20 Mpumalanga Province

Transcription

1 Section B: Profile Mpumalanga and Province Profiles 0 Mpumalanga Province Gert Sibande Municipality (DC0) Naomi Massyn and Noluthando Ndlovu Gert Sibande is situated in Mpumalanga Province and has seven sub-districts: Albert Luthuli, Dipaleseng, Govan Mbeki, Lekwa, Mkhondo, Msukaligwa and Pixley Ka Seme. The district has a population of 0, with a population density of. people per km, and falls into socio-economic Quintile. Gert Sibande is one of the Health Insurance (NHI) pilot districts. Population distribution, sub-district boundaries and health facility locations: Gert Sibande (DC0)

2 Section B: Profile Mpumalanga and Province Profiles Burden of disease profile Percentage of deaths by broad cause and leading causes, 00 0: Gert Sibande (DC0) Percentage of deaths by broad cause and leading causes, 00-0 MP, G Sibande: DC0 Broad age.. Female Male < years - 0.% 0.%.%.%.%.%.0% 0.0%.%.%.%.% -.% 0.%.%.%.%.%.%.0% Prov, MP, G Sibande: DC0 Show History - +.%.%.%.% 0.% Total.%.%.%.% 0.0%.0%.%.0%.%.%.%.%.%.0% Broadcause Injury NCD HIV and TB Comm_mat_peri_nut Broad age < years.0%.%.% % 0.%.% 0.%.%.%.0%.%.%.%.% 0.%.%.%.%.% -.%.%.%.%.%.%.% +.%.0%.%.% < years Rank Diarrhoeal diseases (.%) Lower respiratory infections (.%) Diarrhoeal diseases (.%) Lower respiratory infections (.%) Preterm birth complications (0.%) Preterm birth complications (.0%) Birth asphyxia (.%) Birth asphyxia (.%) HIV/AIDS (.%) HIV/AIDS (.%) Protein-energy malnutrition (.%) Protein-energy malnutrition (.%) Tuberculosis (.%) Other perinatal conditions (.%) Other perinatal conditions (.%) Sepsis/other newborn infectious (.%) Poisonings (including herbal) (.%) Tuberculosis (.%) Poisonings (including herbal) (.%) Fires, hot substances (.%) Lower respiratory infections (.0%) Lower respiratory infections (.%) Diarrhoeal diseases (.%) HIV/AIDS (.0%) Tuberculosis (.%) Road injuries (.%) HIV/AIDS (0.%) Tuberculosis (.0%) Road injuries (.0%) Diarrhoeal diseases (0.%) Meningitis/encephalitis (.%) Drowning (.%) Drowning (.%) Meningitis/encephalitis (.%) Accidental threats to breathing (.%) Epilepsy (.%) Epilepsy (.%) Accidental threats to breathing (.%) Mechanical forces (.%) Fires, hot substances (.%) Tuberculosis (.%) HIV/AIDS (.%) HIV/AIDS (.%) Tuberculosis (.%) Lower respiratory infections (.%) Lower respiratory infections (.%) Diarrhoeal diseases (.%) Road injuries (.%) Road injuries (.%) Accidental threats to breathing (.%) Accidental threats to breathing (.%) Interpersonal violence (.%) Meningitis/encephalitis (.%) Diarrhoeal diseases (.%) Interpersonal violence (.%) Meningitis/encephalitis (.%) Mechanical forces (.%) Mechanical forces (.0%) Endocrine nutritional,blood, immune (.%) Fires, hot substances (.%) Tuberculosis (.%) HIV/AIDS (0.%) HIV/AIDS (.0%) Tuberculosis (.%) Lower respiratory infections (.%) Lower respiratory infections (.%) Diarrhoeal diseases (.%) Diarrhoeal diseases (.0%) Cerebrovascular disease (.%) Road injuries (.0%) Meningitis/encephalitis (.0%) Cerebrovascular disease (.%) Hypertensive heart disease (.%) Diabetes mellitus (.%) Diabetes mellitus (.%) Hypertensive heart disease (.%) Road injuries (.%) Meningitis/encephalitis (.%) Ischaemic heart disease (.%) Ischaemic heart disease (.%) Cerebrovascular disease (.%) Cerebrovascular disease (.%) Hypertensive heart disease (.%) Hypertensive heart disease (.%) Lower respiratory infections (.%) Lower respiratory infections (.%) Ischaemic heart disease (.%) Diabetes mellitus (.%) Diabetes mellitus (.%) Ischaemic heart disease (.%) Diarrhoeal diseases (.%) Diarrhoeal diseases (.%) Tuberculosis (.%) Tuberculosis (.%) COPD (.%) COPD (.%) Nephritis/nephrosis (.%) HIV/AIDS (.%) HIV/AIDS (.%) Nephritis/nephrosis (.%) 0

