12 Non-communicable diseases - Health Systems Trust Health... · 185 Section A: Non-communicable...
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185 Section A: Non-communicable diseases 12 Non-communicable diseases Andre Pascal Kengne and Bilqees Sayed Non-communicable diseases (NCDs) are the leading cause of death globally and in South Africa. a,b The costs of NCDs to economies, individuals, societies and the health system are substantial, hence the importance of national and locally appropriate strategies to limit their impact. c Together with HIV/AIDS and tuberculosis, violence and injuries, maternal and child health, NCDs form the ‘quadruple burden of diseases’, a term used to describe the contemporary South African health challenges. d The co-morbidity of NCDs and major infectious diseases in the same individual is also increasingly common, with many people living with HIV infection and also having NCDs or their common risk factors. e This chapter focuses on two specific NCD indicators: (1) incidence of new diagnoses of hypertension in public health facilities and (2) incidence of new diagnoses of diabetes mellitus in public health facilities. 12.1 Hypertension incidence Hypertension or high blood pressure is the most common risk factor for cardiovascular disease (CVD) which is the leading NCD worldwide. The timely diagnosis of people with hypertension, followed by lifestyle changes and adherence to treatment regimens, substantially reduces the risk of complications associated with hypertension. The true incidence of hypertension would refer to the number of new cases of hypertension in the population in a community-based setting. The 2016 South Africa Demographic and Health Survey f indicates that in South Africa 46% of women and 44% of men age 15 years and older have hypertension. The prevalence of hypertension is particularly high in the Western Cape (52% of women and 59% of men), Northern Cape (53% of women and 52% of men), and Free State (54% of women and 48% of men); it is lowest in Limpopo (34% of women and 29% of men). The incidence of hypertension as defined by the National Indicator Data Set (NIDS) of the National Department of Health measures the number of people newly diagnosed and started on treatment for hypertension in public health facilities per 1 000 population aged 40 years and above. Therefore, the numerator indicates the number of new cases of hypertension started on treatment, regardless of the age of the patient, while the denominator includes everyone aged 40 years and above in the population. As such the resulting incidence rate will be overestimated to some extent, because some people (likely a small number) would be diagnosed and treated for hypertension before the age of 40 years. National overview The incidence of new hypertension diagnosis at the national level in 2016/17 was 18.9 cases per 1 000 population aged 40 years and above, reflecting sustained increases since 2014/2015 (Figure 1). a Pillay-van Wyk V, Msemburi W, Laubscher R, et al. (2016). Mortality trends and differentials in South Africa from 1997 to 2012: Second National Burden of Disease Study. Lancet Glob Health, 4(9):e642–53. b Statistics South Africa. Mortality and Causes of Death in South Africa, 2015: Findings from Death Notification. 2017, 27–28. c Kengne AP, June-Rose McHiza Z, Amoah AG, Mbanya JC. (2013). Cardiovascular diseases and diabetes as economic and developmental challenges in Africa. Prog Cardiovasc Dis. 56(3):302–13. d Kleinert S, Horton R. (2009). South Africa’s health: Departing for a better future? Lancet, 374(9692): 759–60. e Nguyen KA, Peer N, Mills EJ, Kengne AP. (2015). Burden, determinants, and pharmacological management of hypertension in HIV-positive patients and populations: A systematic narrative review. AIDS Rev. Apr-Jun,17 (2):83–95. f National Department of Health. South Africa Demographic and Health Survey, 2016. Key Indicators Report. National Department of Health. Pretoria, 2016. http://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00-092016.pdf [Accessed 30 July 2017].
Transcript of 12 Non-communicable diseases - Health Systems Trust Health... · 185 Section A: Non-communicable...
185
Section A: Non-communicable diseases
12 Non-communicable diseases Andre Pascal Kengne and Bilqees Sayed
Non-communicable diseases (NCDs) are the leading cause of death globally and in South Africa.a,b The costs of NCDs to economies, individuals, societies and the health system are substantial, hence the importance of national and locally appropriate strategies to limit their impact.c Together with HIV/AIDS and tuberculosis, violence and injuries, maternal and child health, NCDs form the ‘quadruple burden of diseases’, a term used to describe the contemporary South African health challenges.d The co-morbidity of NCDs and major infectious diseases in the same individual is also increasingly common, with many people living with HIV infection and also having NCDs or their common risk factors.e
This chapter focuses on two specific NCD indicators: (1) incidence of new diagnoses of hypertension in public health facilities and (2) incidence of new diagnoses of diabetes mellitus in public health facilities.
