An historical demographic investigation into mortality in three historical birth cohorts born between 1837 and 1900 in Mamre, with special reference to life expectancy

This thesis reports on an historical prospective study of three Mamre decadal birth cohorts (1837-1846, 1870-1879, and 1900-1909) constructed retrospectively through existing parish records of the Moravian Mission at Mamre in the Western Cape region of South Africa. Nominative data collection techniques were used to gather information needed to determine the infant mortality rates, quinquennial mortality rates and life expectancies of the three cohorts. Issues related to the quality of data – non-registration and follow-up - were investigated. Birth registration was best for the 1837-46 cohort for males and females, with the 1900-1909 registration being next best. Overall, male registration coverage was substantially better than that for females. Infant death registration was best for males in these 2 cohorts, but were poor for females. Based on these data, the infant mortality rates for the cohorts born in 1837-1846, 1870-1879 and 1900-1909 - 196, 182 and 128 per 1000 respectively for males and 160, 172 and 97 per 1000 respectively for females - appeared to be underestimates. There is some evidence of a downward trend for the infant mortality rates with time for males, but this was not statistically significant. Quinquennial mortality rates for the 3 cohorts did not differ statistically, and are similar to the 1935-37 national 'coloured' figures. The life expectancies also did not differ significantly between cohorts. The life expectancies at birth (range 34- 40 years for males and 32-45 years for females) were probably overestimates due to biased IMR's. The life expectancies at age 1 (range 41-44 for males and 37-49 for females) were more representative figures. Life expectancies at age 20 were fairly stable over time (37-45 years) except for females in the 1900-1909 cohort whose life expectancies were substantially higher than earlier figures. All mortality indices investigated in this study consistently showed a lighter burden of mortality in historical Mamre compared to 'coloureds' in the Cape Colony at the turn of the century. This is probably associated with the better housing, environmental, social, economic and educational conditions at the Mamre mission relative to the rest of the Colony in the century after the emancipation of slaves

The epidemiology of incomplete abortion in South Africa

Objective. To describe the epidemiology of incomplete abortion (spontaneous miscarriage and illegally induced) in South Africa.Design. Multicentre, prospective, descriptive study.Setting. Fifty-six public hospitals in nine provinces (a stratified, random sample of all hospitals treating gynaecological emergencies).Patients. All women of gestation under 22 weeks who presented with incomplete abortion during the 2-week study period.Main outcome measures. Incidence of, morbidity associated with and mortality from incomplete abortion.Main results. An estimated 44 686 (95% Cl 35 633 - 53 709) women per year were admitted to South Africa's public hospitals with incomplete abortion. An estimated 425 (95% Cl 78 - 735) women die in public hospitais from complications of abortion. Fifteen per cent (95% Cl 13 18) of patients have severe morbidity while a further 19% (95% Cl 16 - 22) have moderate morbidity, as assessed by categories designed for the study which largely reflect infection. There were marked inter-provincial differences  and inter-age group differences in trimester of presentation and proportion of patients with appreciable morbidity.Conclusions. Incomplete abortions and, in particular, unsafe abortions are an important cause of mortality and morbidity in South Africa. The methods used in this study underestimate the true incidence for reasons that are discussed. A high priority should be given to the prevention of unsafe abortion

Under-ascertainment of Aboriginality in records of cardiovascular disease in hospital morbidity and mortality data in Western Australia: a record linkage study

<p>Abstract</p> <p>Background</p> <p>Measuring the real burden of cardiovascular disease in Australian Aboriginals is complicated by under-identification of Aboriginality in administrative health data collections. Accurate data is essential to measure Australia's progress in its efforts to intervene to improve health outcomes of Australian Aboriginals. We estimated the under-ascertainment of Aboriginal status in linked morbidity and mortality databases in patients hospitalised with cardiovascular disease.</p> <p>Methods</p> <p>Persons with public hospital admissions for cardiovascular disease in Western Australia during 2000-2005 (and their 20-year admission history) or who subsequently died were identified from linkage data. The Aboriginal status flag in all records for a given individual was variously used to determine their ethnicity (index positive, and in all records both majority positive or ever positive) and stratified by region, age and gender. The index admission was the baseline comparator.</p> <p>Results</p> <p>Index cases comprised 62,692 individuals who shared a total of 778,714 hospital admissions over 20 years, of which 19,809 subsequently died. There were 3,060 (4.9%) persons identified as Aboriginal on index admission. An additional 83 (2.7%) Aboriginal cases were identified through death records, increasing to 3.7% when cases with a positive Aboriginal identifier in the majority (≥50%) of previous hospital admissions over twenty years were added and by 20.8% when those with a positive flag in any record over 20 years were incorporated. These results equated to underestimating Aboriginal status in unlinked index admission by 2.6%, 3.5% and 17.2%, respectively. Deaths classified as Aboriginal in official records would underestimate total Aboriginal deaths by 26.8% (95% Confidence Interval 24.1 to 29.6%).</p> <p>Conclusions</p> <p>Combining Aboriginal determinations in morbidity and official death records increases ascertainment of unlinked cardiovascular morbidity in Western Australian Aboriginals. Under-identification of Aboriginal status is high in death records.</p

New Zealand Regions, 1986 – 2001: Hospitalisation and some Related Health Facts

Once age and gender composition is controlled for, regional health differentials are a function of problems of health service delivery, of socio-economic variance, and overall Maori Pakeha health differences. They indicate relative levels of exclusion and of inequality. This paper shows that these differentials follow in general the patterns seen in other papers in this series.Health, Hospitalisation, Regions, New Zealand

An analysis of the cost of incomplete abortion to the public health sector in South Africa - 1994

Objective. To analyse the medical costs incurred in treating women for incomplete abortion. This stUdy was performed in conjunction with a nationwide survey of women who presented to public hospitals with incomplete abortion in 1994.Design. Cost analysis with two modified Delphi panels used to develop models of resource use reflecting three severity categories of symptoms and three hospital treatment settings.Setting. Public hospitals in South Africa.Participants. A panel of 15 senior level obstetrician/gynaecologists and a second panel of 11 patient care managers representing district, regional and tertiary level hospitals in 7 provinces.Main results. A conservative estimate of the total cost of treating women is R18.7 million ± R3.5 million for 1994. An estimated R9.74 million ± R1.3 million of this was spent treating women with 'unsafe' incomplete abortions.Conclusions. The management of incomplete abortion requires significant public sector expenditure. The long-term indirect costs to women, their families and communities are discussed and treatment costs estimated so that unmet needs for medical care resulting from unsafe abortions can be addressed