Disease profile for Vhembe Health District Limpopo Naomi Massyn, René English, Patricia McCracken, Noluthando Ndlovu, Annette Gerritsen, Debbie Bradshaw & Pamela Groenewald Published by Sup ms porting Health Syste since 1992 34 Essex Terrace Tel: +27 (0)31 266 9090 Westville Fax: +27 (0)31 266 9199 3630 Email: [email protected] South Africa Web: http://www.hst.org.za ISB Number: 978-1-919839-82-0 June 2015 Suggested citation: Naomi Massyn, René English, Patricia McCracken, Noluthando Ndlovu, Annette Gerritsen, Debbie Bradshaw & Pamela Groenewald. Disease profile for Vhembe Health District, Limpopo. Durban: Health Systems Trust; June 2015. The information contained in this publication may be freely distributed and reproduced, as long as the source is acknowledged, and it is used for non-commercial purposes Contents Foreword i Acknowledgments ii Acronyms iii Executive Summary iv 1. Introduction 1 1.1 Background 1 1.2 Aims and objectives 1 1.3 Methods 2 1.3.1 Study design 2 1.3.2 Data Sources and Collection 2 1.3.3 Data management 2 1.3.4 Structure of report 3 1.3.5 Terminology 3 2. Demography 4 2.1 Overview of the Vhembe district 4 2.1.1 Orientation 4 2.1.2 Municipal breakdown and population distribution 6 2.1.3 Local economy 7 2.1.4 Socioeconomic factors and health coverage 7 2.2 Characteristics of Vhembe sub-districts 8 2.2.1 Musina (LIM341) 8 2.2.2 Mutale (LIM342) 8 2.2.3 Thulamela (LIM343) 9 2.2.4 Makhado (LIM344) 9 2.3 Population overview of the Vhembe district 9 2.3.1 Age distribution 9 2.3.2 Race distribution 10 2.4 Summary 11 2.5 Conclusions 11 3. Social determinants of health 12 3.1 Unemployment rates 12 3.1.1 Household income and unemployment, Mutale LM 12 3.1.2 Household income and unemployment, Musina LM 13 3.1.3 Household incomes and unemployment, Thulamela LM 13 3.1.3 Household income and unemployment, Makhado LM 14 3.2 Education 14 3.2.1 Comparative schooling levels across Vhembe 15 3.2.2 Reasons for school dropouts in Vhembe 15 3.2.3 Challenges to education of girls 16 3.2.4 School dropouts and health-policy implementation 17 3.3 Municipal services 17 3.3.1. Municipal service provision across Vhembe sub-districts 17 3.3.2 Water quality 17 3.4 Summary 18 3.5 Recommendations 18 4. Service delivery environment 19 4.1 Distribution of primary health care facilities 19 4.2 PHC headcount 20 4.3 PHC utilisation rates 21 4.3.1 Annualised PHC utilisation rates 21 4.3.2 OPD client not referred rate 21 4.3.3 PHC utilisation children under 5 years 22 4.4. Clinical workloads 23 4.4.1 PHC professional nurses’ workloads 23 4.4.2 PHC doctor work loads 24 4.5 Population ratio per PHC facility 25 4.6 Summary 26 4.7 Conclusions 26 5. Burden of disease 27 5.1 Categorisation of burden of disease 27 5.2 Age distribution of deaths 28 5.3 Cause-of-death profile (broad cause groups) 28 5.4 Leading causes of premature mortality 29 5.5 Trends in leading causes of premature mortality 29 5.6 Causes of death by age group and gender 30 5.6.1 Causes of death: under 5 years 30 5.6.2 Causes of death: 5-14 years 31 5.6.3 Causes of death: 15-24 years 33 5.6.4 Causes of death: 25- 64 years 34 5.6.5 Causes of death: 65+ years 36 5.7 Data-quality challenges 38 5.8 Summary 39 5.9 Recommendations 39 6. Epidemiological (disease) profile of the Vhembe district 41 6.2 Background 41 6.2 HIV and TB control 41 6.2.1 HIV testing and prevalence: Clients 15-49 years 41 6.2.2 Male condom distribution 42 6.2.3 Adults and children on ART 42 6.2.4 Summary 43 6.25 Recommendations 44 6.3 Antenatal HIV care and treatment 44 6.3.1 Antenatal 1st visit coverage 44 6.3.2 Antenatal 1st visit before 20 weeks 45 6.3.3 Antenatal client HIV 1st test positive 46 6.3.4 Antenatal HIV retest rate 47 6.3.5 Antenatal clients initiated on ART 48 6.3.6 Early infant HIV diagnosis 50 6.3.7 Summary 52 6.3.8 Recommendations 53 6.4 Tuberculosis 53 6.4.1 TB incidence 53 6.4.2 TB case finding 54 6.4.3 TB success, smear conversion, cure and defaulter rates 55 6.4.3.1 TB success rate 55 6.4.3.2 Smear conversion rate (new pulmonary smear-positive TB) 55 6.4.3.3 TB cure and defaulter rates (new pulmonary smear-positive) 55 6.4.4 Multi-drug resistant TB 56 6.4.5 TB/HIV co-infection rates 57 6.4.6 ART initiation in co-infected patients 57 6.4.7 Summary 59 6.4.8 Recommendations 59 6.5 Maternal, child and women’s health & nutrition (MCWH) 60 6.5.1 Couple year protection rate 60 6.5.2 Delivery-related indicators 61 6.5.2.1 Delivery rate in facility 61 6.5.2.2 Delivery rate in facility under 18 years 63 6.5.2.3 Delivery by Caesarean section 63 6.5.3 Maternal mortality 66 6.5.4 Termination of pregnancy 68 6.5.5 Summary 69 6.5.6 Recommendations 69 6.6 Child health and nutrition-related indicators 70 6.6.1 Stillbirth, neonatal and inpatient mortality rates to five years old 70 6.6.1.1 Stillbirth 