12.1 Hypertension incidenceHypertension or high blood pressure is the most common risk factor for cardiovascular disease (CVD) which is the leading NCD worldwide. The timely diagnosis of people with hypertension, followed by lifestyle changes and adherence to treatment regimens, substantially reduces the risk of complications associated with hypertension. The true incidence of hypertension would refer to the number of new cases of hypertension in the population in a community-based setting.
The 2016 South Africa Demographic and Health Surveyf indicates that in South Africa 46% of women and 44% of men age 15 years and older have hypertension. The prevalence of hypertension is particularly high in the Western Cape (52% of women and 59% of men), Northern Cape (53% of women and 52% of men), and Free State (54% of women and 48% of men); it is lowest in Limpopo (34% of women and 29% of men).
The incidence of hypertension as defined by the National Indicator Data Set (NIDS) of the National Department of Health measures the number of people newly diagnosed and started on treatment for hypertension in public health facilities per 1 000 population aged 40 years and above. Therefore, the numerator indicates the number of new cases of hypertension started on treatment, regardless of the age of the patient, while the denominator includes everyone aged 40 years and above in the population. As such the resulting incidence rate will be overestimated to some extent, because some people (likely a small number) would be diagnosed and treated for hypertension before the age of 40 years.
National overview
The incidence of new hypertension diagnosis at the national level in 2016/17 was 18.9 cases per 1 000 population aged 40 years and above, reflecting sustained increases since 2014/2015 (Figure 1).
a Pillay-van Wyk V, Msemburi W, Laubscher R, et al. (2016). Mortality trends and differentials in South Africa from 1997 to 2012: Second National Burden of Disease Study. Lancet Glob Health, 4(9):e642–53.
b Statistics South Africa. Mortality and Causes of Death in South Africa, 2015: Findings from Death Notification. 2017, 27–28.
c Kengne AP, June-Rose McHiza Z, Amoah AG, Mbanya JC. (2013). Cardiovascular diseases and diabetes as economic and developmental challenges in Africa. Prog Cardiovasc Dis. 56(3):302–13.
d Kleinert S, Horton R. (2009). South Africa’s health: Departing for a better future? Lancet, 374(9692): 759–60.
e Nguyen KA, Peer N, Mills EJ, Kengne AP. (2015). Burden, determinants, and pharmacological management of hypertension in HIV-positive patients and populations: A systematic narrative review. AIDS Rev. Apr-Jun,17 (2):83–95.
f National Department of Health. South Africa Demographic and Health Survey, 2016. Key Indicators Report. National Department of Health. Pretoria, 2016. http://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00-092016.pdf [Accessed 30 July 2017].
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Hypertension incidence2012/13
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22.32013/14
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16.82016/17
18.9
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Hypertension incidence by province, 2016/17
per 1 000 population 40+ [Source: DHIS]
FS
MP
EC
KZN
NC
GP
LP
NW
WC
10 20 30 40 50
21.8
7.6
26.4
21.7
26.2
16.5
16.0
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21.0
SA: 18.9
ProvincesECFSGPKZNLPMPNCNWWC
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Figure 1: National hypertension incidence, 2011/12–2016/17
Provincial overview
Across provinces, the incidence of new hypertension diagnosis per 1 000 population aged 40 years and older ranged from 7.6 cases in Western Cape (WC) to 26.4 cases in Free State (FS) in 2016/17 (Figure 2). Compared with 2015/16, there were slight decreases in the incidence in Limpopo (LP) and North West (NW) provinces; Northern Cape (NC) remained unchanged; KwaZulu-Natal (KZN) and Western Cape (WC) showed minor increases, whilst the incidence increased by variable magnitude in the remaining provinces (Figure 3). The overall pattern of change in incidence since 2011/12 was in favour of increasing trends in Eastern Cape (EC), Free State, Gauteng (GP) and Mpumalanga (MP), and mostly a flattening trend in other provinces.
Figure 2: Hypertension incidence by province, 2016/17
Hypertension inci yy (Monthly data: loess and linear regression)
Time period
per 1
000
pop
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40+
10
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EC
2011201220132014201520162017
FS GP
KZN LP
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MP
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NC NW
2011201220132014201520162017
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Figure 3: Annual trends in hypertension incidence by province, 2011/12‒ 2016/17
2011 2012 2013 2014 2015 2016 2017
Time period2011 2012 2013 2014 2015 2016 2017 2011 2012 2013 2014 2015 2016 2017
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District overview
The incidence of new hypertension diagnosis per 1 000 population aged 40 years and above in 2016/17, across districts nationwide, ranged from 6.1 cases in Cape Town (WC) to 49.5 cases in Harry Gwala (KZN) as shown in Figure 4 and Map 1.
