalence rate (crude)

✦ Percentage of deaths garbage codes

✦ Percentage of YLLs due to injuries and non-communicable diseases


281


281

Although the district recorded an improvement in the performance of several indicators over the past three years, improvement strategies are needed urgently for the following indicators, especially when compared with the district ranking, 2014/15 provincial and national averages, and the 2014/15 and 2015/16 provincial and national targets. These indicators are:

✦ Child under 5 years severe acute malnutrition case fatality rate

✦ Delivery by Caesarean section rate (district hospitals)

✦ PHC supervisor visit rate (fixed clinic/CHC/CDC)

✦ Inpatient bed utilisation rate (district hospitals)



✦ Mother postnatal visit within 6 days rate

✦ Stillbirth in facility rate


✦ Infant 1st PCR test around 6 weeks uptake rate



✦ Measles 2nd dose coverage

✦ Couple year protection rate

✦ Incidence (diagnosed cases) of TB (all types)



✦ TB death rate (all TB)


✦ TB treatment success rate (all TB)

✦ HIV testing coverage (including ANC)

✦ Percentage of TB cases with known HIV status

✦ Hypertension incidence


✦ PHC doctor and professional nurse clinical workload

✦ Percentage of deaths garbage codes

✦ Percentage of YLLs due to injuries

✦ Percentage of YLLs due to non-communicable diseases

Annual indicators for district: Buffalo City: BUF

Valu

e

0

20

40

60

80

2006 2008 2010 2012 2014

02_Fixed PHC super vis rate

5

6

7

8

2006 2008 2010 2012 2014

03_Avg length of stay (DH)

2

4

6

8

10

2006 2008 2010 2012 2014

03_Child <5 diar fat rate

2

4

6

8

2008 2010 2012 2014 2016

03_Child <5 pneumo death

10

12

14

16

18

20

22

2008 2010 2012 2014 2016

03_Child <5 sev mal fata

5.0

5.5

6.0

6.5

7.0

2008 2010 2012 2014 2016

03_Crude death rate

1400

1600

1800

2000

2200

2006 2008 2010 2012 2014

03_Expenditure per PDE

30

40

50

60

2008 2010 2012 2014 2016

03_OPD new not ref rate (DH)

60

65

70

75

80

2006 2008 2010 2012 2014

03_Usable bed util (DH)

5

10

15

20

25

2006 2008 2010 2012 2014

04_Caesarean sect (DH)

6

7

8

9

10

2006 2008 2010 2012 2014

04_Deliv in fac <18

8

10

12

14

16

2006 2008 2010 2012 2014

04_IP early neo death rate

50

100

150

200

2006 2008 2010 2012 2014

04_Maternal Mort ratio yy

20

40

60

2008 2010 2012 2014 2016

04_Posnatal mother <6d

20

22

24

26

28

2006 2008 2010 2012 2014

04_Stillbirth rate

30

35

40

45

50

55

2006 2008 2010 2012 2014

05_ANC 1st visit <20 w rate

70

80

90

100

2008 2010 2012 2014 2016

05_ANC initiate ART rate

20

40

60

80

100

2006 2008 2010 2012 2014

05_Infant PCR 6w uptake rate

2

4

6

8

10

12

2006 2008 2010 2012 2014

05_Infant PCR pos 6w rate

10

15

20

2010 2012 2014 2016 2018

06_School G1 screen cov yy

District value Provincial average ZA (national) average

282


282


Annual indicators for district: Buffalo City (BUF)

Annual indicators for district: Buffalo City: BUFVa

lue

20

30

40

50

2006 2008 2010 2012 2014

06_VitA 12−59 mm cov yy

60

70

80

90

100

2006 2008 2010 2012 2014

07_Imm cov <1 yy

60

70

80

90

2006 2008 2010 2012 2014

07_Measles 2nd cov yy

0

20

40

60

2006 2008 2010 2012 2014

08_Cerv cancer screen cov yy

25

30

35

40

45

2006 2008 2010 2012 2014

08_Couple Year Prot Rate yy

6

7

8

9

10

11

12

2008 2010 2012 2014

09_New pulmonary TB LTF rate

0

2

4

6

8

10

2008 2010 2012 2014 2016

09_RIF resistance rate

40

50

60

70

2006 2008 2010 2012 2014

09_TB cure rate new sm+

7

8

9

10

11

2008 2010 2012 2014 2016

09_TB deaths all TB

600

700

800

900

2006 2008 2010 2012 2014

09_TB inc all TB

65

70

75

2006 2008 2010 2012 2014

09_TB success all TB

26

28

30

32

34

36

2010 2012 2014 2016 2018

10_HIV test cov inc ANC

10

20

30

40

2006 2008 2010 2012 2014

10_Male cond dist cov yy

40

50

60

70

80

90

2008 2010 2012 2014

10_TB known HIV status

40

60

80

2008 2010 2012 2014 2016

10_TB/HIV on ART

30

35

40

45

50

2006 2008 2010 2012 2014

11_Hypertension prevalence

0.4

0.6

0.8

1.0

1.2

2010 2012 2014 2016 2018

11_Mental hlth adm rate

15

20

25

2010 2012 2014 2016

12_PHC dr clinical work load

22

24

26

28

30

32

34

2010 2012 2014 2016

12_PHC PN clin workload

14

16

18

2006 2008 2010 2012 2014

13_Garbage codes



283


283

Annual indicators for district: Buffalo City (BUF)

284


284


Sarah Baartman District Municipality (DC10) Naomi Massyn and Pamela Groenewald

Sarah Baartman District (previously known as Cacadu) is situated in the Eastern Cape Province and comprises three sub-districts, namely Camdeboo, Kouga and Makana. The district has a population of 461 989, with a population density of 7.9 persons per km2, and falls into socio-economic Quintile 3.

Population distribution, sub-district boundaries and health facility locations: Sarah Baartman (DC10)


<5 years

5-14

15-24

25-64

65+

Total 54.5%26.9%13.2%

36.7%

18.7%

21.9%

41.9%

84.3%

12.6%

19.3%

60.3%

43.1%

71.7%

22.1%

11.4% 9.7%

9.2%

14.9%46.7%26.8%11.7%

51.8%

67.9%

16.8%

18.1%

37.4%

80.8%

11.3%

20.2%

18.6%

38.2%

72.1%

9.2%

EC, S Baartman: DC10

Broad age.. 2008-10 2011-13

<5 years

5-14

15-24

25-64

65+

44.6%

43.5%

12.4%

19.2%

38.0%

82.6%

13.1%

22.5%

40.0%

40.5%

73.0%

13.7%

9.1%

9.2%

47.2%

46.3%

11.9%

12.9%

20.1%

41.1%

82.9%

16.5%

35.9%

40.1%

69.8%

16.3%

9.7%

Rank.. 2008-10 2011-13

<5 y

ears

12345678910

5-14

12345678910

15-2

4

12345678910

25-6

4

12345678910

65+

12345678910







HIV/AIDS (8.2%)

Tuberculosis (5.3%)Congenital heart anomalies (3.3%)

Other perinatal conditions (2.2%)Sepsis/other newborn infectious (2.3%)


Preterm birth complications (10.6%)Diarrhoeal diseases (17.7%)



Other unintentional injuries (4.6%)


Drowning (24.4%)

Epilepsy (4.9%)





HIV/AIDS (10.2%)

Tuberculosis (16.5%)Drowning (35.5%)







Drowning (4.4%)




Accidental threats to breathing (5.3%)Road injuries (7.6%)




Drowning (6.5%)








HIV/AIDS (18.6%)


Trachea/bronchi/lung (2.3%)


Road injuries (3.0%)COPD (2.6%)

Hypertensive heart disease (3.1%)





Road injuries (2.8%)COPD (3.0%)

Diabetes mellitus (2.6%)Hypertensive heart disease (2.8%)

Ischaemic heart disease (4.8%)Cerebrovascular disease (5.1%)



Prostate (2.8%)


COPD (6.1%)



Hypertensive heart disease (10.0%)Ischaemic heart disease (13.7%)Cerebrovascular disease (15.3%)


Tuberculosis (5.4%)

Prostate (2.7%)Trachea/bronchi/lung (3.2%)

COPD (6.7%)

Nephritis/nephrosis (3.6%)Diabetes mellitus (4.9%)



Lower respiratory infections (5.4%)Tuberculosis (5.7%)

Prov, DistrictEC, S Baartman: DC10

Show History

BroadcauseInjury

NCD

HIV and TB

Comm_mat_peri_nut



285


285


Percentage of deaths by broad cause and leading causes, 2008-2013: Sarah Baartman (DC10)

286


286



In the under-5-year age group, communicable diseases together with maternal, perinatal and nutritional conditions accounted for over 70% of deaths. HIV and TB accounted for about 12% of deaths, and injuries for around 5%.

In the 5–14-year age group there were bigger differences in the proportions of broad causes between males and females, with injuries accounting for 36.7% of deaths among females and 51.8% of deaths among males.

In the 15–24-year age group, injury accounted for 67.9% of deaths among males compared with only 18.7% of deaths among females, while HIV and TB accounted for 60.3% of deaths among females compared with only 18.6% among males.

In the 25–64-year age group, HIV and TB accounted for the largest proportion of deaths (38.2% among males and 43.1% among females). Injuries accounted for a small proportion of deaths in this age group, with the percentage being much higher among males than females (16.8% versus 4.8%).

In the 65-years-and-older age group, non-communicable diseases accounted for the highest proportion of deaths (84.3% among females and 80.8% among males).


Among children under 5 years, there was a decline in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions and HIV and TB. In the 5–14-year age group, there was a slight decrease in HIV and TB mortality, and a slight increase in injury-related deaths. In the 15–24-year group, deaths due to HIV and TB declined, and deaths due to non-communicable diseases and injuries increased. There was not much change in the broad cause groups over the period for the 25–64-year and the 65-years-and-older age groups.


Under 5 years

Lower respiratory infections, diarrhoea, prematurity, protein-energy malnutrition, birth asphyxia, HIV and AIDS and TB remained the top causes of death, with HIV and AIDS moving down in the ranking slightly. HIV-related mortality accounted for almost 50% of mortality in this age group.

5–14 years

Drowning, road injuries, HIV and AIDS, and TB remained the top four causes of death in this age group. Diabetes mellitus also came up as a leading cause of death in the second period, which is unusual for this age group.

15–24 years

TB, interpersonal violence, HIV and AIDS, drowning and road injuries remained in the top seven causes of death over this period. Lower respiratory infections and fires were also among the top 10 causes.

25–64 years

TB and HIV and AIDS remained the top causes of death over the whole period. The other leading causes included cerebrovascular disease, ischaemic heart disease, lower respiratory infections, chronic obstructive pulmonary disease, road injuries, hypertensive heart disease and diabetes mellitus, which replaced lung cancer in the top 10 in the latter period.

65 years and older

Cerebrovascular disease, ischaemic heart disease, hypertensive heart disease and chronic obstructive pulmonary disease remained the leading causes of death in this age group over the whole period. Tuberculosis and lower respiratory infections, diabetes, lung cancer and prostate cancer also appeared among the leading causes.