3 Section B: Profile Mpumalanga and Province Profiles Broad cause groups by age and gender In the under--year age group, communicable diseases and maternal, perinatal and nutritional conditions accounted for 0% of deaths among both males and females. This was followed by HIV and TB deaths around % for both females and males. In the -year age group, communicable diseases and maternal, perinatal and nutritional conditions accounted for 0.% of deaths among females and % of deaths among males, while HIV and TB accounted for.% of deaths among females and.% of deaths among males. Males had a higher proportion of deaths attributable to non-communicable diseases than females, and a higher percentage of injury-related deaths. In the -year age group, injury accounted for.0% of deaths in males and only.% in females, while HIV accounted for 0.% of deaths in females compared with only.% of deaths in males. In the -year age group, approximately % of males and females died from HIV and TB. Non-communicable diseases accounted for a higher proportion of deaths among females than males (0.% versus.%). There were also slightly more deaths due to communicable diseases and maternal, perinatal and nutritional conditions among females than males. However, there were more injury-related deaths among males than females (.% versus.%) in this age group. In the -years-and-older age group, non-communicable diseases accounted for most deaths in both genders (.% among females and.% among males). Trends in broad cause groups by age The majority of deaths in children under years remained attributable to communicable diseases and maternal, perinatal and nutritional conditions, although there was decline from.0% to.% between and 0 0. There was a slight increase in all the other broad causes. In the -year age group, deaths due to communicable diseases and maternal, perinatal and nutritional conditions also dominated; however, there was a decline from 0.% to.% between the two periods. Deaths due to non-communicable diseases and injuries increased in this age group. In the -year age group, deaths due to HIV and TB remained stable at around 0%. Injury-related deaths were the highest in this age group at.%, having increased from.% in In the -year age group, non-communicable disease mortality and HIV and TB deaths increased, while there was a decline in deaths due to communicable diseases and maternal, perinatal and nutritional conditions from.% to.%. Injury-related deaths also declined in this age group. In the -years-and-older age group, non-communicable diseases accounted for most of the deaths, with a slight increase from.0% to.%. There was not much change in the other broad cause groups. Trends in leading causes of death by age Under years There was no change in the top six leading causes of death, namely diarrhoeal diseases, lower respiratory infections, preterm birth complications, birth asphyxia, HIV and AIDS and protein-energy malnutrition. Tuberculosis fell to ninth place, other perinatal conditions moved to seventh place, and poisonings (including herbal) moved up the ranks. Sepsis/ other newborn infectious diseases dropped out of the top 0 leading causes of death, replaced by deaths due to fires and hot substances. years Lower respiratory infections remained the leading cause of death, followed by HIV and AIDS, which moved up from fourth position. Other deaths in the top five were still attributable to road injuries, TB and diarrhoeal diseases. Drowning, meningitis/encephalitis, epilepsy and accidental threats to breathing remained in the top 0, with mechanical forces replaced by deaths due to fire and hot substances. years HIV and AIDS, TB and lower respiratory infections remained the leading causes of death in this age group, with HIV and AIDS replacing TB as number one. There were fewer deaths due to diarrhoeal diseases in 0 0 than in However, there was an increase in deaths due to interpersonal violence. Other leadings causes of death included meningitis/encephalitis and mechanical forces, while death due to fire and hot substances replaced endocrine, nutritional, blood and immune diseases in the top 0. years The same trend was observed in this age group (as in the -year age group), with HIV and AIDS, TB and lower respiratory infections remaining the leading cause of death, and HIV and AIDS replacing TB as the leading cause of death. Diarrhoeal diseases remained unchanged in fourth position, while road injuries move up from ninth to fifth position. Other leading

4 Section B: Profile Mpumalanga and Province Profiles causes of death included cerebrovascular disease, diabetes mellitus, hypertensive heart disease, meningitis/encephalitis and ischaemic heart disease. years and older The five leading causes of death in this age group remained largely unchanged, namely cerebrovascular disease, hypertensive heart disease, lower respiratory infections, diabetes mellitus and ischaemic heart disease, with diabetes mellitus moving up in the ranking. Other conditions included diarrhoeal diseases, TB, chronic obstructive pulmonary disease, HIV and AIDS and nephritis/nephrosis. Indicator performance: Gert Sibande (DC0) value ranking Category Indicator 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ Management PHC supervisor visit rate PHC (fixed clinic/chc/cdc) Management Average length of stay Inpatients (district hospitals) [Days] Expenditure per patient day equivalent (district hospitals) [Rand (real 0/ prices)] Inpatient bed utilisation rate (district hospitals) OPD new client not referred rate (district hospitals) Mortality Child under years diarrhoea Inpatients case fatality rate Child under years pneumonia case fatality rate Child under years severe acute malnutrition case fatality rate Inpatient crude death rate Delivery Delivery by Caesarean section rate (district hospitals) Delivery in facility under years rate Inpatient early neonatal death rate [per 000 live births] Maternal mortality in facility ratio [per live births] Mother postnatal visit within days rate Stillbirth in facility rate [per 000 births] PMTCT Antenatal st visit before 0 weeks rate Antenatal client initiated on ART rate Infant st PCR test around weeks uptake rate Infant st PCR test positive around weeks rate Child Health School Grade screening coverage Vitamin A dose - months coverage Immunisation Immunisation coverage under year Measles nd dose coverage Reproductive health TB case finding Cervical cancer screening coverage ( Couple year protection rate TB Rifampicin resistance confirmed client rate

