South African tuberculosis mortality data--showing the first sign of the AIDS epidemic?
OBJECTIVE
To report on the magnitude and distribution of registered tuberculosis (TB) mortality rates in South Africa for 1994 and 1995 in the context of changes in overall mortality registration.


METHODS
Retrospective analysis of routinely collected data.


METHODS
The South African population.


METHODS
Deceased persons with death certificates stating TB as cause of death.


METHODS
Age-adjusted mortality rates for all causes and for TB.


RESULTS
There are large, and to some extent unexpected, variations in registered TB mortality in South Africa. For the country as a whole TB mortality has risen from 38 to 53 per 100,000 for males and from 15 to 23 per 100,000 for females for the years 1994 to 1995. In the Eastern Cape TB deaths account for 10% of registered male deaths and 7% of registered female deaths. The two provinces that have the highest HIV prevalence among women attending antenatal clinics, namely KwaZulu-Natal and North West, recorded increases in registered TB deaths of 100% and 75% respectively for males, and 130% and 74% respectively for females. TB deaths among younger women appear to have risen particularly fast in these two provinces. Nationally the proportion of extrapulmonary tuberculosis (ETB) has risen from 5.2% to 7.4% of all TB deaths, pointing to an increase in HIV-related TB deaths.


CONCLUSIONS
The deficiencies and changes in the vital registration system make it difficult to draw firm conclusions from these data, but there is an alarming increase in TB mortality that is unlikely to be an artefact of the data alone. Some of the increase in TB mortality is likely to be due to misreporting of cause of death of AIDS patients. An audit should be conducted to investigate the enormous disparities between vital registration TB mortality, and TB deaths recorded under the TB notification system.
Kleinschmidt
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D017088:AIDS-Related Opportunistic Infections / Q000401:mortality*; D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries / Q000592:standards; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000401:mortality*