287


287

Indicator performance: Sarah Baartman (DC10)

District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



88.0 87.2 84.6 14 77.6 91.0 73.5



3.6 3.7 4.0 17 5.3 4.9 4.6


1 987.7 2 225.5 2 096.8 5 2 005.9 2 136.4


62.6 59.4 63.9 31 59.0 65.0 65.8


72.4 71.8 70.3 40 64.3 60.7



2.0 1.7 1.5 11 5.2 5.8 5.6 3.3 3.5 3.0


1.0 2.4 2.5 23 4.2 6.0 4.0 2.9


4.0 1.9 3.9 6 11.8 12.0 10.0 11.6 8.0 7.0


4.8 4.6 4.6 12 6.3 5.2


27.7 24.6 24.7 20.6 22.7


7.7 7.9 8.2 28 9.6 10.3 7.4


5.0 6.7 11.4 36 13.3 12.0 10.1 0


173.3 121.7 61.7 8 148.3 114.0 112.0 132.5 100 80.0


73.1 68.6 71.1 22 58.0 55.0 74.3 80.0 85.0


22.9 20.1 19.4 23 19.6 20.7


56.9 61.8 63.2 8 48.8 42.0 50.0 53.9 65.0 70.0


74.5 76.1 90.1 31 91.7 90.0 91.2 93.0 96.0


92.3 100.3 104.9 17 95.2 100.6


4.7 2.5 2.2 46 1.7 2.8 1.5 1.5 1.8 2.0


24.3 8.3 47 13.4 70.0 27.4 23.2 30.0 35.0


48.6 48.1 54.9 19 53.0 55.0 55.0 52.2 55.0


77.4 72.5 80.1 32 80.9 90.0 90.0 89.8 95.0 91.0


69.1 68.9 71.4 45 73.6 95.0 90.0 82.8 85.0 85.0

Reproductive health


31.2 37.3 41.7 40 56.3 42.0 44.0 54.5 60.0 64.0


36.1 36.2 39.0 41 39.4 60.0 46.8 55.0


5.8 5.9 4.6 10 6.0 6.4

HIV HIV testing coverage (including ANC)

25.8 30.4 37 36.0 32.1


11.3 12.0 20.8 45 33.6 38.0 38.4

Non-communicable diseases


20.7 17.8 17.6 15.7 3.5 13.9


3.8 4.3 1.3 1.2

Human Resources


27.0 28.5 30.4 13 23.8 26.9


30.4 29.0 28.0 9 33.7 29.4

288


288


District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



1 099.6 1 119.9 1 127.1 52 792.3 592.5



75.1 79.0 77.7 22 70.5 76.8

TB death rate (all TB) [Percentage] 8.5 8.4 7.4 22 9.3 5.9 7.4 6.0 5.0

TB defaulter rate (new smear positive) [Percentage]

7.6 7.7 7.5 38 7.7 7.0 6.8 5.8 6.0 5.5


77.0 78.1 81.7 10 77.0 78.9 82.0 77.9 82.0 83.0


88.7 94.4 92.0 33 92.3 92.8


84.9 84.3 87.9 11 89.1 78.9


44.6 48 36.3 31.8

Burden of disease


12.7 14.8 13.2 21 13.5 14.5


18.9 14.3 13.6 34 20.7 14.0


13.4 11.8 11.9 10 16.1 22.1


34.8 31.2 32.5 38 32.6 27.9


12.2 14.7 13.6 34 14.2 13.1


39.6 42.3 42.0 41 37.1 36.9










✦ PHC professional nurse clinical workload


✦ Percentage of years of life lost (YLLs) due to communicable, maternal, perinatal, nutrition causes.


✦ Infant 1st PCR test positive around 6 weeks rate


✦ Measles 2nd dose coverage)

✦ Male condom distribution coverage

✦ Hypertension prevalence rate (crude).

✦ Incidence (diagnosed cases) of TB (all types) (highest in the country)

Although the district recorded an improvement in the performance of several indicators over the past three years,


289


289

improvement strategies are needed urgently for the following indicators, especially when compared with the district ranking, 2014/15 provincial and national averages, and the 2014/15 and 2015/16 provincial and national targets. These indicators are:


✦ Inpatient bed utilisation rate

✦ OPD new client not referred rate

✦ Delivery by Caesarean section rate







✦ Cervical cancer screening coverage



✦ Mental health admission rate








Annual indicators for district: S Baartman: DC10

Valu

e

0

20

40

60

80

2006 2008 2010 2012 2014


3.5

4.0

4.5

5.0

5.5

6.0

2006 2008 2010 2012 2014


2

4

6

8

10

2006 2008 2010 2012 2014


2

4

6

8

2008 2010 2012 2014 2016


5

10

15

20

2008 2010 2012 2014 2016


5

6

7

2008 2010 2012 2014 2016

03_Crude death rate

1200

1400

1600

1800

2000

2200

2006 2008 2010 2012 2014


60

65

70

75

80

85

2008 2010 2012 2014 2016


60

65

70

2006 2008 2010 2012 2014


10

15

20

25

2006 2008 2010 2012 2014


8

9

10

2006 2008 2010 2012 2014

04_Deliv in fac <18

4

6

8

10

12

14

16

2006 2008 2010 2012 2014


50

100

150

2006 2008 2010 2012 2014


20

40

60

2008 2010 2012 2014 2016


18

20

22

24

26

28

2006 2008 2010 2012 2014

04_Stillbirth rate

30

40

50

60

2006 2008 2010 2012 2014


50

60

70

80

90

2008 2010 2012 2014 2016


60

80

100

2006 2008 2010 2012 2014


2

4

6

8

10

12

2006 2008 2010 2012 2014


10

15

20

25

2010 2012 2014 2016 2018



290


290


Annual indicators for district: Sarah Baartman (DC10)

Annual indicators for district: S Baartman: DC10Va

lue

20

30

40

50

2006 2008 2010 2012 2014


70

75

80

85

90

2006 2008 2010 2012 2014

07_Imm cov <1 yy

60

70

80

90

2006 2008 2010 2012 2014


0

10

20

30

40

50

2006 2008 2010 2012 2014


30

35

40

45

2006 2008 2010 2012 2014


6

7

8

9

2008 2010 2012 2014


0

2

4

6

2008 2010 2012 2014 2016


50

60

70

80

2006 2008 2010 2012 2014


8

9

10

11

2008 2010 2012 2014 2016

09_TB deaths all TB

600

800

1000

1200

1400

2006 2008 2010 2012 2014

09_TB inc all TB

70

75

80

2006 2008 2010 2012 2014


26

28

30

32

34

36

2010 2012 2014 2016 2018


10

15

20

25

30

35

2006 2008 2010 2012 2014


50

60

70

80

90

2008 2010 2012 2014


40

60

80

2008 2010 2012 2014 2016

10_TB/HIV on ART

30

35

40

45

2006 2008 2010 2012 2014


1

2

3

4

2010 2012 2014 2016 2018


22

24

26

28

30

2010 2012 2014 2016


28

29

30

31

32

33

2010 2012 2014 2016


13.0

13.5

14.0

14.5

2006 2008 2010 2012 2014

13_Garbage codes



291


291

Annual indicators for district: Sarah Baartman (DC10)

292


292


Amathole District Municipality (DC12) Naomi Massyn and Pamela Groenewald

Amathole is situated in the central part of the Eastern Cape Province and comprises four sub-districts: Mbhashe, Mnquma, Amahlathi and Nkonkobe. The district has a population of 896 875, with a population density of 41.5 persons per km2, and falls within Quintile 1, the lowest socio-economic group.

Population distribution, sub-district boundaries and health facility locations: Amathole (DC12)


<5 years

5-14

15-24

25-64

65+

Total 51.2%26.3%18.0%

22.2%

14.3%

13.2%

24.1%

17.5%

35.1%

78.8%

11.4%

20.6%

47.1%

42.2%

68.7%

33.0%

21.1%

18.4%

11.4%

14.1%43.7%26.4%15.9%

38.6%

66.9%

14.5%

11.7%

19.0%

13.3%

33.0%

74.1%

17.1%

38.3%

11.8%

69.3%

25.2%

14.1%

8.8%

EC, Amathole: DC12

Broad age.. 2008-10 2011-13

<5 years

5-14

15-24

25-64

65+

31.0%

36.1%

11.5%

21.9%

15.6%

32.3%

76.9%

11.8%

21.9%

30.9%

40.6%

70.1%

25.3%

17.4%

18.3%

9.5%

32.3%

47.7%

11.4%

13.6%

20.5%

15.0%

35.9%

76.7%

15.0%

26.0%

39.4%

67.5%

32.2%

11.4%

13.3%

11.5%

9.5%9.4%

9.2%

Rank.. 2008-10 2011-13

<5 y

ears

12345678910

5-14

12345678910

15-2

4

12345678910

25-6

4

12345678910

65+

12345678910

Poisonings (including herbal) (1.7%)

Protein-energy malnutrition (5.7%)

Birth asphyxia (3.7%)


Asthma (1.7%)Meningitis/encephalitis (2.1%)


HIV/AIDS (8.1%)

Tuberculosis (3.8%)Drowning (3.7%)



Epilepsy (2.0%)


Septicaemia (2.0%)


HIV/AIDS (7.0%)

Tuberculosis (2.5%)


Drowning (10.8%)


Meningitis/encephalitis (6.6%)Road injuries (8.8%)Diarrhoeal diseases (10.5%)


HIV/AIDS (10.6%)

Tuberculosis (12.7%) Drowning (13.9%)

Epilepsy (6.3%)

Asthma (2.7%)Accidental threats to breathing (3.7%)




HIV/AIDS (9.2%)

Tuberculosis (6.4%)

Epilepsy (3.3%)







HIV/AIDS (17.3%)


Epilepsy (3.1%)








Asthma (3.5%)


Meningitis/encephalitis (3.0%)Diabetes mellitus (2.3%)


Diarrhoeal diseases (6.1%)Cerebrovascular disease (3.5%)

Lower respiratory infections (7.6%)HIV/AIDS (19.7%)Tuberculosis (21.0%)

Epilepsy (2.4%)Asthma (2.8%)Interpersonal violence (2.9%)Diabetes mellitus (3.0%)

Hypertensive heart disease (3.6%)Diarrhoeal diseases (3.4%)



Oesophagus (3.7%)


Asthma (7.1%)






Tuberculosis (8.6%)

Oesophagus (3.6%)


Asthma (6.5%)COPD (6.4%)Diabetes mellitus (5.8%)





Prov, DistrictEC, Amathole: DC12

Show History

BroadcauseInjury

NCD

HIV and TB

Comm_mat_peri_nut



293


293


Percentage of deaths by broad cause and leading causes, 2008-2013: Amathole (DC12)

294


294



In the under-5-year age group, communicable diseases together with maternal, perinatal and nutritional conditions accounted for almost 70% of deaths. HIV and TB accounted for about 11% of deaths, and injuries for around 8%.

In the 5–14-year age group there were bigger differences in the proportions of broad causes between males and females. Communicable diseases together with maternal, perinatal and nutritional conditions accounted for 33.0% of deaths among females versus 25.2% of deaths among males; HIV and TB accounted for 20.6% mortality among females versus 17.1% among males; non-communicable diseases accounted for 24.1% (females) versus 19.0% (males); and injuries accounted for 22.2% (females) versus 38.6% (males).

In the 15–24-year age group, injury accounted for 66.9% of deaths among males and only 14.3% among females, while HIV and TB accounted for 47.1% of deaths among females.

In the 25–64-year age group, HIV and TB accounted for the largest proportion of deaths (42.2% among females and 38.3% among males). Deaths due to non-communicable diseases increased to 35.1% among females and 33.0% among males. Injuries accounted for a small proportion of deaths in this age group, with the percentage being much higher among males (14.5%) than females (4.3%).

In the 65-years-and-older age group, non-communicable diseases accounted for the highest proportion of deaths (78.8% among females and 74.1% among males). Communicable diseases together with maternal, perinatal and nutritional conditions accounted for around 12% of deaths. This was the only age group where deaths due to HIV and TB were higher among males than females.


In children under 5 years, deaths due to communicable diseases and maternal, perinatal and nutritional conditions decreased from 70.1% to 67.5% between 2008–2010 and 2011–2013; HIV and TB mortality decreased from 11.8% to 9.4%; and non-communicable disease mortality and injury-related deaths increased slightly. In the 5–14-year age group, deaths due to communicable diseases and maternal, perinatal and nutritional conditions increased, while HIV and TB mortality declined over this period. In the 15–24-year age group, injury-related deaths increased markedly from 36.1% to 47.7%, while deaths due to HIV and TB and communicable diseases together with maternal, perinatal and nutritional conditions declined. Not much change was observed in the 25–64-year age group, apart from a slight decrease in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions, and a slight increase in deaths due to non-communicable diseases. In the 65-years-and-older age group there was not much change in the broad cause groups over the period.


Under 5 years

Diarrhoeal diseases, lower respiratory infections, HIV and AIDS, protein-energy malnutrition and prematurity remained the leading causes of death between 2008–2010 and 2011–2013. Birth asphyxia and drowning moved up in the rankings, and TB moved down slightly. Mortality in this age group was still largely HIV-related.