5 Section B: Profile Mpumalanga and Province Profiles value ranking Category Indicator 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ HIV HIV testing coverage (including ANC) Male condom distribution coverage Noncommunicable diseases Human Resources Hypertension incidence [per 000] Mental health admission rate PHC doctor clinical workload [Clients per doctor per day] PHC professional nurse clinical workload [Clients per nurse per day] value ranking Category Indicator TB case finding Incidence (diagnosed cases) of TB - all types [Cases per TB treatment outcomes HIV NCDs Burden of disease population] TB cure rate (new smear positive)..... TB death rate (all TB) TB defaulter rate (new smear positive) TB treatment success rate (all TB) Percentage of TB cases with known..... HIV status (ETR.Net) TB/HIV co-infected client on ART rate (ETR.Net) Hypertension prevalence rate... (crude) Percentage of deaths garbage codes Percentage of deaths ill-defined Percentage of YLLs due to communicable, maternal, perinatal, nutrition causes Percentage of YLLs due to HIV and TB Percentage of YLLs due to injuries Percentage of YLLs due to non-communicable diseases Value in red improvement strategies are urgently needed Value highlighted in yellow performance is ranked among the 0 best in the country Value highlighted in red performance is ranked among the 0 worst in the country The district performed very well with regard to some indicators, which ranked among the 0 best in the country in the last reporting period. These indicators were: Maternal mortality in facility ratio (third lowest in the country) Male condom distribution coverage Incidence (diagnosed cases) of TB (all types) Hypertension prevalence rate (crude) (second lowest in the country) Percentage of years of life lost (YLLs) due to non-communicable diseases (third lowest in the country) However, the performance of 0 indicators ranked among the 0 worst in the country. These indicators were: Child under years severe acute malnutrition case fatality rate (highest in the country) Mother postnatal visit within days rate Antenatal st visit before 0 weeks rate Antenatal client initiated on ART rate

6 Section B: Profile Mpumalanga and Province Profiles TB Rifampicin resistance confirmed client rate HIV testing coverage (including ANC) Percentage of TB cases with known HIV status Percentage of YLLs due to communicable, maternal, perinatal and nutritional causes Although the district recorded an improvement in the performance of several indicators over the past three years, improvement strategies are needed urgently for the following indicators, especially when compared with the district ranking, 0/ provincial and national s, and the 0/ and 0/ provincial and national s. These indicators are: PHC supervisor visit rate (fixed clinic/chc/cdc) Inpatient bed utilisation rate (district hospitals) OPD new client not referred rate (district hospitals) Child under years diarrhoea case fatality rate Child under years severe acute malnutrition case fatality rate Delivery by Caesarean section rate (district hospitals) Mother postnatal visit within days rate Stillbirth in facility rate Antenatal st visit before 0 weeks rate Antenatal client initiated on ART rate School Grade screening coverage Vitamin A dose months coverage Immunisation coverage under year Measles nd dose coverage Couple year protection rate TB Rifampicin resistance confirmed client rate HIV testing coverage (including ANC) PHC doctor clinical workload PHC professional nurse clinical workload TB death rate (all TB) TB treatment success rate (all TB) Percentage of TB cases with known HIV status Percentage of YLLs due to communicable, maternal, perinatal and nutritional causes Percentage of YLLs due to HIV and TB

7 Section B: Profile Mpumalanga and Province Profiles Annual indicators for district: Gert Sibande (DC0) 0 0_Fixed PHC super vis rate.0 0_Avg length of stay (DH) 0_Child < diar fat rate 0_Child < pneumo death _Child < sev mal fata 0_Crude death rate 0_Expenditure per PDE 0_OPD new not ref rate (DH) _Usable bed util (DH) 0_Caesarean sect (DH) 0_Deliv in fac < 0_IP early neo death rate _Maternal Mort ratio yy 0_Posnatal mother <d 0_Stillbirth rate 0_ANC st visit <0 w rate _ANC initiate ART rate 00 0_Infant PCR w uptake rate 0 0_Infant PCR pos w rate 0_School G screen cov yy value ZA (national)

8 Section B: Profile Mpumalanga and Province Profiles Annual indicators for district: Gert Sibande (DC0) 0_VitA mm cov yy 0_Imm cov < yy 0_Measles nd cov yy 0_Cerv cancer screen cov yy _Couple Year Prot Rate yy 0 0_New pulmonary TB LTF rate 0_RIF resistance rate 0 0_TB cure rate new sm _TB deaths all TB 0_TB inc all TB 0_TB success all TB 0_HIV test cov inc ANC _Male cond dist cov yy 0_TB known HIV status 0_TB/HIV on ART _Hypertension prevalence _Mental hlth adm rate _PHC dr clinical work load _PHC PN clin workload _Garbage codes value ZA (national)

9 Section B: Profile Mpumalanga and Province Profiles Nkangala Municipality (DC) Naomi Massyn and Noluthando Ndlovu Nkangala is situated in Mpumalanga Province and has six sub-districts: Dr JS Moroka, Emakhazeni, Emalahleni, Steve Tshwete, Thembisile Hani and Victor Khanye. The district has a population of, with a population density of people per km and falls into socio-economic Quintile. Population distribution, sub-district boundaries and health facility locations: Nkangala (DC)

