Background. Producing timely and accurate estimates of the impact of COVID-19 on mortality is challenging for most countries, but impossible for South Africa (SA) from cause-of-death statistics. Objectives. To quantify the excess deaths and likely magnitude of COVID-19 in SA in 2020 and draw conclusions on monitoring the epidemic in 2021. Methods. Basic details of deaths registered on the National Population Register by the Department of Home Affairs (DoHA) are provided to the South African Medical Research Council weekly. Adjustments are made to the numbers of weekly deaths to account for non-registration on the population register, as well as late registration of death with the DoHA. The weekly number of deaths is compared with the number predicted based on the Holt-Winters time-series analysis of past deaths for provinces and metropolitan areas. Excess deaths were calculated for all-causes deaths and natural deaths, using the predicted deaths as a baseline. In addition, an adjustment was made to the baseline for natural deaths to account for the drop in natural deaths due to lockdown. Results. We estimated that just over 550 000 deaths occurred among persons aged ≥1 year during 2020, 13% higher than the 485 000 predicted before the pandemic. A pronounced increase in weekly deaths from natural causes peaked in the middle of July across all ages except <20 years, and across all provinces with slightly different timing. During December, it became clear that SA was experiencing a second wave of COVID-19 that would exceed the death toll of the first wave. In 2020, there were 70 000 -76 000 excess deaths from natural causes, depending on the base. Using the adjusted base, the excess death rate from natural causes was 122 per 100 000 population, with a male-to-female ratio of 0.78. Deaths from unnatural causes halved for both males and females during the stringent lockdown level 5. The numbers reverted towards the predicted number with some fluctuations as lockdown restrictions varied. Just under 5 000 unnatural deaths were averted. Conclusions. Tracking the weekly numbers of deaths in near to real time has provided important information about the spatiotemporal impact of the pandemic and highlights that the ~28 000 reported COVID-19 deaths during 2020 substantially understate the death toll from COVID-19. There is an urgent need to re-engineer the system of collecting and processing cause-of-death information so that it can be accessed in a timely way to inform public health actions.
Objective To estimate the completeness of live birth registration through South Africa’s civil registration and vital statistics system between 1996 and 2011. Methods The number of births registered by the civil registration and vital statistics system was compared with independent estimates of the true number of births derived using: (i) the reverse survival method applied to 2011 census data; (ii) the application of estimated age-specific fertility rates to population estimates from censuses and surveys; and (iii) data from the public-sector district health information system. Findings In 1996, an estimated 25% of births were registered within the calendar year of birth and 33% were registered before the end of the subsequent calendar year. By 2008, 76% of registrations occurred within the calendar year of birth, 84% occurred by the end of the following year and 90% occurred before the child’s fifth birthday. These improvements were seen in all provinces and differences in completeness between provinces narrowed markedly. Improvements in the completeness of registration coincided with government efforts to strengthen the system, new legislation on vital registration and the introduction of child support grants, which required birth certificates. Interprovincial migration of children influenced the completeness of registration in affected provinces. There was some terminological confusion among government agencies on defining the timeliness of registration and the year of birth. Conclusion The completeness of birth registration in South Africa increased rapidly between 1996 and 2004. To allow international comparison, the method for measuring the completeness of birth registration needs to be standardized.
Demography is the study of population dynamics (most frequently, those relating to human populations), and the measurement and analysis of associated vital rates of birth, death, migration, and marriage. Encompassing demography is a broader field of research, ‘population studies’ or ‘social demography’, which seeks to situate the results of demographic inquiries in their social, political, economic, and institutional contexts. Nevertheless, the boundaries between the two are ill‐defined. The integration of both quantitative and qualitative analysis has been essential to the discipline from its earliest origins. There are three major aspects to demographic work: the description of a population at a point in time, by reference to specific criteria (age, sex, etc.); the analysis of the vital processes that contribute to the state of a population at that point in time; and, finally, the interpretation of the effects of these vital processes on future population dynamics, taking into account population‐specific social, economic, and cultural systems [59]. This review first traces briefly the evolution of, and trends in, demographic theory since Graunt. This article also presents the different demographic techniques in the fields of mortality, fertility, migration, and population projections.
This paper presents a model for assessing the potential effect of an HIV/AIDS vaccine in South Africa, and for calculating the amount of vaccine that would be required. A number of different hypothetical vaccine profiles and vaccine distribution strategies are considered. Results suggest that a sterilising vaccine could reduce the HIV incidence between 2015 and 2025 by up to 50%, while a disease modifying vaccine would be unlikely to reduce HIV incidence by more than a third. The effect on AIDS mortality over the same period would be substantially smaller, and it is unlikely that any preventive vaccine would reduce AIDS mortality by more than 10% between 2015 and 2025.
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