70 6.5.1.2 Inpatient early neonatal death and mortality rates 71 6.6.1.3 Inpatient neonatal death and neonatal mortality in facility rates 72 6.6.1.4 Inpatient deaths and mortality under one year old 73 6.6.1.5 Inpatient deaths under five years 74 6.6.2 Immunisation coverage under 1 year 75 6.6.3 Children under five years: Diarrhoea with dehydration 76 6.6.4 Children under five years: Diarrhoea case fatality rate 77 6.6.5 Children under five years old: Pneumonia incidence 77 6.6.6 Children under five: Pneumonia case fatality rate 78 6.6.7 Incidence of children underweight for age and severe acute malnutrition 79 6.6.8 Children under two years: Underweight for age 79 6.6.9 Children under five years: Severe acute malnutrition 80 6.6.10 Children under five years: Severe acute malnutrition fatalities 81 6.6.11 Summary 81 6.6.12 Recommendations 82 6.7 Disease prevention: Non-communicable diseases 83 6.7.1 Hypertension 83 6.7.2 Diabetes incidence 83 6.7.3 Diabetes detection rates 84 6.7.4 Mental health case load 85 6.7.5 Dental extraction to restoration ratios 86 6.7.6 Summary 86 6.7.7 Recommendations 87 6.8 Disease Prevention and Control: Communicable diseases 88 6.8.1 Malaria 88 6.8.2 Summary 90 6.8.3 Recommendations 90 7. Data quality 91 7.1 Background 91 7.2 Adherence to SOP 91 7.3 Information-technology availability and quality 91 7.4 Completeness of death-notification forms 92 7.5 Use of ICD-10 coding and other guidelines 92 7.6 Summary 93 7.7 Recommendations 93 8. Main findings and interpretation 94 8.1 Demographic, socioeconomic and service delivery environment 94 8.2 Burden of diseases 95 8.3 HIV and TB 96 8.4 Maternal and child health 96 8.5 Non-communicable diseases 97 8.6 Disease prevention and control 97 8.7 Data quality 97 8.8 Limitations 97 9. Recommendations 98 9.1 Demographic, socioeconomic and service-delivery environment 98 9.2 Burden of disease 98 9.3 Epidemiology 99 9.3.1 HIV/TB control 99 9.3.2 Antenatal HIV care and treatment 99 9.3.3 TB 99 9.3.4 Maternal, child and women’s health & nutrition 100 9.3.5 Child health & nutrition 100 9.3.6 Non-communicable diseases 100 9.3.7 Communicable diseases 101 9.3.8 Data quality 101 10. Indicator definitions 102 Appendices 107 Appendix A: Quantitative data collection 107 Appendix B: Qualitative data collection 109 Addenda 110 Addendum A: Rapid assessment questionnaire for medical practitioners 110 Addendum B: Questionnaire to medical practitioners 111 Questions 111 Addendum C: Rapid assessment questionnaire to medical practitioners 112 Questionnaire for Medical Practitioners 112 A. General information: 112 B. Participant information: 112 C. IM Training: 112 D. Data quality review: 112 E. Information technology: 112 Addendum D: Death notification form 1 114 Addendum E: Death notification form 2 115 Addendum F: TPH 3 (a) form 116 References 117 List of Figures Figure 1: Vhembe population distribution across sub-districts, 2011 6 Figure 2: Age distribution across Vhembe sub-districts, 2011 10 Figure 3: Vhembe district population pyramid, midyear 2013 10 Figure 4: Proportion of population per race group across Vhembe sub-districts, 2011 11 Figure 5: Unemployment rates across Vhembe sub-districts, 2011 12 Figure 6: Average annual household income, Mutale LM, 2013 13 Figure 7: Average annual household income, Musina LM, 2013 13 Figure 8: Average annual household income, Thulamela LM, 2013 14 Figure 9: Average annual household income, Makhado LM, 2013 14 Figure 10: Schooling profile across Vhembe sub-districts, 2011 15 Figure 11: Reasons for not attending education institutions for persons aged 7-18 years, Limpopo, 2009-2013 16 Figure 12: Reasons why individuals aged 7-18 years were not attending school by gender, Limpopo, 2013 16 Figure 13: Municipal services across Vhembe sub-districts, 2011 17 Figure 14: PHC utilisation rate (annualised) across Vhembe sub-districts, 2010-2013 21 Figure 15: OPD new client not referred rate, Vhembe district, 2010-2013 22 Figure 16: PHC headcount utilisation rate under 5 years across Vhembe sub-districts, 2010-2013 23 Figure 17: PHC professional nurse clinical workload across Vhembe sub-districts, 2010-2013 23 Figure 18: PHC doctor clinical work load across Vhembe sub-districts, 2010-2013 24 Figure 19: Age distribution of deaths, Vhembe district, 2008-2013 (excluding 2009 and 2011) 28 Figure 20: Percentage of YLLs by broad causes, Vhembe district, 2011 29 Figure 21: Trends in 10 leading YLLs, Vhembe district, 2008-2011 30 Figure 22: Leading causes of death under 5 years, Vhembe district, 2008-2013 30 Figure 23: Comparison of number of deaths between <1 year and 1 to 4 years, Vhembe district, 2008-2013 31 Figure 24: Leading causes of death 5-14 years, Vhembe district, 2008-2013 (N=1 102) 31 Figure 25: Leading causes of male deaths,