10 Section B: Profile Mpumalanga and Province Profiles Burden of disease profile Percentage of deaths by broad cause and leading causes, 00 0: Nkangala (DC) Percentage of deaths by broad cause and leading causes, 00-0 MP, Nkangala: DC Broad age.. Female Male < years -.%.% 0.0% 0.%.%.%.%.%.0%.%.% - 0.%.%.%.%.0%.%.%.% Prov, MP, Nkangala: DC Show History - +.%.%.%.%.% Total.%.%.%.%.0%.%.%.%.%.%.%.%.% Broadcause Injury NCD HIV and TB Comm_mat_peri_nut Broad age < years %.%.%.%.%.0%.%.%.%.%.%.%.%.%.0%.%.%.%.%.%.%.0%.%.0% 0.%.%.0%.%.%.% < years Rank Diarrhoeal diseases (.%) Lower respiratory infections (.0%) Preterm birth complications (.%) HIV/AIDS (.%) Birth asphyxia (.%) Protein-energy malnutrition (.0%) Tuberculosis (.%) Septicaemia (.%) Sepsis/other newborn infectious (.0%) Poisonings (including herbal) (.0%) Lower respiratory infections (.%) Road injuries (.%) Diarrhoeal diseases (.%) HIV/AIDS (.%) Tuberculosis (.%) Drowning (.%) Fires, hot substances (.%) Meningitis/encephalitis (.%) Epilepsy (.%) Poisonings (including herbal) (.%) Tuberculosis (.%) Road injuries (.%) Lower respiratory infections (.0%) HIV/AIDS (0.%) Diarrhoeal diseases (.%) Accidental threats to breathing (.%) Fires, hot substances (.%) Poisonings (including herbal) (.%) Meningitis/encephalitis (.%) Interpersonal violence (.%) Tuberculosis (.%) Lower respiratory infections (.0%) HIV/AIDS (.%) Diarrhoeal diseases (.%) Road injuries (.%) Hypertensive heart disease (.%) Ischaemic heart disease (.0%) Cerebrovascular disease (.%) Diabetes mellitus (.%) COPD (.%) Hypertensive heart disease (.0%) Cerebrovascular disease (.%) Lower respiratory infections (.0%) Diabetes mellitus (.%) Ischaemic heart disease (.%) Diarrhoeal diseases (.%) COPD (.%) Tuberculosis (.%) Nephritis/nephrosis (.%) Other circulatory diseases (.0%) Lower respiratory infections (.%) Diarrhoeal diseases (.%) Preterm birth complications (.0%) Birth asphyxia (.%) HIV/AIDS (.%) Protein-energy malnutrition (.0%) Sepsis/other newborn infectious (.%) Poisonings (including herbal) (.%) Other perinatal conditions (.%) Accidental threats to breathing (.%) Lower respiratory infections (.%) Diarrhoeal diseases (.%) HIV/AIDS (.%) Tuberculosis (0.%) Road injuries (.%) Drowning (.%) Accidental threats to breathing (.%) Fires, hot substances (.%) Poisonings (including herbal) (.%) Meningitis/encephalitis (.%) HIV/AIDS (.%) Accidental threats to breathing (.%) Lower respiratory infections (.%) Tuberculosis (0.0%) Road injuries (.%) Poisonings (including herbal) (.%) Mechanical forces (.%) Meningitis/encephalitis (.0%) Diarrhoeal diseases (.%) Exposure to natural forces (.%) HIV/AIDS (.%) Tuberculosis (.%) Lower respiratory infections (.%) Hypertensive heart disease (.%) Ischaemic heart disease (.%) Cerebrovascular disease (.%) Road injuries (.%) Diabetes mellitus (.%) Diarrhoeal diseases (.%) Poisonings (including herbal) (.%) Hypertensive heart disease (0.%) Cerebrovascular disease (.%) Lower respiratory infections (0.%) Diabetes mellitus (.%) Ischaemic heart disease (.%) Tuberculosis (.%) COPD (.%) Nephritis/nephrosis (.%) Diarrhoeal diseases (.%) Septicaemia (.0%)

11 Section B: Profile Mpumalanga and Province Profiles Broad cause groups by age and gender In the under--year age group, communicable diseases and maternal, perinatal and nutritional conditions contributed to about % of deaths among both male and female children. HIV and TB, non-communicable diseases and injuries, each accounted for less than 0% of deaths among both males and females in this age group. Although the proportion was not as high as in the previous group, communicable diseases together with maternal, perinatal and nutritional conditions contributed the most to deaths in the -year age group for both males and females. Injuryrelated deaths among males (.%) were higher than among females (.%), and deaths due to non-communicable diseases were slightly higher among females than males. In the -year age group, injuries accounted for almost 0% of deaths among males, compared with only.% of deaths among females. The main leading broad causes of death among females in this age group were spread almost evenly between HIV and TB (.%), and communicable diseases together with maternal, perinatal and nutritional conditions (0.%) respectively. Deaths due to HIV and TB were the lowest among males at.%. In the -year age group, non-communicable diseases were the leading broad cause of death for both males and females. This was followed closely by HIV and TB (.% among males and.% among females). Deaths due to communicable diseases and maternal, perinatal and nutritional conditions were higher among females than males (.% versus.%), while injury-related deaths were much higher among males than females (.% versus.%). In the -years-and-older age group, non-communicable diseases were the predominant broad cause of death, accounting for.% of deaths among females and.% among males. Trends in broad cause groups by age Broad cause trends remained relatively consistent between and 0 0 for children under years and those in the -year, -year, -year, and -years-and-older age groups. Trends in leading causes of death by age Under years Lower respiratory infections, diarrhoeal diseases, preterm birth complications, birth asphyxia and HIV and AIDS remained the top five leading causes of death in children under years of age, followed by protein-energy malnutrition. Tuberculosis and septicaemia dropped out of the top 0 leading causes of death and were replaced by other perinatal conditions and accidental threats to breathing. Sepsis/other newborn infectious diseases and poisonings (including herbal) both moved up in the rankings. years The top five leading causes of death remained unchanged over the two periods and included lower respiratory infections, diarrhoeal diseases, HIV and AIDS, TB and road injuries. A new addition to the top 0 causes was accidental threats to breathing (number ), while epilepsy dropped out of the top 0. Deaths due to drowning, fires and hot substances, meningitis/encephalitis, and poisonings (including herbal), were still part of the top 0. years HIV and AIDS replaced TB as the number one leading cause of death in 0 0, moving up from fourth position in This could be due to more accurate reporting of HIV on death certificates. Tuberculosis dropped from first to fourth place, while accidental threats to breathing peaked as the second leading cause of death, up from a previous sixth position. Lower respiratory infections and road injuries still featured prominently, in addition to poisonings (including herbal), diarrhoeal diseases and meningitis/encephalitis. Deaths due to exposure to natural forces took 0th place, replacing interpersonal violence. years Tuberculosis moved down the rankings to become the second leading cause of death, followed by lower respiratory infections, while HIV and AIDS moved up to become the first leading cause of death. Diarrhoeal diseases dropped from fourth to ninth position; they were replaced by hypertensive heart disease, ischaemic heart disease and cerebrovascular disease. Road injuries and diabetes mellitus still featured in the top 0, while chronic obstructive pulmonary disease dropped out of the top 0 and was replaced by poisonings (including herbal). years and older The top five leading causes of death remained unchanged in this age group between the two periods, and included hypertensive heart disease, cerebrovascular disease, lower respiratory infections, diabetes mellitus and ischaemic heart disease. Tuberculosis and nephritis/nephrosis moved up the rankings, while diarrhoeal diseases moved down.