5–14 years

The top four leading causes of death in this age group shifted from TB, drowning, HIV and AIDS and diarrhoea, to drowning, lower respiratory infections, diarrhoea and HIV and AIDS. Lower respiratory infections increased markedly, while TB decreased markedly.

15–24 years

Interpersonal violence, HIV and AIDS, and TB remained the three leading causes of death in this age group, followed by road injuries, lower respiratory infections, diarrhoea, epilepsy and meningitis.

25–64 years

HIV and AIDS, TB and lower respiratory infection remained the leading causes of death, accounting for almost 50% of deaths in this age group. Cerebrovascular disease, hypertensive heart disease, diarrhoea, diabetes mellitus, interpersonal violence, asthma and epilepsy appeared in the top 10 causes of death.

65 years and older

The top 10 leading causes remained the same over this period except for hypertensive heart disease, which moved above cerebrovascular disease in 2011–13. Tuberculosis, lower respiratory infection, asthma, chronic obstructive pulmonary disease, diabetes, oesophageal cancer, ischaemic heart disease and cardiomyopathy were the remaining leading causes.


295


295

Indicator performance: Amathole (DC12)

District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



83.1 84.6 86.7 12 77.6 91.0 73.5



5.5 5.6 5.5 25 5.3 4.9 4.6


1 880.8 1 948.2 1 844.1 32 2 005.9 2 136.4


59.5 59.1 59.0 40 59.0 65.0 65.8


74.6 72.9 74.8 44 64.3 60.7



8.6 5.3 3.0 28 5.2 5.8 5.6 3.3 3.5 3.0


6.6 6.1 2.6 26 4.2 6.0 4.0 2.9


18.1 8.7 14.1 37 11.8 12.0 10.0 11.6 8.0 7.0


7.9 7.1 6.5 43 6.3 5.2


13.2 14.9 17.9 20.6 22.7


11.8 11.7 11.3 49 9.6 10.3 7.4


10.7 10.4 10.8 31 13.3 12.0 10.1 0


18.6 86.3 58.8 5 148.3 114.0 112.0 132.5 100 80.0


65.8 68.7 73.3 15 58.0 55.0 74.3 80.0 85.0


18.2 17.1 13.4 2 19.6 20.7


37.7 46.2 54.3 36 48.8 42.0 50.0 53.9 65.0 70.0


61.9 89.4 95.9 14 91.7 90.0 91.2 93.0 96.0


121.2 125.6 121.8 6 95.2 100.6


3.2 2.4 1.9 39 1.7 2.8 1.5 1.5 1.8 2.0


11.5 14.2 38 13.4 70.0 27.4 23.2 30.0 35.0


52.7 55.7 73.6 3 53.0 55.0 55.0 52.2 55.0


65.2 69.6 86.6 22 80.9 90.0 90.0 89.8 95.0 91.0


62.9 64.8 74.8 35 73.6 95.0 90.0 82.8 85.0 85.0

Reproductive health


42.2 64.3 89.5 1 56.3 42.0 44.0 54.5 60.0 64.0


27.5 29.9 46.2 25 39.4 60.0 46.8 55.0


7.3 6.2 5.9 26 6.0 6.4


36.8 51.9 3 36.0 32.1


14.9 17.1 47.4 12 33.6 38.0 38.4



17.4 19.8 24.9 15.7 3.5 13.9


0.8 0.7 1.3 1.2

Human Resources


11.0 16.1 20.2 25 23.8 26.9


27.5 30.3 41.4 49 33.7 29.4

296


296


District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



582.2 647.2 651.5 25 792.3 592.5



61.8 61.4 68.3 43 70.5 76.8



7.2 8.8 5.7 29 7.7 7.0 6.8 5.8 6.0 5.5


72.8 71.9 78.6 24 77.0 78.9 82.0 77.9 82.0 83.0


91.9 92.5 94.2 20 92.3 92.8


67.3 84.2 84.8 20 89.1 78.9


36.0 33 36.3 31.8

Burden of disease


13.1 13.1 14.0 32 13.5 14.5


17.6 16.5 14.9 39 20.7 14.0


18.9 17.1 16.4 12 16.1 22.1


31.6 32.0 29.7 32 32.6 27.9


13.3 14.2 15.2 41 14.2 13.1


36.2 36.8 38.8 35 37.1 36.9






✦ Stillbirth in facility rate (second lowest)


✦ Vitamin A dose 12–59 months coverage (third highest in the country)

✦ Cervical cancer screening coverage (best in the country)

✦ HIV testing coverage including ANC


✦ OPD new client not referred rate (district hospitals)

✦ Inpatient crude death rate




Although the district recorded an improvement in the performance of several indicators over the past three years, improvement strategies are urgently needed for the following indicators, especially when compared with the district ranking, 2014/15 provincial and national averages, and the 2014/15 and 2015/16 provincial and national targets. These indicators are:


✦ Average length of stay (district hospitals)





297


297















Annual indicators for district: Amathole: DC12

Valu

e

0

20

40

60

80

2006 2008 2010 2012 2014


4.5

5.0

5.5

6.0

6.5

7.0

2006 2008 2010 2012 2014


4

6

8

10

12

2006 2008 2010 2012 2014


4

6

8

2008 2010 2012 2014 2016


10

15

20

25

2008 2010 2012 2014 2016


5.0

5.5

6.0

6.5

7.0

7.5

8.0

2008 2010 2012 2014 2016

03_Crude death rate

1400

1600

1800

2000

2006 2008 2010 2012 2014


50

55

60

65

70

75

2008 2010 2012 2014 2016


60

65

70

75

80

2006 2008 2010 2012 2014


5

10

15

20

2006 2008 2010 2012 2014


8

9

10

11

12

2006 2008 2010 2012 2014

04_Deliv in fac <18

10

12

14

16

2006 2008 2010 2012 2014


50

100

150

2006 2008 2010 2012 2014


20

40

60

2008 2010 2012 2014 2016


15

20

25

2006 2008 2010 2012 2014

04_Stillbirth rate

30

40

50

2006 2008 2010 2012 2014


70

80

90

2008 2010 2012 2014 2016


40

60

80

100

120

2006 2008 2010 2012 2014


2

4

6

8

10

12

2006 2008 2010 2012 2014


12

14

16

18

20

22

2010 2012 2014 2016 2018



298


298


Annual indicators for district: Amathole (DC12)

Annual indicators for district: Amathole: DC12Va

lue

10

20

30

40

50

60

70

2006 2008 2010 2012 2014


70

80

90

2006 2008 2010 2012 2014

07_Imm cov <1 yy

50

60

70

80

90

100

2006 2008 2010 2012 2014


0

20

40

60

80

2006 2008 2010 2012 2014


30

35

40

45

2006 2008 2010 2012 2014


6

7

8

2008 2010 2012 2014


6

7

8

9

10

11

2008 2010 2012 2014 2016


50

55

60

65

70

75

2006 2008 2010 2012 2014


8

9

10

11

2008 2010 2012 2014 2016

09_TB deaths all TB

400

500

600

700

800

900

2006 2008 2010 2012 2014

09_TB inc all TB

70

72

74

76

78

2006 2008 2010 2012 2014


25

30

35

40

45

50

2010 2012 2014 2016 2018


10

20

30

40

2006 2008 2010 2012 2014


50

60

70

80

90

2008 2010 2012 2014


40

60

80

2008 2010 2012 2014 2016

10_TB/HIV on ART

30

35

40

45

50

2006 2008 2010 2012 2014


0.8

0.9

1.0

1.1

1.2

1.3

2010 2012 2014 2016 2018


15

20

25

2010 2012 2014 2016


30

35

40

2010 2012 2014 2016


12

13

14

2006 2008 2010 2012 2014

13_Garbage codes



299


299

Annual indicators for district: Amathole (DC12)

300


300


Chris Hani District Municipality (DC13) Naomi Massyn and Pamela Groenewald

Chris Hani District is situated in the heart of the Eastern Cape Province. It comprises six sub-districts, namely Inxuba Yethemba, Lukhanji, Intsika Yethu, Emalahleni, Nngcobo and Sakhisizwe. The district has a population of 804 765, with a population density of 22.3 persons per km2, and falls into socio-economic Quintile 1, among the poorest districts.

Population distribution, sub-district boundaries and health facility locations: Chris Hani (DC13)


<5 years

5-14

15-24

25-64

65+

Total 48.3%25.3%21.9%

27.6%

13.1%

11.9%

19.0%

14.8%

35.0%

77.9%

17.9%

46.1%

38.8%

71.7%

35.5%

26.1%

21.7%

13.2%

9.5%

13.8%40.7%25.5%20.0%

41.2%

66.8%

13.8%

18.9%

12.5%

32.4%

71.7%

20.0%

11.4%

36.0%

72.0%

19.9%

17.8%

14.2%

9.4%

EC, C Hani: DC13

Broad age.. 2008-10 2011-13

<5 years

5-14

15-24

25-64

65+

33.3%

37.4%

18.9%

13.4%

31.9%

74.5%

20.5%

29.3%

36.1%

75.1%

27.4%

19.9%

23.1%

14.2%

9.0%

9.9%

38.2%

43.2%

10.4%

16.4%

19.0%

13.8%

35.8%

76.0%

17.4%

28.1%

38.8%

66.8%

25.4%

14.9%

15.1%

13.1%

8.8%

Rank.. 2008-10 2011-13

<5 y

ears

12345678910

5-14

12345678910

15-2

4

12345678910

25-6

4

12345678910

65+

12345678910

Poisonings (including herbal) (2.6%)Sepsis/other newborn infectious (2.0%)



Septicaemia (1.9%)


HIV/AIDS (6.8%)

Tuberculosis (3.2%)





Asthma (2.4%)



HIV/AIDS (5.6%)

Tuberculosis (2.6%)

Exposure to natural forces (3.6%)

Drowning (14.6%)

Epilepsy (3.5%)




HIV/AIDS (6.2%)



Drowning (17.4%)

Epilepsy (4.3%)Accidental threats to breathing (5.3%)Meningitis/encephalitis (5.8%)

Road injuries (8.6%)Diarrhoeal diseases (7.1%)



Epilepsy (2.8%)






Lower respiratory infections (7.5%)HIV/AIDS (13.7%)


Epilepsy (3.2%)









Asthma (2.6%)

Interpersonal violence (2.5%)Meningitis/encephalitis (2.5%)





Asthma (2.7%)

Interpersonal violence (2.8%)Diabetes mellitus (2.7%)


Ischaemic heart disease (2.9%)Diarrhoeal diseases (4.0%)Cerebrovascular disease (4.4%)


Oesophagus (3.6%)

Cardiomyopathy (5.4%)Asthma (6.6%)






Oesophagus (3.1%)

Cardiomyopathy (7.2%)Asthma (6.5%)






Prov, DistrictEC, C Hani: DC13

Show History

BroadcauseInjury

NCD

HIV and TB

Comm_mat_peri_nut



301


301


Percentage of deaths by broad cause and leading causes, 2008-2013: Chris Hani (DC13)

302


302



In the under-5-year age group, communicable diseases together with maternal, perinatal and nutritional conditions accounted for more than 70% of deaths. HIV and TB accounted for about 10% of deaths, and injuries for around 8%.

In the 5–14-year age group there were bigger differences in the proportions of broad causes between males and females. Communicable diseases together with maternal, perinatal and nutritional conditions accounted for 35.5% of deaths among females versus 19.9% of deaths among males, while injuries accounted for 27.6% of deaths among females versus 41.2% of deaths among males.

In the 15–24-year age group, injury accounted for 66.8% of deaths among males compared with only 13.1% among females, while HIV and TB accounted for 46.1% of deaths among females compared with only 11.4% among males. Communicable diseases together with maternal, perinatal and nutritional conditions accounted for 26.1% among female deaths and only 9.4% among male deaths.


In the 65-years-and-older age group, non-communicable diseases accounted for the highest proportion of deaths (77.9% among females and 71.7% among males). Communicable diseases together with maternal, perinatal and nutritional conditions accounted for more than 13% of deaths. This was the only age group where deaths due to HIV and TB were higher among males than females.


