Integrated primary care based on scale-up of antiretroviral therapy for HIV is essential to tackle the sustained and increasing burden of chronic infectious and non-communicable disease in Africa. This is the conclusion of authors of an Article in the Alma Ata Special Issue of The Lancet, authored by Dr Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa, and colleagues.
The researchers looked at mortality trends from rural South Africa [or: a rural sub-district in South Africa] over the 13-year period 1992-2005. Between 1992-94 and 2002-05, all-cause mortality increased by 87% due to a six-fold rise in deaths from infectious disease affecting most age groups and both sexes. Mortality from non-communicable disease, including stroke, hypertension, diabetes and cancers, also increased by 15% in the same period. The change in female risk of death from HIV and tuberculosis (15-fold increase) was almost double that of the change in male risk (8-fold increase). The burden of disorders requiring chronic care increased far more than the burden requiring acute care, due to the increased incidence of both HIV and tuberculosis, and chronic non-communicable conditions.
The authors conclude: "Mortality from non-communicable disease remains evident, particularly in males, for whom the relative increase in HIV and tuberculosis mortality, although substantial, was much less than that for females. Significantly rising mortality is not limited to younger age groups, but is pronounced in adults aged 40-59 years and even older. Thus, were it not for HIV and tuberculosis, we suggest that mortality from non-communicable disease would be higher…The implications for primary health-care are substantial, with integrated chronic care based on scaled-up delivery of antiretroviral therapy needed to address this expanding burden…The imperative, therefore, to develop quality primary health-care systems, which are able to address effectively the rapidly expanding burden of chronic illness, could not be greater."
Dr Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa T) +27-82-9066830 / +27-11-7172083 E) Stephen.Tollman@wits.ac.za
Full paper: http://press.thelancet.com/AAsamortality.pdf
Journal
The Lancet