12 Section B: Profile Mpumalanga and Province Profiles Indicator performance: Nkangala (DC) value ranking Category Indicator 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ Management PHC supervisor visit rate PHC (fixed clinic/chc/cdc) Management Average length of stay Inpatients (district hospitals) [Days] Expenditure per patient day equivalent (district hospitals) [Rand (real 0/ prices)] Inpatient bed utilisation rate (district hospitals) OPD new client not referred rate (district hospitals) Mortality Child under years Inpatients diarrhoea case fatality rate Child under years pneumonia case fatality rate Child under years severe acute malnutrition case fatality rate Inpatient crude death rate Delivery Delivery by Caesarean..... section rate (district hospitals) Delivery in facility under years rate Inpatient early neonatal death rate [per 000 live births] Maternal mortality in facility ratio [per live births] Mother postnatal visit within days rate Stillbirth in facility rate [per births] PMTCT Antenatal st visit before weeks rate Antenatal client initiated on ART rate Infant st PCR test around weeks uptake rate Infant st PCR test positive around weeks rate Child Health School Grade screening coverage Vitamin A dose months coverage Immunisation Immunisation coverage under year Measles nd dose coverage Reproductive Cervical cancer screening health coverage Couple year protection rate TB case finding TB Rifampicin resistance..... confirmed client rate HIV HIV testing coverage (including ANC) Male condom distribution coverage Noncommunicable Hypertension incidence [per diseases 000] Mental health admission rate Human PHC doctor clinical workload..... Resources [Clients per doctor per day] PHC professional nurse clinical workload [Clients per nurse per day]

13 Section B: Profile Mpumalanga and Province Profiles value ranking Category Indicator TB case finding Incidence (diagnosed cases) of TB - all types [Cases per TB treatment outcomes HIV NCDs Burden of disease population] TB cure rate (new smear positive)..... TB death rate (all TB) TB defaulter rate (new smear positive) TB treatment success rate (all TB) Percentage of TB cases with known HIV status (ETR.Net) TB/HIV co-infected client on ART rate (ETR.Net) Hypertension prevalence rate... (crude) Percentage of deaths garbage codes Percentage of deaths ill-defined Percentage of YLLs due to..... communicable, maternal, perinatal, nutrition causes Percentage of YLLs due to HIV and TB Percentage of YLLs due to injuries Percentage of YLLs due to non-communicable diseases Value in red improvement strategies are urgently needed Value highlighted in yellow performance is ranked among the 0 best in the country Value highlighted in red performance is ranked among the 0 worst in the country The district performed very well with regard to some indicators, which ranked among the 0 best in the country in the last reporting period. These indicators were: Average length of stay (district hospitals) Expenditure per patient day equivalent for district hospitals Inpatient early neonatal death rate PHC professional nurse clinical workload Incidence (diagnosed cases) of TB (all types) Percentage of TB cases with known HIV status However, the performance of nine indicators ranked among the 0 worst in the country. These indicators were: Child under years pneumonia case fatality rate Inpatient crude death rate Stillbirth in facility rate School Grade screening coverage Immunisation coverage under year Measles nd dose coverage Couple year protection rate (second lowest in the country) Percentage of deaths garbage codes (highest in the country) Percentage of years of life lost (YLLs) due to injuries Although the district recorded an improvement in the performance of several indicators over the past three years, improvement strategies are needed urgently for the following indicators, especially when compared with the district ranking, 0/ provincial and national s, and the 0/ and 0/ provincial and national s. These indicators are: Average length of stay (district hospitals) PHC supervisor visit rate (fixed clinic/chc/cdc)

14 Section B: Profile Mpumalanga and Province Profiles Inpatient bed utilisation rate (district hospitals) OPD new client not referred rate (district hospitals) Child under years diarrhoea case fatality rate Child under years pneumonia case fatality rate Child under years severe acute malnutrition case fatality rate Inpatient crude death rate Maternal mortality in facility ratio Mother postnatal visit within days rate Stillbirth in facility rate Antenatal st visit before 0 weeks rate School Grade screening coverage Vitamin A dose months coverage Immunisation coverage under year Measles nd dose coverage Cervical cancer screening coverage Couple year protection rate HIV testing coverage (including ANC) Male condom distribution coverage PHC doctor clinical workload TB death rate (all TB) TB defaulter rate (new smear positive) TB treatment success rate (all TB) Percentage of deaths garbage codes Percentage of YLLs due to communicable, maternal, perinatal, nutrition causes Percentage of YLLs due to injuries