In children under 5 years, there was a marked decline in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions and HIV and TB between 2008–2010 and 2011–2013, while the proportion of deaths due to non-communicable diseases and injuries increased. In the 5–14-year age group, injury-related deaths increased, while deaths due to HIV, TB and communicable diseases together with maternal, perinatal and nutritional conditions declined over this period. In the 15–24-year age group, injury-related deaths increased slightly, while HIV, TB and communicable diseases together with maternal, perinatal and nutritional conditions declined. In the 25–64- year age group, a decrease was observed in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions, and a slight increase was observed in deaths due to TB, HIV and non-communicable diseases. In the 65-years-and-older age group there was not much change in the broad cause groups over the period.


Under 5 years

Diarrhoeal diseases, lower respiratory infections, prematurity, HIV and AIDS, protein-energy malnutrition, birth asphyxia and TB remained the leading causes of death between 2008–2010 and 2011–2013. Mortality in this age group was still largely HIV-related.

5–14 years

Drowning, lower respiratory infection, TB, HIV and AIDS, road injuries, diarrhoeal disease and meningitis remained the leading causes of death in this age group.

15–24 years

Interpersonal violence, HIV and AIDS, TB and lower respiratory infections remained the leading causes of death in this age group, followed by road injuries, meningitis, diarrhoea and epilepsy.

25 – 64 years

Tuberculosis, HIV and AIDS, lower respiratory infection, cerebrovascular disease and diarrhoea remained the leading causes of death, accounting for over the 50% of deaths in this age group. Ischaemic heart disease, interpersonal violence, diabetes mellitus, asthma and hypertensive heart disease also appeared in the top 10 causes of death.

65 years and older

The top 10 leading causes of death remained the same over this period. Cerebrovascular disease, hypertensive heart disease, lower respiratory infection and TB were the top causes. Asthma, diabetes, chronic obstructive pulmonary disease, ischaemic heart disease and oesophageal cancer were the remaining leading causes.


303


303

Indicator performance: Chris Hani (DC13)

District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



76.6 76.9 73.8 31 77.6 91.0 73.5



4.5 5.3 5.6 29 5.3 4.9 4.6


1 768.3 1 992.5 2 090.2 6 2 005.9 2 136.4


59.2 53.6 50.2 48 59.0 65.0 65.8


78.0 71.6 69.2 38 64.3 60.7



5.3 5.8 4.4 37 5.2 5.8 5.6 3.3 3.5 3.0


4.0 4.4 3.5 35 4.2 6.0 4.0 2.9


17.0 9.7 10.0 22 11.8 12.0 10.0 11.6 8.0 7.0


8.5 7.8 8.1 52 6.3 5.2


13.9 14.0 14.1 20.6 22.7


10.5 10.7 10.2 45 9.6 10.3 7.4


10.2 12.5 12.2 39 13.3 12.0 10.1 0


162.3 168.5 199.8 42 148.3 114.0 112.0 132.5 100 80.0


70.7 75.5 76.1 13 58.0 55.0 74.3 80.0 85.0


20.5 17.8 18.5 19 19.6 20.7


52.1 55.1 59.6 17 48.8 42.0 50.0 53.9 65.0 70.0


92.6 80.0 92.6 25 91.7 90.0 91.2 93.0 96.0


87.3 96.8 101.8 22 95.2 100.6


2.6 1.5 1.9 37 1.7 2.8 1.5 1.5 1.8 2.0


25.8 22.9 23 13.4 70.0 27.4 23.2 30.0 35.0


40.5 48.7 59.0 11 53.0 55.0 55.0 52.2 55.0


85.2 84.7 83.6 25 80.9 90.0 90.0 89.8 95.0 91.0


69.2 69.6 76.5 32 73.6 95.0 90.0 82.8 85.0 85.0

Reproductive health


61.3 75.5 77.8 6 56.3 42.0 44.0 54.5 60.0 64.0


36.7 38.2 43.5 29 39.4 60.0 46.8 55.0


5.3 4.7 6.0 28 6.0 6.4


37.8 42.5 9 36.0 32.1


25.1 26.4 34.7 29 33.6 38.0 38.4



20.6 14.1 16.8 15.7 3.5 13.9


1.5 2.1 1.3 1.2

Human Resources


22.7 21.7 21.7 19 23.8 26.9


25.2 25.1 26.9 15 33.7 29.4

304


304


District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



841.0 802.7 707.9 30 792.3 592.5



70.1 67.8 74.7 31 70.5 76.8

TB death rate (all TB) [Percentage] 13.0 12.1 10.7 38 9.3 5.9 7.4 6.0 5.0TB defaulter rate (new smear positive) [Percentage]

6.9 7.2 6.5 35 7.7 7.0 6.8 5.8 6.0 5.5


70.5 67.5 76.6 31 77.0 78.9 82.0 77.9 82.0 83.0


89.7 93.5 94.9 14 92.3 92.8


71.2 88.1 90.7 8 89.1 78.9


36.9 38 36.3 31.8

Burden of disease


13.5 13.5 13.6 25 13.5 14.5


14.4 14.4 12.0 30 20.7 14.0


22.9 18.9 17.4 15 16.1 22.1


30.5 30.5 31.9 34 32.6 27.9


11.7 13.1 13.6 36 14.2 13.1


34.9 37.6 37.1 30 37.1 36.9




The district performed very well with regard to some indicators and the performance is ranked among the 10 best in the country in the last reporting period for the following indicators:



✦ HIV testing coverage including ANC

✦ TB/HIV co-infected client on ART rate

The performance for some indicators, however, is ranked among the 10 worst in the country. These indicators include:

✦ Inpatient bed utilisation rate

✦ Inpatient crude death rate (highest in the country)


Although the district recorded an improvement in the performance of several indicators over the past three years, improvement strategies are urgently needed for the following indicators especially when compared to the district ranking, 2014/15 provincial and the national averages and the 2014/15 and 2015/16 provincial and the national targets. These are:

✦ Child under 5 years diarrhoea case fatality rate












305


305














✦ Percentage of YLLs due to HIV and TB


Annual indicators for district: C Hani: DC13

Valu

e

0

20

40

60

80

2006 2008 2010 2012 2014


4.5

5.0

5.5

6.0

2006 2008 2010 2012 2014


4

6

8

10

12

2006 2008 2010 2012 2014


3

4

5

6

7

8

2008 2010 2012 2014 2016


10

12

14

16

18

20

22

2008 2010 2012 2014 2016


5

6

7

8

2008 2010 2012 2014 2016

03_Crude death rate

1200

1400

1600

1800

2000

2006 2008 2010 2012 2014


60

65

70

75

2008 2010 2012 2014 2016


50

55

60

65

70

2006 2008 2010 2012 2014


5

10

15

20

2006 2008 2010 2012 2014


8

9

10

11

12

2006 2008 2010 2012 2014

04_Deliv in fac <18

5

10

15

2006 2008 2010 2012 2014


50

100

150

200

2006 2008 2010 2012 2014


20

40

60

2008 2010 2012 2014 2016


18

20

22

24

26

28

2006 2008 2010 2012 2014

04_Stillbirth rate

30

40

50

60

2006 2008 2010 2012 2014


70

80

90

100

110

120

2008 2010 2012 2014 2016


50

60

70

80

90

100

2006 2008 2010 2012 2014


5

10

15

2006 2008 2010 2012 2014


15

20

25

2010 2012 2014 2016 2018



306


306


Annual indicators for district: Chris Hani (DC13)

Annual indicators for district: C Hani: DC13Va

lue

20

30

40

50

60

2006 2008 2010 2012 2014


65

70

75

80

85

90

2006 2008 2010 2012 2014

07_Imm cov <1 yy

60

70

80

90

100

2006 2008 2010 2012 2014


0

20

40

60

80

2006 2008 2010 2012 2014


30

35

40

45

2006 2008 2010 2012 2014


5

6

7

8

2008 2010 2012 2014


5.0

5.5

6.0

6.5

7.0

7.5

2008 2010 2012 2014 2016


50

55

60

65

70

75

2006 2008 2010 2012 2014


8

9

10

11

12

13

2008 2010 2012 2014 2016

09_TB deaths all TB

600

700

800

900

2006 2008 2010 2012 2014

09_TB inc all TB

68

70

72

74

76

78

2006 2008 2010 2012 2014


30

35

40

2010 2012 2014 2016 2018


10

15

20

25

30

35

2006 2008 2010 2012 2014


50

60

70

80

90

2008 2010 2012 2014


40

60

80

2008 2010 2012 2014 2016

10_TB/HIV on ART

32

34

36

38

2006 2008 2010 2012 2014


1.0

1.2

1.4

1.6

1.8

2.0

2010 2012 2014 2016 2018


22

23

24

25

26

27

2010 2012 2014 2016


26

28

30

32

34

2010 2012 2014 2016


12.5

13.0

13.5

14.0

14.5

2006 2008 2010 2012 2014

13_Garbage codes



307


307

Annual indicators for district: Chris Hani (DC13)

308


308


Joe Gqabi District Municipality (DC 14) Naomi Massyn and Pamela Groenewald

Joe Gqabi District is located in the Eastern Cape Province, bordering the Free State Province and Lesotho to the north. It consists of three sub-districts, namely Elundini, Maletswai and Senqu. The population stands at 354 819, with a population density of 13.8 persons per km2. The district falls into socio-economic Quintile 1, among the poorest districts.

Population distribution, sub-district boundaries and health facility locations: Joe Gqabi (DC 14)


<5 years

5-14

15-24

25-64

65+

Total 47.1%28.5%20.6%

24.0%

13.1%

24.3%

14.3%

32.8%

78.8%

14.1%

21.2%

50.2%

43.4%

70.2%

30.5%

22.5%

20.1%

12.1%

11.4%39.4%28.8%20.4%

39.7%

57.6%

11.5%

14.0%

16.7%

30.6%

71.1%

15.9%

17.2%

40.3%

11.7%

75.9%

30.4%

17.6%

14.2%

EC, Joe Gqabi: DC14

Broad age.. 2008-10 2011-13

<5 years

5-14

15-24

25-64

65+

34.9%

31.0%

18.7%

15.6%

29.7%

74.5%

12.1%

17.5%

35.1%

42.8%

75.5%

28.8%

18.2%

21.0%

13.2%

30.7%

39.0%

18.0%

15.3%

34.1%

76.4%

12.9%

18.9%

33.0%

40.5%

69.9%

32.4%

12.7%

16.0%

12.8%

9.4%

9.6%

Rank.. 2008-10 2011-13

<5 y

ears

12345678910

5-14

12345678910

15-2

4

12345678910

25-6

4

12345678910

65+

12345678910

Drowning (1.9%)


Birth asphyxia (2.8%)Other respiratory (3.2%)Preterm birth complications (4.9%)




Drowning (3.2%)





Septicaemia (4.3%)


HIV/AIDS (10.4%)

Tuberculosis (3.1%)


Drowning (17.8%)

Other respiratory (4.2%)Mechanical forces (4.5%)Meningitis/encephalitis (6.0%)






Drowning (19.2%)

Epilepsy (4.3%)





HIV/AIDS (14.5%)

Tuberculosis (8.6%)









Drowning (2.4%)

Epilepsy (3.8%)





Road injuries (7.5%)Lower respiratory infections (5.9%)

HIV/AIDS (23.0%)




Meningitis/encephalitis (2.2%)Hypertensive heart disease (2.1%)






Interpersonal violence (2.4%)Road injuries (2.4%)















Tuberculosis (8.3%)

Other circulatory diseases (3.0%)Asthma (2.6%)

COPD (4.1%)Nephritis/nephrosis (3.2%)





Tuberculosis (6.4%)

Prov, DistrictEC, Joe Gqabi: DC14

Show History

BroadcauseInjury

NCD

HIV and TB

Comm_mat_peri_nut



309


309


Percentage of deaths by broad cause and leading causes, 2008-2013: Joe Gqabi (DC 14)

310


310



In the under-5-year age group, communicable diseases together with maternal, perinatal and nutritional conditions accounted for more than 70% of deaths. HIV and TB accounted for about 14% of deaths, and injuries for around 8%.

In the 5–14-year age group there were bigger differences in the proportions of broad causes between females and males. Injuries accounted for 24.0% of deaths among females and 39.7% of deaths among males, while non-communicable diseases accounted for 24.3% of deaths among females and 14.0% of deaths among males.

