title: Initial burden of disease estimates for South Africa, 2000.
abstract: BACKGROUND
  This paper describes the first national burden of disease study for South Africa. The main focus is the burden due to premature mortality, i.e. years of life lost (YLLs). In addition, estimates of the burden contributed by morbidity, i.e. the years lived with disability (YLDs), are obtained to calculate disability-adjusted life years (DALYs); and the impact of AIDS on premature mortality in the year 2010 is assessed.
  
  
  METHODS
  Owing to the rapid mortality transition and the lack of timely data, a modelling approach has been adopted. The total mortality for the year 2000 is estimated using a demographic and AIDS model. The non-AIDS cause-of-death profile is estimated using three sources of data: Statistics South Africa, the National Department of Home Affairs, and the National Injury Mortality Surveillance System. A ratio method is used to estimate the YLDs from the YLL estimates.
  
  
  RESULTS
  The top single cause of mortality burden was HIV/AIDS followed by homicide, tuberculosis, road traffic accidents and diarrhoea. HIV/AIDS accounted for 38% of total YLLs, which is proportionately higher for females (47%) than for males (33%). Pre-transitional diseases, usually associated with poverty and underdevelopment, accounted for 25%, non-communicable diseases 21% and injuries 16% of YLLs. The DALY estimates highlight the fact that mortality alone underestimates the burden of disease, especially with regard to unintentional injuries, respiratory disease, and nervous system, mental and sense organ disorders. The impact of HIV/AIDS is expected to more than double the burden of premature mortality by the year 2010.
  
  
  CONCLUSIONS
  This study has drawn together data from a range of sources to develop coherent estimates of premature mortality by cause. South Africa is experiencing a quadruple burden of disease comprising the pre-transitional diseases, the emerging chronic diseases, injuries, and HIV/AIDS. Unless interventions that reduce morbidity and delay morbidity become widely available, the burden due to HIV/AIDS can be expected to grow very rapidly in the next few years. An improved base of information is needed to assess the morbidity impact more accurately.
authors.affiliation: Burden of Disease Research Unit, Medical Research Council of South Africa, Tygerberg, W Cape.
authors.forename: Debbie
authors.initials: D
authors.lastname: Bradshaw
authors.forename: Pam
authors.initials: P
authors.lastname: Groenewald
authors.forename: Ria
authors.initials: R
authors.lastname: Laubscher
authors.forename: Nadine
authors.initials: N
authors.lastname: Nannan
authors.forename: Beatrice
authors.initials: B
authors.lastname: Nojilana
authors.forename: Rosana
authors.initials: R
authors.lastname: Norman
authors.forename: Desiréé
authors.initials: D
authors.lastname: Pieterse
authors.forename: Michelle
authors.initials: M
authors.lastname: Schneider
authors.forename: David E
authors.initials: DE
authors.lastname: Bourne
authors.forename: Ian M
authors.initials: IM
authors.lastname: Timaeus
authors.forename: Rob
authors.initials: R
authors.lastname: Dorrington
authors.forename: Leigh
authors.initials: L
authors.lastname: Johnson
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D013019:South Africa / Q000453:epidemiology