15 Section B: Profile Mpumalanga and Province Profiles Annual indicators for district: Nkangala (DC) 0_Fixed PHC super vis rate 0_Avg length of stay (DH) 0_Child < diar fat rate 0_Child < pneumo death _Child < sev mal fata.0 0_Crude death rate _Expenditure per PDE 0 0_OPD new not ref rate (DH) _Usable bed util (DH) 0_Caesarean sect (DH) 0_Deliv in fac < 0_IP early neo death rate _Maternal Mort ratio yy 0_Posnatal mother <d 0_Stillbirth rate 0_ANC st visit <0 w rate _ANC initiate ART rate 0_Infant PCR w uptake rate 0_Infant PCR pos w rate 0_School G screen cov yy value ZA (national)

16 Section B: Profile Mpumalanga and Province Profiles Annual indicators for district: Nkangala (DC) 0 0_VitA mm cov yy 00 0_Imm cov < yy 0 0_Measles nd cov yy 0 0 0_Cerv cancer screen cov yy _Couple Year Prot Rate yy.0 0_New pulmonary TB LTF rate 0_RIF resistance rate 0_TB cure rate new sm _TB deaths all TB 0_TB inc all TB 0_TB success all TB 0_HIV test cov inc ANC _Male cond dist cov yy 0_TB known HIV status 0_TB/HIV on ART _Hypertension prevalence _Mental hlth adm rate _PHC dr clinical work load _PHC PN clin workload _Garbage codes value ZA (national)

17 Section B: Profile Mpumalanga and Province Profiles Ehlanzeni Municipality (DC) Naomi Massyn and Noluthando Ndlovu Ehlanzeni is situated in Mpumalanga Province and has five sub-districts: Bushbuckridge, Mbombela, Nkomazi, Thaba Chweu and Umjindi. It shares borders with Swaziland and Mozambique. The district has a population of, with a population density of. people per km. It falls into socio-economic Quintile, among the second-wealthiest districts. Population distribution, sub-district boundaries and health facility locations: Ehlanzeni (DC

18 Section B: Profile Mpumalanga and Province Profiles Burden of disease profile Percentage of deaths by broad cause and leading causes, 00 0: Ehlanzeni (DC) Percentage of deaths by broad cause and leading causes, 00-0 MP, Ehlanzeni: DC Broad age.. Female Male < years.%.%.% - 0.%.%.%.%.%.%.%.% -.%.%.%.%.%.%.% Prov, MP, Ehlanzeni: DC Show History - +.%.%.%.0%.% Total.%.%.%.%.%.%.% 0.% 0.%.%.% 0.%.%.% Broadcause Injury NCD HIV and TB Comm_mat_peri_nut Broad age < years.%.%.% - -.%.%.%.0%.%.%.%.%.0%.%.%.%.%.% 0.%.% -.%.%.%.%.%.%.% + 0.%.%.%.%.% < years Rank Diarrhoeal diseases (0.%) Diarrhoeal diseases (.%) Lower respiratory infections (.%) Lower respiratory infections (.%) Preterm birth complications (.%) Preterm birth complications (0.%) HIV/AIDS (.%) HIV/AIDS (.%) Birth asphyxia (.%) Birth asphyxia (.%) Protein-energy malnutrition (.%) Protein-energy malnutrition (.%) Tuberculosis (.%) Tuberculosis (.%) Septicaemia (.%) Sepsis/other newborn infectious (.0%) Sepsis/other newborn infectious (.%) Other perinatal conditions (.%) 0 Meningitis/encephalitis (.%) Septicaemia (.%) Tuberculosis (.%) Tuberculosis (.%) Diarrhoeal diseases (.%) Diarrhoeal diseases (.%) Lower respiratory infections (.%) Lower respiratory infections (.%) Road injuries (.%) HIV/AIDS (.0%) HIV/AIDS (.%) Road injuries (.%) Meningitis/encephalitis (.%) Drowning (.%) Drowning (.%) Meningitis/encephalitis (.%) Cerebrovascular disease (.0%) Cerebrovascular disease (.%) Other unintentional injuries (.0%) Septicaemia (.%) 0 Septicaemia (.%) Other unintentional injuries (.%) Tuberculosis (.0%) Tuberculosis (.%) HIV/AIDS (.%) HIV/AIDS (.%) Lower respiratory infections (.%) Road injuries (.%) Road injuries (0.%) Lower respiratory infections (.%) Diarrhoeal diseases (.%) Diarrhoeal diseases (.%) Interpersonal violence (.%) Meningitis/encephalitis (.%) Meningitis/encephalitis (.%) Mechanical forces (.%) Accidental threats to breathing (.%) Accidental threats to breathing (.0%) Mechanical forces (.%) Interpersonal violence (.%) 0 Cerebrovascular disease (.%) Septicaemia (.%) Tuberculosis (.%) Tuberculosis (.%) HIV/AIDS (.0%) HIV/AIDS (0.%) Lower respiratory infections (.%) Lower respiratory infections (.%) Diarrhoeal diseases (.%) Diarrhoeal diseases (.%) Cerebrovascular disease (.%) Cerebrovascular disease (.%) Meningitis/encephalitis (.%) Road injuries (.%) Road injuries (.%) Meningitis/encephalitis (.0%) Diabetes mellitus (.%) Diabetes mellitus (.%) Hypertensive heart disease (.%) Ischaemic heart disease (.%) 0 Endocrine nutritional,blood, immune (.%) Hypertensive heart disease (.%) Cerebrovascular disease (0.%) Cerebrovascular disease (.%) Hypertensive heart disease (0.0%) Hypertensive heart disease (0.%) Lower respiratory infections (.%) Tuberculosis (.%) Diarrhoeal diseases (.%) Diabetes mellitus (.%) Tuberculosis (.%) Lower respiratory infections (.%) Diabetes mellitus (.0%) Ischaemic heart disease (.%) Ischaemic heart disease (.0%) Diarrhoeal diseases (.%) Cardiomyopathy (.%) Nephritis/nephrosis (.%) Nephritis/nephrosis (.%) Septicaemia (.%) 0 HIV/AIDS (.%) HIV/AIDS (.%)