In the 15–24-year age group, injury accounted for 57.6% of deaths among males compared with only 13.1% among females, while HIV and TB accounted for 50.2% of deaths among females and only 17.2% among males.


In the 65-years-and-older age group, non-communicable diseases accounted for the highest proportion of deaths (78.8% among females and 71.1% among males). Communicable diseases together with maternal, perinatal and nutritional conditions accounted for 12.1% of deaths among females and 14.2% among males.


In children under 5 years, there was a marked decline in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions, and an increase in injury-related deaths. In the 5–14-year age group, there was a slight increase in deaths due to HIV and TB and communicable diseases together with maternal, perinatal and nutritional conditions, and a decline in injury-related deaths. In the 15–24-year age group, mortality due to HIV and TB and communicable diseases together with maternal, perinatal and nutritional conditions decreased slightly, while injury-related deaths increased. In the 25–64-year age group, a decrease was observed in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions and TB and HIV, while an increase was observed in non-communicable disease mortality. There was not much change in the broad cause groups over the period in the 65-years-and-older age group.


Under 5 years

Diarrhoeal diseases, lower respiratory infections, protein-energy malnutrition, HIV and AIDS, and prematurity, remained the leading causes of death between 2008–2010 and 2011–2013. Tuberculosis and other respiratory conditions moved down in the ranking, while birth asphyxia and drowning moved up. Mortality in this age group was still largely HIV-related.

5–14 years

Drowning, HIV and AIDS and diarrhoeal disease remained the leading causes of death in this age group. Tuberculosis moved down in the ranking, while road injuries moved up. Lower respiratory infections, meningitis and epilepsy were among the leading causes of death.

15–24 years

HIV and AIDS, interpersonal violence, and accidental threats to breathing remained the leading causes of death in this age group, followed by road injuries, lower respiratory infection, epilepsy, meningitis and drowning.

25–64 years

HIV and AIDS, TB and lower respiratory infection remained the leading causes of death over this period, accounting for almost 50% of deaths in this age group. Cerebrovascular disease, hypertensive heart disease, diarrhoea, diabetes mellitus, ischaemic heart disease, interpersonal violence and road injuries also appeared in the top 10 causes of death.

65 years and older

Cerebrovascular disease and hypertensive heart disease remained the top two leading causes. Lower respiratory infections, ischaemic heart disease, TB, diabetes mellitus, chronic obstructive pulmonary disease, nephritis/nephrosis, other circulatory diseases and asthma were the remaining leading causes.


311


311

Indicator performance: Joe Gqabi (DC 14)

District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



83.2 79.2 72.0 34 77.6 91.0 73.5



5.3 5.7 5.6 27 5.3 4.9 4.6


2 120.6 1 805.7 2 040.4 12 2 005.9 2 136.4


68.5 70.7 70.4 16 59.0 65.0 65.8


76.0 76.4 74.3 43 64.3 60.7



6.4 6.0 3.0 27 5.2 5.8 5.6 3.3 3.5 3.0


9.3 10.5 0.5 7 4.2 6.0 4.0 2.9


14.3 16.0 11.3 28 11.8 12.0 10.0 11.6 8.0 7.0


7.7 7.2 6.7 48 6.3 5.2


10.3 9.5 12.0 20.6 22.7


10.9 12.4 11.7 51 9.6 10.3 7.4


10.0 9.3 8.9 15 13.3 12.0 10.1 0


140.3 105.2 104.6 20 148.3 114.0 112.0 132.5 100 80.0


89.9 89.5 72.8 17 58.0 55.0 74.3 80.0 85.0


17.6 16.7 16.5 12 19.6 20.7


44.0 47.0 50.9 41 48.8 42.0 50.0 53.9 65.0 70.0


77.6 88.3 96.0 13 91.7 90.0 91.2 93.0 96.0


101.2 93.9 105.0 16 95.2 100.6


1.6 0.9 0.9 2 1.7 2.8 1.5 1.5 1.8 2.0


34.3 33.5 11 13.4 70.0 27.4 23.2 30.0 35.0


39.2 39.3 45.6 41 53.0 55.0 55.0 52.2 55.0


65.6 63.9 73.9 49 80.9 90.0 90.0 89.8 95.0 91.0


57.7 61.7 69.0 48 73.6 95.0 90.0 82.8 85.0 85.0

Reproductive health


53.7 56.1 55.6 25 56.3 42.0 44.0 54.5 60.0 64.0


32.4 30.4 34.6 48 39.4 60.0 46.8 55.0


5.8 7.7 6.2 33 6.0 6.4


28.2 32.1 30 36.0 32.1


17.4 19.7 30.8 34 33.6 38.0 38.4



30.2 26.0 17.2 15.7 3.5 13.9


1.3 1.3 1.3 1.2

Human Resources


44.8 34.2 31.2 15 23.8 26.9


33.3 34.8 40.9 48 33.7 29.4

312


312


District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



740.3 651.6 674.7 26 792.3 592.5



68.1 67.4 68.3 42 70.5 76.8



7.6 8.4 6.3 34 7.7 7.0 6.8 5.8 6.0 5.5


69.8 66.3 73.1 39 77.0 78.9 82.0 77.9 82.0 83.0


88.4 92.1 95.7 11 92.3 92.8


64.9 83.4 93.0 5 89.1 78.9


36.0 34 36.3 31.8

Burden of disease


12.1 12.4 13.0 18 13.5 14.5


27.8 29.7 29.7 49 20.7 14.0


24.9 18.6 19.6 21 16.1 22.1


31.7 34.5 32.9 39 32.6 27.9


10.4 11.2 12.4 24 14.2 13.1


33.0 35.7 35.1 24 37.1 36.9





✦ Child under 5 years pneumonia case fatality rate




✦ OPD new client not referred rate for district hospitals

✦ Inpatient crude death rate)

✦ Delivery in facility under 18 years rate (second highest in the country)





✦ TB death rate for all TB (third highest in the country)

✦ Percentage of deaths ill-defined





313


313








✦ Vitamin A dose 12–59 months coverage (annualised)













Annual indicators for district: Joe Gqabi: DC14

Valu

e

0

20

40

60

80

2006 2008 2010 2012 2014


4.5

5.0

5.5

6.0

2006 2008 2010 2012 2014


5

10

15

2006 2008 2010 2012 2014


0

2

4

6

8

10

12

2008 2010 2012 2014 2016


15

20

25

2008 2010 2012 2014 2016


5.0

5.5

6.0

6.5

7.0

7.5

2008 2010 2012 2014 2016

03_Crude death rate

1200

1400

1600

1800

2000

2006 2008 2010 2012 2014


60

65

70

75

2008 2010 2012 2014 2016


60

65

70

75

80

85

90

2006 2008 2010 2012 2014


10

15

20

2006 2008 2010 2012 2014


8

9

10

11

12

13

2006 2008 2010 2012 2014

04_Deliv in fac <18

5

10

15

20

2006 2008 2010 2012 2014


50

100

150

200

2006 2008 2010 2012 2014


20

40

60

80

2008 2010 2012 2014 2016


15

20

25

2006 2008 2010 2012 2014

04_Stillbirth rate

20

30

40

50

2006 2008 2010 2012 2014


70

80

90

2008 2010 2012 2014 2016


40

60

80

100

120

2006 2008 2010 2012 2014


5

10

15

2006 2008 2010 2012 2014


15

20

25

30

35

2010 2012 2014 2016 2018



314


314


Annual indicators for district: Joe Gqabi (DC 14)

Annual indicators for district: Joe Gqabi: DC14Va

lue

20

30

40

50

2006 2008 2010 2012 2014


65

70

75

80

85

90

2006 2008 2010 2012 2014

07_Imm cov <1 yy

50

60

70

80

90

100

2006 2008 2010 2012 2014


0

10

20

30

40

50

2006 2008 2010 2012 2014


30

35

40

45

2006 2008 2010 2012 2014


6.0

6.5

7.0

7.5

8.0

8.5

2008 2010 2012 2014


6.0

6.5

7.0

7.5

2008 2010 2012 2014 2016


50

55

60

65

70

75

2006 2008 2010 2012 2014


8

10

12

14

2008 2010 2012 2014 2016

09_TB deaths all TB

400

600

800

2006 2008 2010 2012 2014

09_TB inc all TB

66

68

70

72

74

76

78

2006 2008 2010 2012 2014


26

28

30

32

34

36

2010 2012 2014 2016 2018


10

15

20

25

30

35

2006 2008 2010 2012 2014


50

60

70

80

90

2008 2010 2012 2014


40

60

80

2008 2010 2012 2014 2016

10_TB/HIV on ART

32

34

36

38

2006 2008 2010 2012 2014


1.05

1.10

1.15

1.20

1.25

1.30

2010 2012 2014 2016 2018


25

30

35

40

45

2010 2012 2014 2016


30

32

34

36

38

40

2010 2012 2014 2016


12

13

14

2006 2008 2010 2012 2014

13_Garbage codes



315


315

Annual indicators for district: Joe Gqabi (DC 14)

316


316


OR Tambo District Municipality (DC15) Naomi Massyn and Pamela Groenewald

OR Tambo District is the most populous of the six district municipalities in the Eastern Cape Province, with a population of 1 366 244 and a population density of 113.0 persons per km2. The district covers about 80% of what used to be the homeland Transkei and includes five sub-districts: King Sabata Dalindyebo, Nyandeni, Mhlontlo, Port St Johns and Ingquza Hill. The district falls into socio-economic Quintile 1, among the poorest districts.

Population distribution, sub-district boundaries and health facility locations: OR Tambo (DC15)


<5 years

5-14

15-24

25-64

65+

Total 40.9%33.7%20.3%

22.2%

14.3%

12.9%

24.4%

16.8%

28.6%

72.2%

12.1%

24.2%

45.2%

48.6%

11.4%

68.0%

29.3%

23.7%

18.6%

13.8%

16.0%34.3%32.7%17.0%

31.4%

61.4%

14.6%

19.4%

16.2%

27.5%

65.7%

11.4%

24.1%

12.6%

44.0%

17.2%

68.4%

25.2%

14.0%

13.3%

8.8%

9.8%

EC, OR Tambo: DC15

Broad age.. 2008-10 2011-13

<5 years

5-14

15-24

25-64

65+

28.1%

34.5%

20.8%

16.2%

26.8%

67.6%

22.1%

29.5%

44.9%

14.3%

72.4%

28.9%

19.9%

19.8%

15.0%

8.5%

26.6%

40.4%

13.0%

22.2%

16.8%

29.3%

71.4%

13.0%

25.7%

28.9%

47.4%

13.3%

64.1%

25.5%

13.9%

12.5%

12.3%

9.9%

Rank.. 2008-10 2011-13

<5 y

ears

12345678910

5-14

12345678910

15-2

4

12345678910

25-6

4

12345678910

65+

12345678910

Sepsis/other newborn infectious (1.9%)Drowning (1.7%)



Septicaemia (2.1%)Meningitis/encephalitis (3.0%)



Poisonings (including herbal) (2.6%)Drowning (2.1%)


Preterm birth complications (3.7%)Septicaemia (2.7%)Meningitis/encephalitis (2.6%)



Exposure to natural forces (3.6%)Drowning (6.4%)






HIV/AIDS (8.2%)



Drowning (8.9%)

Epilepsy (3.2%)Accidental threats to breathing (3.5%)Meningitis/encephalitis (5.2%)













Drowning (2.6%)








HIV/AIDS (15.7%)










Interpersonal violence (2.2%)Mechanical forces (2.1%)


Nephritis/nephrosis (2.2%)Diabetes mellitus (2.3%)

Diarrhoeal diseases (3.6%)Cerebrovascular disease (3.7%)Lower respiratory infections (5.0%)


Oesophagus (3.7%)Cardiomyopathy (3.3%)

Asthma (4.1%)






Oesophagus (3.7%)Cardiomyopathy (3.6%)

Asthma (3.1%)







Prov, DistrictEC, OR Tambo: DC15

Show History

BroadcauseInjury

NCD

HIV and TB

Comm_mat_peri_nut



317


317


Percentage of deaths by broad cause and leading causes, 2008-2013: OR Tambo (DC15)

318


318



In the under-5-year age group, communicable diseases together with maternal, perinatal and nutritional conditions accounted for about 68% of deaths. HIV and TB accounted for about 12% of deaths, and injuries for around 9%.