Incidence varied across districts within provinces, particularly in KwaZulu-Natal, but less so in Northern Cape and Western Cape (Figure 5). Compared with 2015/16, incidences varied by districts across provinces with consistent increases observed only in Mpumalanga and Northern Cape. Hypertension incidence was in general similar across metro and non-metro districts, and varied in similar ways over time by socio-economic status, however with the most deprived districts always having the highest incidence (Figure 6).
Map 1: Hypertension incidence by sub-district, 2016/17
Hypertension incidence by district, 2016/17
per 1 000 population 40+ [Source: DHIS]
Harry Gwala: DC43Sekhukhune: DC47
Mangaung: MANG Sibande: DC30
T Mofutsanyana: DC19Amathole: DC12
OR Tambo: DC15Fezile Dabi: DC20
Ehlanzeni: DC32Buffalo City: BUF
C Hani: DC13ZF Mgcawu: DC8
Xhariep: DC16uMgungundlovu: DC22
Joe Gqabi: DC14Amajuba: DC25
Sedibeng: DC42Tshwane: TSH
eThekwini: ETHNM Molema: DC38
Pixley ka Seme: DC7JT Gaetsewe: DC45
King Cetshwayo: DC28Ekurhuleni: EKU
Ugu: DC21Nkangala: DC31
RS Mompati: DC39Namakwa: DC6
Frances Baard: DC9uMkhanyakude: DC27
Dr K Kaunda: DC40S Baartman: DC10
Johannesburg: JHBuMzinyathi: DC24
uThukela: DC23Zululand: DC26
West Rand: DC48Mopani: DC33
Central Karoo: DC5Lejweleputswa: DC18N Mandela Bay: NMA
Capricorn: DC35A Nzo: DC44
Waterberg: DC36Bojanala: DC37Vhembe: DC34
Cape Winelands: DC2Eden: DC4
West Coast: DC1Overberg: DC3iLembe: DC29
Cape Town: CPT
10 20 30 40 50
28.4
6.1
10.1
16.6
29.0
27.2
24.3
29.0
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12.9
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19.9
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SA: 18.9
ProvincesECFSGPKZNLPMPNCNWWC
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Figure 4: Hypertension incidence by district, 2016/2017
Annual trends: Hypertension incidence
per 1
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pop
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/14
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EC A NzoEC AmatholeEC Buffalo CityEC C HaniEC Joe GqabiEC N Mandela BayEC OR TamboEC S BaartmanFS Fezile DabiFS LejweleputswaFS MangaungFS T MofutsanyanaFS Xhariep
GP EkurhuleniGP JohannesburgGP SedibengGP TshwaneGP West RandKZN AmajubaKZN eThekwiniKZN Harry GwalaKZN iLembeKZN King CetshwayoKZN UguKZN uMgungundlovuKZN uMkhanyakude
KZN uMzinyathiKZN uThukelaKZN ZululandLP CapricornLP MopaniLP SekhukhuneLP VhembeLP WaterbergMP EhlanzeniMP G SibandeMP NkangalaNC Frances BaardNC JT Gaetsewe
NC NamakwaNC Pixley ka SemeNC ZF MgcawuNW BojanalaNW Dr K KaundaNW NM MolemaNW RS MompatiWC Cape TownWC Cape WinelandsWC Central KarooWC EdenWC OverbergWC West Coast
●
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●
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Figure 5: Annual trends for hypertension incidence by province, 2011/12–2016/2017
Hypertension inci yy
FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017Financial year
per 1
000
pop
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Indicator value by SEQ (weighted average of data by district quintile)
SEQSEQ 1 (most deprived)
SEQ 2 (deprived)
SEQ 3
SEQ 4 (well off)
SEQ 5 (least deprived)
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Figure 6: Trends in average district values by socio-economic quintile for hypertension incidence, 2011/12–2016/17
Sub-district overview
Across sub-districts the incidence of diagnosed hypertension per 1 000 population aged 40 years and above in 2016/17 ranged from 2.3 cases in Mookgophong (Waterberg (LP)) to 127.8 in Ingwe (Harry Gwala (KZN)) as shown in Table 1. Incidences varied by a lesser magnitude (less than 10 per 1 000 population aged 40 years and above) across approximately 42 sub-districts within their respective districts.