19 Section B: Profile Mpumalanga and Province Profiles Broad cause groups by age and gender In the under--year age group, communicable diseases and maternal, perinatal and nutritional conditions accounted for.% of female deaths and.% of male. HIV and TB accounted for about % of deaths among females and slightly less among males. In the -year age group, there was only a slight gender variation in the proportion of deaths due to communicable diseases and maternal, perinatal and nutritional conditions (.% among males versus 0.% among females). There was a more pronounced male-female difference for injury-related deaths (.% versus.%). The differences for HIV and TB deaths were.% (male) versus.% (female), and for non-communicable diseases the proportions were.% (male) versus.% (female). In the -year age group there was a big difference in the major broad causes of death for males and females. HIV and TB accounted for more deaths among females than males (.% versus.%), while injuries accounted for more deaths among males than females (.% versus 0.%). More female deaths were due to communicable diseases and maternal, perinatal and nutritional conditions (.%) than was the case for males (.%). In the -year age group, HIV and TB were the main broad cause of death for both males and females at around 0% each. However, there was almost four times the number of injury-related deaths among males (.%) than females (.%). In the -years-and-older age group, non-communicable diseases accounted for.0% of deaths in females and.% of deaths in males. Deaths due to HIV and TB were slightly higher in males (.%) than females. Trends in broad cause groups by age Although communicable diseases and maternal, perinatal and nutritional conditions still accounted for most deaths in the under--year age group, figures declined from.% to.% between and 0 0. In the -year age group, deaths due to communicable diseases together with maternal, perinatal and nutritional conditions and HIV and TB declined, while deaths due to non-communicable diseases and injuries increased. Similar trends were observed in the -year age group, with a nearly percentage point decline in deaths due to communicable diseases and maternal, perinatal and nutritional conditions, and an increase from.% to.% for deaths due to non-communicable diseases. In the -year age group deaths due to communicable diseases and maternal, perinatal and nutritional conditions decreased from.% to.%, while all other broad causes increased. In the -and-older age group, deaths due to non-communicable diseases increased from.% to.%, while deaths due to communicable diseases and maternal, perinatal and nutritional conditions and injuries declined. Trends in leading causes of death by age Under years The leading causes of death remained largely unchanged in the top 0, with the exception of meningitis/encephalitis, which was replaced as other perinatal conditions and septicaemia moved up the ranks. Diarrhoeal diseases, lower respiratory infections, preterm birth complications, HIV and AIDS and birth asphyxia were among the leading causes of death. years Tuberculosis, diarrhoeal diseases and lower respiratory infections remained the leading causes of death, in addition to HIV and AIDS (which moved up the ranks) and road injuries. The rest of the list of top leading causes of death remained unchanged, with the exception of drowning and septicaemia, which moved up the ranks, and meningitis/encephalitis and other unintentional injuries, which dropped down. years Tuberculosis and HIV and AIDS still topped the leading causes of death, followed by road injuries, lower respiratory infections and diarrhoeal diseases. Most notably, interpersonal violence moved down the ranks from sixth to ninth place, while septicaemia replaced cerebrovascular disease in the top 0. years The top five leading causes of death remained unchanged, namely TB, HIV and AIDS, lower respiratory infections, diarrhoeal diseases and cerebrovascular disease. Road injuries moved up the ranks, while meningitis/encephalitis and hypertensive heart disease moved down and diabetes mellitus remained the same. Endocrine, nutritional, blood and immune diseases were replaced by ischaemic heart disease. years and older Cerebrovascular disease and hypertensive heart disease remained the leading causes of death over the two periods. TB moved up the ranks to become the third leading cause of death, replacing lower respiratory infections, which moved

20 Section B: Profile Mpumalanga and Province Profiles down to fifth position. Diabetes mellitus also moved up the ranks, from sixth to fourth position. Diarrhoeal diseases moved down the ranks, while ischaemic heart disease and nephritis/nephrosis moved up. Septicaemia replaced cardiomyopathy, and HIV and AIDS completed the top 0. Indicator performance: Ehlanzeni (DC value ranking Category Indicator 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ Management PHC supervisor visit rate PHC (fixed clinic/chc/cdc) Management Average length of stay Inpatients (district hospitals) [Days] Expenditure per patient day equivalent (district hospitals) [Rand (real 0/ prices)] Inpatient bed utilisation rate (district hospitals) OPD new client not referred rate (district hospitals) Mortality Child under years Inpatients diarrhoea case fatality rate Child under years pneumonia case fatality rate Child under years severe acute malnutrition case fatality rate Inpatient crude death rate..... Delivery Delivery by Caesarean..... section rate (district hospitals) Delivery in facility under years rate Inpatient early neonatal death rate [per 000 live births] Maternal mortality in facility ratio [per live births] Mother postnatal visit within days rate Stillbirth in facility rate [per births] PMTCT Antenatal st visit before weeks rate Antenatal client initiated on ART rate Infant st PCR test around weeks uptake rate Infant st PCR test positive around weeks rate Child Health School Grade screening coverage Vitamin A dose months coverage Immunisation Immunisation coverage under year Measles nd dose coverage Reproductive Cervical cancer screening health coverage ( Couple year protection rate TB case finding TB Rifampicin resistance confirmed client rate HIV HIV testing coverage (including ANC) Male condom distribution coverage Noncommunicable Hypertension incidence [per diseases 000] Mental health admission rate