In the 5–14-year age group, there were bigger differences in the proportions of broad causes between males and females, with injuries accounting for 22.2% of deaths among females and 31.4% of deaths among males. HIV and TB accounted for 24% of deaths in this age group.

In the 15–24-year age group, injury accounted for 61.4% of deaths among males compared with only 14.3% of deaths among females, while HIV and TB accounted for 45.2% of deaths among females compared with 12.6% among males. Non-communicable diseases accounted for around16% of deaths in this age group.

In the 25–64-year age group, HIV and TB accounted for the largest proportion of deaths (44.0% among males and 48.6% among females). Deaths due to non-communicable diseases increased to 28.6% among females and 27.5% among males. Injuries accounted for a small proportion of deaths in this age group, with the percentage being much higher among males (14.6%) than females (4.2%).

In the 65-years-and-older age group, non-communicable diseases accounted for the highest proportion of deaths (72.2% among females and 65.7% among males). Communicable diseases together with maternal, perinatal and nutritional conditions accounted for around 13% of deaths. HIV and TB deaths were higher among males than females.


In children under 5 years, there was a marked decline in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions (from 72.4% to 64.1%), and an increase in injury-related deaths. In the 5–14-year age group, there was a slight increase in deaths due to HIV and TB and non-communicable diseases, and a slight decline in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions and injuries. In the 15–24-year age group, deaths due to HIV and TB and communicable diseases together with maternal, perinatal and nutritional conditions decreased slightly, while injury-related deaths increased (from 34.5% to 40.4%). In the 25–64-year age group, a decrease was observed in deaths due to communicable diseases together with maternal, perinatal and nutritional conditions, and an increase was observed in HIV and TB mortality (from 44.9% to 47.4%). In the 65-years-and-older age group there was not much change in the broad cause groups over the period.


Under 5 years

Diarrhoeal diseases, lower respiratory infections, protein-energy malnutrition, HIV and AIDS, TB, prematurity, septicaemia and meningitis remained the leading causes of death between 2008–2010 and 2011–2013. Birth asphyxia did not appear among the leading causes. Mortality in this age group was still largely HIV-related.

5–14 years

Tuberculosis, HIV and AIDS, drowning, diarrhoeal disease and road injuries remained the leading causes of death in this age group. Meningitis moved down in the ranking, while drowning moved up. Meningitis, accidental threats to breathing and epilepsy were among the leading causes.

15–24 years

HIV and AIDS, interpersonal violence, TB, accidental threats to breathing and road injuries remained the leading causes of death in this age group, followed by mechanical forces, lower respiratory infection, meningitis, diarrhoea and drowning.

25–64 years

HIV and AIDS, TB, and lower respiratory infection remained the leading causes of death over this period, accounting for almost 50% of deaths in this age group. Cerebrovascular disease, diarrhoea, road injuries, diabetes mellitus, nephritis /nephrosis and interpersonal violence also appeared in the top 10 causes of death.

65 years and older

Cerebrovascular disease, TB, hypertensive heart disease, lower respiratory infections, diabetes mellitus and chronic obstructive pulmonary disease remained the top leading causes. Oesophageal cancer, cardiomyopathy, diarrhoea and asthma were the remaining leading causes.


319


319

Indicator performance: OR Tambo (DC15)

District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



83.5 78.6 81.7 21 77.6 91.0 73.5



5.5 7.1 6.4 49 5.3 4.9 4.6


1 823.8 1 915.8 1 987.5 19 2 005.9 2 136.4


59.4 58.8 55.5 44 59.0 65.0 65.8


48.1 56.9 52.0 20 64.3 60.7



15.1 14.7 9.6 52 5.2 5.8 5.6 3.3 3.5 3.0


8.6 9.4 5.3 48 4.2 6.0 4.0 2.9


21.4 21.9 11.6 29 11.8 12.0 10.0 11.6 8.0 7.0


8.5 7.8 7.3 50 6.3 5.2


18.8 22.0 21.1 20.6 22.7


12.9 12.2 11.5 50 9.6 10.3 7.4


20.3 13.3 13.7 45 13.3 12.0 10.1 0


68.5 229.7 198.5 41 148.3 114.0 112.0 132.5 100 80.0


31.8 31.0 40.7 49 58.0 55.0 74.3 80.0 85.0


28.4 25.6 23.9 38 19.6 20.7


31.5 34.4 41.8 51 48.8 42.0 50.0 53.9 65.0 70.0


86.2 69.2 86.6 43 91.7 90.0 91.2 93.0 96.0


65.9 77.3 83.8 48 95.2 100.6


3.4 1.7 1.5 21 1.7 2.8 1.5 1.5 1.8 2.0


19.8 12.9 42 13.4 70.0 27.4 23.2 30.0 35.0


28.7 36.2 50.0 30 53.0 55.0 55.0 52.2 55.0


60.1 58.0 74.9 48 80.9 90.0 90.0 89.8 95.0 91.0


60.8 59.6 74.0 38 73.6 95.0 90.0 82.8 85.0 85.0

Reproductive health


21.3 27.2 51.8 28 56.3 42.0 44.0 54.5 60.0 64.0


26.7 29.2 40.0 39 39.4 60.0 46.8 55.0


6.6 5.7 5.5 21 6.0 6.4


35.2 40.8 14 36.0 32.1


21.9 23.0 41.2 19 33.6 38.0 38.4



33.6 29.1 14.8 15.7 3.5 13.9


0.6 0.7 1.3 1.2

Human Resources


26.9 36.5 24.7 10 23.8 26.9


45.1 47.9 45.2 50 33.7 29.4

320


320


District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target

Category Indicator 2011 2012 2013 2014 2013 2013 2013 2014 2013 2013 2014TB case finding Incidence (diagnosed cases)

of TB - all types [Cases per 100 000 population]

969.8 875.6 764.1 35 792.3 592.5



73.6 72.6 71.6 36 70.5 76.8

TB death rate (all TB) [Percentage]

13.8 13.7 11.4 40 9.3 5.9 7.4 6.0 5.0


4.5 4.7 5.3 26 7.7 7.0 6.8 5.8 6.0 5.5


71.3 72.0 76.2 32 77.0 78.9 82.0 77.9 82.0 83.0


88.0 88.6 89.5 46 92.3 92.8


58.5 89.7 93.4 3 89.1 78.9


32.4 23 36.3 31.8

Burden of disease


12.0 13.4 13.9 30 13.5 14.5


35.1 33.6 31.7 50 20.7 14.0


19.9 16.9 16.3 11 16.1 22.1


38.2 38.9 37.4 48 32.6 27.9


12.3 14.6 16.3 46 14.2 13.1


29.6 29.7 29.9 13 37.1 36.9




The district performed very well with regard to the PHC doctor clinical workload and TB/HIV co-infected client on ART rate and the performance ranked among the 10 best in the country in the last reporting period.

The performance for some indicators, however, is ranked among the 10 worst in the country. These indicators were:



✦ Child under 5 years diarrhoea case fatality rate (highest in the country)


✦ Inpatient crude death rate (third highest in the country)

✦ Delivery in facility under 18 years rate (third highest in the country)



✦ Antenatal 1st visit before 20 weeks rate (second lowest in the country)




✦ PHC professional nurse clinical workload (third highest in the country)


✦ Percentage of deaths ill-defined (third highest in the country)

✦ Percentage of years of life los (YLLs) due to HIV and TB



321


321





✦ Child under 5 years diarrhoea, pneumonia and severe acute malnutrition case fatality rate


























Annual indicators for district: OR Tambo: DC15

Valu

e

0

20

40

60

80

2006 2008 2010 2012 2014


4

5

6

7

8

9

2006 2008 2010 2012 2014


5

10

15

20

25

2006 2008 2010 2012 2014


5

10

15

20

2008 2010 2012 2014 2016


15

20

25

30

2008 2010 2012 2014 2016


5

6

7

8

2008 2010 2012 2014 2016

03_Crude death rate

1400

1600

1800

2000

2006 2008 2010 2012 2014


40

50

60

2008 2010 2012 2014 2016


45

50

55

60

65

70

2006 2008 2010 2012 2014


10

15

20

2006 2008 2010 2012 2014


8

10

12

14

2006 2008 2010 2012 2014

04_Deliv in fac <18

10

12

14

16

18

20

2006 2008 2010 2012 2014


50

100

150

200

2006 2008 2010 2012 2014


20

40

60

2008 2010 2012 2014 2016


20

22

24

26

28

30

2006 2008 2010 2012 2014

04_Stillbirth rate

20

30

40

50

2006 2008 2010 2012 2014


60

70

80

90

2008 2010 2012 2014 2016


50

60

70

80

90

100

2006 2008 2010 2012 2014


2

4

6

8

10

12

2006 2008 2010 2012 2014


14

16

18

20

22

2010 2012 2014 2016 2018



322


322


Annual indicators for district: OR Tambo (DC15)

Annual indicators for district: OR Tambo: DC15Va

lue

10

20

30

40

50

2006 2008 2010 2012 2014


60

70

80

90

2006 2008 2010 2012 2014

07_Imm cov <1 yy

60

80

100

120

140

2006 2008 2010 2012 2014


0

10

20

30

40

50

2006 2008 2010 2012 2014


20

25

30

35

40

45

2006 2008 2010 2012 2014


4

5

6

7

8

2008 2010 2012 2014


5.5

6.0

6.5

7.0

7.5

2008 2010 2012 2014 2016


40

50

60

70

2006 2008 2010 2012 2014


8

10

12

14

2008 2010 2012 2014 2016

09_TB deaths all TB

600

700

800

900

1000

2006 2008 2010 2012 2014

09_TB inc all TB

70

72

74

76

78

2006 2008 2010 2012 2014


30

35

40

2010 2012 2014 2016 2018


10

20

30

40

2006 2008 2010 2012 2014


40

50

60

70

80

90

2008 2010 2012 2014


20

40

60

80

2008 2010 2012 2014 2016

10_TB/HIV on ART

26

28

30

32

34

36

2006 2008 2010 2012 2014


0.6

0.8

1.0

1.2

2010 2012 2014 2016 2018


25

30

35

2010 2012 2014 2016


30

35

40

45

2010 2012 2014 2016


11

12

13

14

2006 2008 2010 2012 2014

13_Garbage codes



323


323

Annual indicators for district: OR Tambo (DC15)

324


324


Alfred Nzo District Municipality (DC44) Naomi Massyn and Pamela Groenewald

Alfred Nzo District is located in the north-eastern corner of the Eastern Cape Province, and has a population of 828 711, with a population density of 77.2 people per km2. The district comprises Maluti and uMzimvubu sub-districts and falls within socio-economic Quintile 1, among the poorest districts.

Population distribution, sub-district boundaries and health facility locations: Alfred Nzo (DC44)


<5 years

5-14

15-24

25-64

65+

Total 41.9%29.0%25.4%

20.3%

11.2%

17.5%

17.3%

29.4%

72.7%

21.2%

45.4%

43.3%

76.8%

41.0%

26.1%

24.3%

16.6%

9.6%

11.5%34.1%30.8%23.7%

28.5%

55.9%

24.5%

13.7%

26.9%

65.0%

15.2%

18.0%

41.6%

14.7%

73.5%

31.7%

12.4%

21.0%

17.5%

9.9%

EC, A Nzo: DC44

Broad age.. 2008-10 2011-13

<5 years

5-14

15-24

25-64

65+

26.5%

31.1%

22.0%

17.0%

29.2%

69.6%

11.7%

16.7%

29.5%

38.8%

71.9%

34.8%

22.4%

25.3%

17.1%

22.9%

33.1%

20.8%

13.4%

26.4%

69.6%

19.3%

38.1%

47.8%

11.5%

79.2%

37.1%

15.4%

18.4%

16.7%

Rank.. 2008-10 2011-13

<5 y

ears

12345678910

5-14

12345678910

15-2

4

12345678910

25-6

4

12345678910

65+

12345678910

Poisonings (including herbal) (2.1%)



Other digestive (1.6%)




HIV/AIDS (7.2%)

Tuberculosis (4.7%)

Other perinatal conditions (1.9%)Drowning (1.8%)






Drowning (7.7%)Epilepsy (7.5%)

Other respiratory (2.9%)Accidental threats to breathing (3.0%)




HIV/AIDS (10.0%)

Tuberculosis (7.4%)Drowning (6.5%)Epilepsy (6.1%)

Other respiratory (3.2%)Septicaemia (2.0%)











HIV/AIDS (11.6%)


Drowning (2.0%)

















Other respiratory (2.0%)Interpersonal violence (1.9%)

Meningitis/encephalitis (2.9%)Diabetes mellitus (2.3%)





Asthma (4.2%)

COPD (2.9%)







Other respiratory (4.3%)Asthma (3.8%)

COPD (2.9%)







Prov, DistrictEC, A Nzo: DC44

Show History

BroadcauseInjury

NCD

HIV and TB

Comm_mat_peri_nut



325


325


Percentage of deaths by broad cause and leading causes, 2008-2013: Alfred Nzo (DC44)

326


326



In the under-5-year age group, communicable diseases together with maternal, perinatal and nutritional conditions accounted for 76.8% of deaths among females and 73.5% among males. HIV and TB and non-communicable diseases accounted for about 10% each, and injuries for around 5%.