21 Section B: Profile Mpumalanga and Province Profiles value ranking Category Indicator 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ 0/ Human PHC doctor clinical workload Resources [Clients per doctor per day] PHC professional nurse clinical workload [Clients per nurse per day]..... value ranking Category Indicator TB case finding Incidence (diagnosed cases) of TB - all types [Cases per TB treatment outcomes HIV NCDs Burden of disease population] TB cure rate (new smear positive) TB death rate (all TB) TB defaulter rate (new smear positive) TB treatment success rate (all TB) Percentage of TB cases with known HIV status (ETR.Net) TB/HIV co-infected client on ART rate (ETR.Net) Hypertension prevalence rate... (crude) Percentage of deaths garbage codes Percentage of deaths ill-defined Percentage of YLLs due to..... communicable, maternal, perinatal, nutrition causes Percentage of YLLs due to HIV and TB Percentage of YLLs due to injuries Percentage of YLLs due to non-communicable diseases Value in red improvement strategies are urgently needed Value highlighted in yellow performance is ranked among the 0 best in the country Value highlighted in red performance is ranked among the 0 worst in the country The district performed very well with regard to some indicators, which ranked among the 0 best in the country in the last reporting period. These indicators were: Average length of stay (district hospitals) (although above the provincial ) Inpatient early neonatal death rate Antenatal st visit before 0 weeks rate Cervical cancer screening coverage TB/HIV co-infected client on ART rate (highest in country) Hypertension prevalence rate (crude) Percentage of years of life lost (YLLs) due to injuries Percentage of YLLs due to non-communicable diseases. However, the performance of seven indicators ranked among the 0 worst in the country. These indicators were: Child under years diarrhoea case fatality rate Child under years pneumonia case fatality rate (second highest in the country) Child under years severe acute malnutrition case fatality rate TB Rifampicin resistance confirmed client rate PHC professional nurse clinical workload Percentage of YLLs due to HIV and TB

22 Section B: Profile Mpumalanga and Province Profiles Although the district recorded an improvement in the performance of several indicators over the past three years, improvement strategies are needed urgently for the following indicators, especially when compared with the district ranking, 0/ provincial and national s, and the 0/ and 0/ provincial and national s. These indicators are: PHC supervisor visit rate (fixed clinic/chc/cdc) Average length of stay (district hospitals) Inpatient bed utilisation rate (district hospitals) OPD new client not referred rate (district hospitals) Child under years diarrhoea case fatality rate Child under years pneumonia case fatality rate Child under years severe acute malnutrition case fatality rate Inpatient crude death rate Delivery in facility under years rate Mother postnatal visit within days rate Antenatal st visit before 0 weeks rate Infant st PCR test positive around weeks rate School Grade screening coverage Vitamin A dose - months coverage Immunisation coverage under year Measles nd dose coverage Couple year protection rate TB Rifampicin resistance confirmed client rate Male condom distribution coverage PHC doctor clinical workload PHC professional nurse clinical workload TB cure rate (new smear positive) TB death rate (all TB) TB treatment success rate (all TB) Percentage of YLLs due to communicable, maternal, perinatal, nutrition causes Percentage of YLLs due to HIV and TB 0

23 Section B: Profile Mpumalanga and Province Profiles Annual indicators for district: Ehlanzeni (DC) 0_Fixed PHC super vis rate 0_Avg length of stay (DH) 0_Child < diar fat rate 0_Child < pneumo death _Child < sev mal fata. 0_Crude death rate 0_Expenditure per PDE 00 0_OPD new not ref rate (DH) _Usable bed util (DH) 0_Caesarean sect (DH) 0_Deliv in fac < 0_IP early neo death rate _Maternal Mort ratio yy 0_Posnatal mother <d 0_Stillbirth rate 0_ANC st visit <0 w rate _ANC initiate ART rate 0_Infant PCR w uptake rate 0_Infant PCR pos w rate 0_School G screen cov yy value ZA (national)

24 Section B: Profile Mpumalanga and Province Profiles Annual indicators for district: Ehlanzeni (DC) 0_VitA mm cov yy 0_Imm cov < yy 0_Measles nd cov yy 0_Cerv cancer screen cov yy _Couple Year Prot Rate yy 0_New pulmonary TB LTF rate 0_RIF resistance rate 0 0_TB cure rate new sm _TB deaths all TB 0_TB inc all TB 0_TB success all TB 0_HIV test cov inc ANC _Male cond dist cov yy 0_TB known HIV status 0_TB/HIV on ART _Hypertension prevalence _Mental hlth adm rate _PHC dr clinical work load _PHC PN clin workload _Garbage codes value ZA (national)