In the 5–14-year age group there were bigger differences in the proportions of broad causes between females and males. Communicable diseases together with maternal, perinatal and nutritional conditions accounted for 41.0% of deaths among females versus 31.7% among males; HIV and TB accounted for 21.2% of deaths among females versus 15.2% among males; non-communicable diseases accounted for 17.5% (female) versus 24.5% (male); and injuries accounted for 20.3% (female) versus 28.5% (male).

In the 15–24-year age group, injury accounted for 55.9% of deaths among males compared with only 11.2% among females, while HIV and TB accounted for 45.4% of deaths among females compared with only 18.0% among males.


In the 65-years-and-older age group, non-communicable diseases accounted for the highest proportion of deaths (72.7% among females and 65.0% among males). Communicable diseases together with maternal, perinatal and nutritional conditions accounted for around 17% of deaths. This was the only age group where deaths due to HIV and TB were higher among males (14.7%) than females.


In children under 5 years, deaths due to communicable diseases and maternal, perinatal and nutritional conditions increased from 71.9% to 79.2% between 2008–2010 and 2011–2013 (in contrast to the rest of the province), while the proportion of deaths due to the other broad causes all decreased. In the 5–14-year age group, deaths due to HIV and TB and communicable diseases together with maternal, perinatal and nutritional conditions increased, while injury-related deaths and non-communicable disease mortality declined over this period. In the 15–24-year age group, injury-related deaths and HIV and TB mortality increased. In the 25–64-year age group, the percentage of deaths due to HIV and TB increased from 38.8% to 47.8%, while deaths due to communicable diseases and maternal, perinatal and nutritional conditions declined from 25.3% to 18.4%. This could have been due to more accurate reporting of HIV on death certificates. Non-communicable disease mortality remained more or less at the same level, while injury-related deaths increased slightly over the period. In the 65-years-and-older age group there was not much change in the broad cause groups over the period.


Under 5 years

Diarrhoeal diseases and lower respiratory infections remained the leading causes of death between 2008–2010 and 2011–2013. Despite prematurity and birth asphyxia moving up in the rankings, and protein-energy malnutrition, HIV and AIDS and TB moving down slightly, mortality in this age group was still largely HIV-related.

5–14 years

Diarrhoea, lower respiratory infections and HIV remained the leading causes of death, with TB replacing meningitis as the fourth leading cause. Road injuries, drowning, epilepsy and accidental threats to breathing (probably cases of interpersonal violence) also ranked among the top 10 causes of death.

15–24 years

Tuberculosis, HIV and interpersonal violence remained the three leading causes of death in this age group, followed by road injuries, diarrhoea, lower respiratory infections, meningitis, and drowning.

25–64 years

Tuberculosis, HIV, lower respiratory infection and diarrhoea remained the leading causes of death, accounting for more than 50% of deaths in this age group. Cerebrovascular disease, diabetes mellitus, interpersonal violence and ischaemic heart disease appeared in the top 10 causes of death.

65 years and older

Cerebrovascular disease, TB and lower respiratory infections remained among the leading causes of death, with hypertensive heart disease and diabetes mellitus moving up in the ranking over this period. Diarrhoea, asthma, ischaemic heart disease and chronic obstructive pulmonary disease remained in the top 10 causes of death in this age group.


327


327

Indicator performance: Alfred Nzo (DC44)

District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



86.4 62.0 53.1 45 77.6 91.0 73.5



5.5 5.0 5.2 16 5.3 4.9 4.6


1 758.1 1 960.8 1 810.6 37 2 005.9 2 136.4


66.2 60.7 65.8 28 59.0 65.0 65.8


62.4 55.1 52.8 22 64.3 60.7



11.6 10.0 7.7 50 5.2 5.8 5.6 3.3 3.5 3.0


8.2 8.1 6.7 52 4.2 6.0 4.0 2.9


17.6 18.6 18.1 44 11.8 12.0 10.0 11.6 8.0 7.0


8.4 7.5 6.6 44 6.3 5.2


18.5 19.2 22.2 20.6 22.7


13.4 12.9 12.8 52 9.6 10.3 7.4


10.9 9.5 8.7 14 13.3 12.0 10.1 0


55.5 123.2 67.9 13 148.3 114.0 112.0 132.5 100 80.0


49.1 49.1 53.3 42 58.0 55.0 74.3 80.0 85.0


18.1 16.9 14.9 6 19.6 20.7


32.6 37.5 37.5 52 48.8 42.0 50.0 53.9 65.0 70.0


87.4 73.9 87.0 41 91.7 90.0 91.2 93.0 96.0


104.2 105.4 120.3 8 95.2 100.6


3.6 2.4 2.2 45 1.7 2.8 1.5 1.5 1.8 2.0


6.5 3.2 50 13.4 70.0 27.4 23.2 30.0 35.0


50.5 57.2 50.2 28 53.0 55.0 55.0 52.2 55.0


68.8 73.2 72.3 50 80.9 90.0 90.0 89.8 95.0 91.0


69.4 79.0 67.7 50 73.6 95.0 90.0 82.8 85.0 85.0

Reproductive health


25.4 23.2 23.1 52 56.3 42.0 44.0 54.5 60.0 64.0


21.2 20.6 21.3 52 39.4 60.0 46.8 55.0


6.3 5.4 4.7 13 6.0 6.4


31.0 32.4 29 36.0 32.1


16.0 11.5 15.2 49 33.6 38.0 38.4



12.5 13.7 14.0 15.7 3.5 13.9


0.6 0.7 1.3 1.2

Human Resources


29.6 33.9 35.1 32 23.8 26.9


49.0 46.5 46.5 51 33.7 29.4

328


328


District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



712.8 657.3 599.2 20 792.3 592.5



71.9 67.7 67.1 45 70.5 76.8



6.2 5.9 5.5 28 7.7 7.0 6.8 5.8 6.0 5.5


75.2 73.5 72.1 43 77.0 78.9 82.0 77.9 82.0 83.0


86.6 82.3 94.3 18 92.3 92.8


64.0 82.4 83.6 23 89.1 78.9


25.8 9 36.3 31.8

Burden of disease


7.4 8.5 8.9 2 13.5 14.5


51.0 55.0 52.4 52 20.7 14.0


26.6 25.2 24.6 36 16.1 22.1


37.7 37.8 37.1 47 32.6 27.9


8.7 8.9 10.5 9 14.2 13.1


27.0 28.1 27.8 6 37.1 36.9






✦ Infant 1st PCR test around 6 weeks uptake rate (although more than 100%)


✦ Percentage of deaths garbage codes (second lowest in the country)

✦ Percentage of years of life lost (YLLs) due to injuries and non-communicable diseases



✦ Child under 5 years diarrhoea, pneumonia and severe acute malnutrition case fatality rates


✦ Delivery in facility under 18 years rate (highest in the country)

✦ Antenatal 1st visit before 20 weeks rate (lowest in the country)


✦ School Grade 1 screening coverage (third lowest in the country)

✦ Immunisation coverage under 1 year (third lowest in the country)

✦ Measles 2nd dose coverage (third lowest in the country)

✦ Cervical cancer screening coverage (lowest in the country)

✦ Couple year protection rate (lowest in the country)


✦ PHC professional nurse clinical workload (second highest in the country)




329


329


✦ Percentage of deaths ill-defined (highest in the country)


Although the district recorded an improvement in the performance of several indicators over the past three years, improvement strategies are urgently needed for the following indicators, especially when compared with the district ranking, 2014/15 provincial and national averages, and the 2014/15 and 2015/16 provincial and national targets. These indicators are:



✦ Child under 5 years diarrhoea, pneumonia and severe acute malnutrition case fatality rates,






















✦ Percentage of YLLs due to communicable, maternal, perinatal and nutrition causes


Annual indicators for district: A Nzo: DC44

Valu

e

0

20

40

60

80

2006 2008 2010 2012 2014


5

6

7

8

2006 2008 2010 2012 2014


5

10

15

20

2006 2008 2010 2012 2014


4

6

8

10

12

2008 2010 2012 2014 2016


15

20

25

2008 2010 2012 2014 2016


5

6

7

8

2008 2010 2012 2014 2016

03_Crude death rate

1200

1400

1600

1800

2000

2006 2008 2010 2012 2014


55

60

65

70

2008 2010 2012 2014 2016


50

55

60

65

70

2006 2008 2010 2012 2014


5

10

15

20

2006 2008 2010 2012 2014


8

9

10

11

12

13

2006 2008 2010 2012 2014

04_Deliv in fac <18

5

10

15

20

25

2006 2008 2010 2012 2014


60

80

100

120

140

160

2006 2008 2010 2012 2014


20

40

60

2008 2010 2012 2014 2016


15

20

25

30

35

40

2006 2008 2010 2012 2014

04_Stillbirth rate

20

30

40

50

2006 2008 2010 2012 2014


70

75

80

85

90

2008 2010 2012 2014 2016


40

60

80

100

120

2006 2008 2010 2012 2014


5

10

2006 2008 2010 2012 2014


5

10

15

20

2010 2012 2014 2016 2018



330


330


Annual indicators for district: Alfred Nzo (DC44)

Annual indicators for district: A Nzo: DC44Va

lue

20

30

40

50

2006 2008 2010 2012 2014


60

70

80

90

2006 2008 2010 2012 2014

07_Imm cov <1 yy

60

70

80

90

100

2006 2008 2010 2012 2014


0

10

20

30

40

50

2006 2008 2010 2012 2014


20

25

30

35

40

45

2006 2008 2010 2012 2014


5.5

6.0

6.5

7.0

7.5

8.0

8.5

2008 2010 2012 2014


5

6

7

8

9

10

2008 2010 2012 2014 2016


50

60

70

2006 2008 2010 2012 2014


8

9

10

11

12

13

2008 2010 2012 2014 2016

09_TB deaths all TB

600

700

800

900

2006 2008 2010 2012 2014

09_TB inc all TB

60

65

70

75

2006 2008 2010 2012 2014


26

28

30

32

34

36

2010 2012 2014 2016 2018


10

15

20

25

30

35

2006 2008 2010 2012 2014


40

60

80

2008 2010 2012 2014


20

40

60

80

2008 2010 2012 2014 2016

10_TB/HIV on ART

25

30

35

2006 2008 2010 2012 2014


0.8

1.0

1.2

2010 2012 2014 2016 2018


25

30

35

2010 2012 2014 2016


30

35

40

45

2010 2012 2014 2016


8

10

12

14

2006 2008 2010 2012 2014

13_Garbage codes



331


331

Annual indicators for district: Alfred Nzo (DC44)

332


332


Nelson Mandela Bay Metropolitan District (NMA) Naomi Massyn and Pamela Groenewald

Nelson Mandela Bay is a Category A municipality in the Eastern Cape Province and comprises three health sub-districts, namely Nelson Mandela A, Nelson Mandela B and Nelson Mandela C. It has a population of 1 184 988, with a population density of 604.9 persons per km2, and falls into socio-economic Quintile 5, among the wealthiest districts.

Population distribution, sub-district boundaries and health facility locations: Nelson Mandela Bay (NMA)


<5 years

5-14

15-24

25-64

65+

Total 57.3%25.0%13.3%

20.4%

13.9%

16.1%

27.9%

16.1%

46.6%

86.5%

11.5%

28.9%

55.7%

38.8%

67.9%

22.9%

14.3%

9.8%

13.8%49.3%26.0%

35.4%

62.2%

14.8%

15.3%

26.0%

13.1%

41.9%

83.3%

24.9%

19.3%

36.7%

68.3%

13.7%

EC, N Mandela Bay: NMA

Broad age.. 2008-10 2011-13

<5 years

5-14

15-24

25-64

65+

30.7%

40.6%

14.8%

24.0%

13.4%

42.7%

84.4%

12.5%

27.5%

35.6%

38.0%

67.6%

17.8%

9.2%

24.0%

39.6%

18.2%

32.9%

16.9%

46.7%

86.4%

25.1%

36.3%

36.8%

69.5%

18.0%

Rank.. 2008-10 2011-13

<5 y

ears

12345678910

5-14

12345678910

15-2

4

12345678910

25-6

4

12345678910

65+

12345678910

Congenital heart anomalies (3.0%)





Asthma (2.1%)


HIV/AIDS (8.0%)

Tuberculosis (4.7%)Congenital heart anomalies (4.3%)

Other perinatal conditions (4.8%)





Septicaemia (3.3%)



HIV/AIDS (4.6%)


Drowning (8.2%)

Epilepsy (5.7%)








Drowning (13.6%)

Epilepsy (4.3%)Endocrine nutritional,blood, immune (4.6%)Meningitis/encephalitis (5.1%)Road injuries (6.6%)




Epilepsy (1.6%)




Accidental threats to breathing (4.7%)Road injuries (7.7%)



HIV/AIDS (10.9%)



Asthma (1.7%)

Interpersonal violence (14.9%)Mechanical forces (8.6%)Accidental threats to breathing (7.7%)




Asthma (2.8%)Interpersonal violence (2.7%)Road injuries (2.4%)

Diabetes mellitus (3.4%)Hypertensive heart disease (3.5%)Ischaemic heart disease (3.9%)




Interpersonal violence (2.4%)Nephritis/nephrosis (2.9%)







Asthma (3.1%)

COPD (4.4%)





Tuberculosis (3.7%) Trachea/bronchi/lung (3.4%)Asthma (2.4%)

COPD (5.4%)Nephritis/nephrosis (4.4%)




Prov, DistrictEC, N Mandela Bay: NMA

Show History

BroadcauseInjury

NCD

HIV and TB

Comm_mat_peri_nut



333


333


Percentage of deaths by broad cause and leading causes, 2008-2013: Nelson Mandela Bay (NMA)

334


334



In the under-5-year age group, communicable diseases together with maternal, perinatal and nutritional conditions accounted for around 68% of deaths. Non-communicable diseases accounted for about 16% of deaths, HIV and TB for about 12%, and injuries for around 4%.

In the 5–14-year age group there were bigger differences in the proportions of broad causes between females and males. Injuries accounted for 20.4% of deaths among females and 35.4% of deaths among males, and communicable diseases together with maternal, perinatal and nutritional conditions accounted for 22.9% among females versus 13.7% among males.

In the 15–24-year age group, injury accounted for 62.2% of deaths among males compared with only 13.9% among females, while HIV and TB accounted for 55.7% of deaths among females versus 19.3% among males.

In the 25–64-year age group, non-communicable diseases accounted for the largest proportion of deaths (41.9% among males and 46.6% among females). Injuries accounted for a small proportion of deaths, with the percentage being much higher among males (14.8%) than females (4.8%).

In the 65-years-and-older age group, non-communicable diseases accounted for the highest proportion of deaths (86.5% among females and 83.3% among males). HIV and TB deaths were higher among males than females.


There was not much change in broad cause groups among children under 5 years over this period. In the 5–14-year age group there was a slight decrease in HIV and TB mortality, a bigger decrease in injury-related deaths, and a marked increase in non-communicable disease mortality. There was not much change in broad cause groups for the 15–24-year, 25–64 year, and the 65-years-and-older age groups over the period.


Under 5 years

Deaths due to diarrhoea, lower respiratory infection, HIV and AIDS and TB declined markedly over this period. Deaths due to prematurity increased markedly, along with deaths due to sepsis/other neonatal infections, birth asphyxia and other perinatal conditions. HIV-related mortality declined to less than 30% in this district.

5–14 years

Tuberculosis, HIV and AIDS, drowning, lower respiratory infections and road injuries remained the top five causes of death in this age group over this period, although the proportion of road injuries declined and drowning increased. Meningitis and epilepsy were also among the top 10 causes.

15–24 years

HIV and AIDS, TB, interpersonal violence, mechanical forces and road injuries remained in the top six causes of death over this period, with HIV increasing markedly. Fires, lower respiratory infections and diarrhoea also appeared among the top 10 causes.

25–64 years

Tuberculosis, HIV and AIDS and cerebrovascular disease remained the top three causes of death over the whole period. Lower respiratory infections declined, with diabetes mellitus, ischaemic heart disease, hypertensive heart disease and lung cancer moving up in the ranking. Interpersonal violence also appeared in the top 10 causes in both periods.

65 years and older

Cerebrovascular disease, ischaemic heart disease, hypertensive heart disease and diabetes mellitus remained the leading causes of death in this age group over the whole period. Lower respiratory infections dropped in the ranking in the latter period.


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Indicator performance: Nelson Mandela Bay (NMA)

District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



63.8 90.6 74.8 30 77.6 91.0 73.5



3.6 3.5 3.7 26 5.3 4.9 4.6


2 858.9 3 259.2 2 918.8 50 2 005.9 2 136.4


67.1 58.5 60.5 38 59.0 65.0 65.8


22.3 29.2 8.9 2 64.3 60.7



3.0 2.5 1.4 10 5.2 5.8 5.6 3.3 3.5 3.0


3.4 4.3 4.7 42 4.2 6.0 4.0 2.9


5.1 9.8 12.6 33 11.8 12.0 10.0 11.6 8.0 7.0


6.3 5.1 5.1 18 6.3 5.2


40.1 41.1 41.1 20.6 22.7


7.1 6.7 5.7 7 9.6 10.3 7.4


27.7 25.7 19.5 52 13.3 12.0 10.1 0


126.0 132.9 125.3 24 148.3 114.0 112.0 132.5 100 80.0


58.7 52.3 54.2 41 58.0 55.0 74.3 80.0 85.0


16.8 17.7 19.0 22 19.6 20.7


46.3 49.9 55.4 32 48.8 42.0 50.0 53.9 65.0 70.0


94.6 93.9 96.4 12 91.7 90.0 91.2 93.0 96.0


85.3 96.3 90.8 37 95.2 100.6


2.5 2.8 1.8 31 1.7 2.8 1.5 1.5 1.8 2.0


13.5 13.2 41 13.4 70.0 27.4 23.2 30.0 35.0


39.6 42.1 47.3 39 53.0 55.0 55.0 52.2 55.0


84.7 85.8 87.6 19 80.9 90.0 90.0 89.8 95.0 91.0


65.7 69.8 74.2 37 73.6 95.0 90.0 82.8 85.0 85.0

Reproductive health


44.1 44.3 44.6 34 56.3 42.0 44.0 54.5 60.0 64.0


31.8 34.3 41.8 35 39.4 60.0 46.8 55.0


6.9 6.9 6.4 37 6.0 6.4


22.0 23.2 48 36.0 32.1


13.6 15.8 27.2 37 33.6 38.0 38.4



11.8 9.8 9.4 15.7 3.5 13.9


1.7 1.6 1.3 1.2

Human Resources


34.8 27.7 28.7 8 23.8 26.9


38.9 32.3 30.3 5 33.7 29.4

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District value

District ranking

Provincial average

Provincial target

Provincial target

National average

National target

National target



993.9 983.6 1 009.1 49 792.3 592.5



66.4 62.8 68.5 40 70.5 76.8

TB death rate (all TB) [Percentage] 7.7 7.9 6.8 16 9.3 7.4 6.0 5.0


9.6 12.1 10.9 50 7.7 7.0 5.8 6.0 5.5


72.7 71.8 77.7 28 77.0 78.9 77.9 82.0 83.0


78.3 83.3 91.9 34 92.3 92.8


74.4 88.5 90.5 9 89.1 78.9


40.0 43 36.3 31.8

Burden of disease


13.9 13.4 12.3 14 13.5 14.5


6.8 8.0 7.4 10 20.7 14.0


11.4 12.2 11.8 9 16.1 22.1


31.8 29.7 29.3 31 32.6 27.9


11.6 11.8 11.9 19 14.2 13.1


45.1 46.3 47.0 45 37.1 36.9





✦ OPD new client not referred rate for district hospitals( second lowest)

✦ Child under 5 years diarrhoea case fatality rate


✦ PHC doctor and professional nurse clinical workloads



✦ Percentage of years of life lost (YLLs) due to communicable, maternal, perinatal, nutrition causes



✦ Inpatient early neonatal death rate (highest in the country)



✦ TB defaulter rate (new smear positive) (third highest in the country)








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337



✦ Delivery by Caesarean section rate (district hospitals)























Annual indicators for district: N Mandela Bay: NMA

Valu

e

0

20

40

60

80

2006 2008 2010 2012 2014


3.5

4.0

4.5

5.0

5.5

6.0

2006 2008 2010 2012 2014


2

4

6

8

10

2006 2008 2010 2012 2014


3

4

5

6

7

8

2008 2010 2012 2014 2016


5

10

15

20

2008 2010 2012 2014 2016


5.0

5.5

6.0

6.5

7.0

2008 2010 2012 2014 2016

03_Crude death rate

1500

2000

2500

3000

2006 2008 2010 2012 2014


10

20

30

40

50

60

70

2008 2010 2012 2014 2016


60

65

70

75

2006 2008 2010 2012 2014


10

20

30

40

2006 2008 2010 2012 2014


6

7

8

9

10

2006 2008 2010 2012 2014

04_Deliv in fac <18

10

15

20

25

2006 2008 2010 2012 2014


60

80

100

120

140

160

2006 2008 2010 2012 2014


20

40

60

2008 2010 2012 2014 2016


20

25

30

2006 2008 2010 2012 2014

04_Stillbirth rate

30

35

40

45

50

55

2006 2008 2010 2012 2014


70

80

90

2008 2010 2012 2014 2016


50

60

70

80

90

100

2006 2008 2010 2012 2014


2

4

6

8

10

12

2006 2008 2010 2012 2014


14

16

18

20

22

2010 2012 2014 2016 2018



338


338


Annual indicators for district: Nelson Mandela Bay (NMA)

Annual indicators for district: N Mandela Bay: NMAVa

lue

20

30

40

50

2006 2008 2010 2012 2014


65

70

75

80

85

90

2006 2008 2010 2012 2014

07_Imm cov <1 yy

60

70

80

90

2006 2008 2010 2012 2014


0

10

20

30

40

50

2006 2008 2010 2012 2014


30

35

40

45

2006 2008 2010 2012 2014


6

8

10

12

2008 2010 2012 2014


0

2

4

6

2008 2010 2012 2014 2016


50

55

60

65

70

75

2006 2008 2010 2012 2014


7

8

9

10

11

2008 2010 2012 2014 2016

09_TB deaths all TB

600

800

1000

1200

2006 2008 2010 2012 2014

09_TB inc all TB

66

68

70

72

74

76

78

2006 2008 2010 2012 2014


25

30

35

2010 2012 2014 2016 2018


10

20

30

2006 2008 2010 2012 2014


50

60

70

80

90

2008 2010 2012 2014


40

60

80

2008 2010 2012 2014 2016

10_TB/HIV on ART

30

32

34

36

38

40

2006 2008 2010 2012 2014


1.2

1.4

1.6

2010 2012 2014 2016 2018


25

30

35

2010 2012 2014 2016


30

32

34

36

38

2010 2012 2014 2016


12.5

13.0

13.5

14.0

14.5

2006 2008 2010 2012 2014

13_Garbage codes



339


339

Annual indicators for district: Nelson Mandela Bay (NMA)

Documents

15 Eastern Cape Province - hst.org.za