Table 1: Sub-districts with the lowest and the highest hypertension incidence, by district and province, 2016/17
Province DistrictHypertension incidence per 1 000 population aged +40 years
Average Lowest (sub-district) Highest (sub-district)Eastern Cape Alfred Nzo 12.0 5.4 (Mbizana) 17.7 (Matatiele)
Amathole 29.9 7.8 (Nxuba) 76.3 (Nkonkobe)Buffalo City 28.4 28.4 (Buffalo City) 28.4 (Buffalo City)Chris Hani 27.7 9.7 (Sakhisizwe) 44.8 (Engcobo)Joe Gqabi 24.3 16.5 (Maletswai) 31.6 (Elundini)Nelson Mandela Bay 12.6 12.6 (N Mandela Bay) 12.6 (N Mandela Bay)OR Tambo 20.9 17.7 (Port St Johns) 33.9 (King Sabata Dalindyebo)Sarah Baartman 16.6 9.5 (Makana) 35.7 (Camdeboo)
Free State Fezile Dabi 28.8 17.3 (Mafube) 55.5 (Ngwathe)Lejweleputswa 12.9 10.5 (Matjhabeng) 20.2 (Tswelopele)Mangaung 34.9 34.9 (Mangaung) 34.9 (Mangaung)Thabo Mofutsanyana 29.7 15.4 (Phumelela) 60.6 (Mantsopa)Xhariep 25.7 8.0 (Letsemeng) 44.6 (Naledi)
Gauteng Ekurhuleni 22.0 22.0 (Ekurhuleni) 22.0 (Ekurhuleni)Johannesburg 16.3 16.3 (Johannesburg) 16.3 (Johannesburg)Sedibeng 23.6 22.7 (Emfuleni) 29.2 (Lesedi)Tshwane 23.0 23.0 (Tshwane) 23.0 (Tshwane)West Rand 15.0 12.7 (Randfontein) 16.5 (Westonaria)
KwaZulu-Natal Amajuba 24.0 7.0 (Dannhauser) 31.0 (Emadlangeni)eThekwini 22.9 22.9 (eThekwini) 22.9 (eThekwini)iLembe 9.3 6.5 (KwaDukuza) 15.5 (Maphumulo)Ugu 19.9 8.1 (Vulamehlo) 37.0 (uMuziwabantu)uMgungundlovu 24.4 11.7 (uMngeni) 44.5 (Impendle)uMkhanyakude 17.1 13.4 (Umhlabuyalingana) 37.4 (The Big 5)uMzinyathi 16.2 12.6 (Umvoti) 19.1 (Nquthu)uThukela 16.2 9.0 (Okhahlamba) 22.1 (Umtshezi)Zululand 15.8 7.2 (eDumbe) 23.6 (Nongoma)Harry Gwala 49.5 17.2 (Ubuhlebezwe) 127.8 (Ingwe)King Cetshwayo 22.2 7.4 (Mbonambi) 85.5 (Nkandla)
0.0
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1.42014/15
1.72015/16 2016/17
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Province DistrictHypertension incidence per 1 000 population aged +40 years
Average Lowest (sub-district) Highest (sub-district)Limpopo Capricorn 12.1 8.3 (Aganang) 13.8 (Polokwane)
Mopani 14.2 10.5 (Greater Letaba) 22.2 (Greater Giyani)Sekhukhune 35.5 15.4 (Fetakgomo) 60.2 (Ephraim Mogale)Vhembe 11.4 4.0 (Mutale) 15.5 (Makhado)Waterberg 12.0 2.3 (Mookgophong) 25.2 (Modimolle)
Mpumalanga Ehlanzeni 28.6 12.4 (Umjindi) 42.0 (Mbombela)Gert Sibande 33.8 24.5 (Govan Mbeki) 56.1 (Lekwa)Nkangala 18.6 13.4 (Steve Tshwete) 33.4 (Emakhazeni)
Northern Cape Frances Baard 17.4 11.4 (Sol Plaatjie) 34.7 (Magareng)JT Gaetsewe 22.4 13.1 (Ga-Segonyana) 39.6 (Gamagara)Namakwa 17.7 8.2 (Nama Khoi) 70.1 (Khâi-Ma)Pixley Ka Seme 22.7 13.7 (Renosterberg) 44.8 (Thembelihle)ZF Mgcawu 27.0 9.6 (Kai !Garib) 125.9 (Kgatelopele)
North West Bojanala 12.0 9.6 (Madibeng) 17.0 (Moses Kotane)Dr K Kaunda 16.7 13.7 (Tlokwe) 31.6 (Maquassi Hills)NM Molema 22.7 13.1 (Tswaing) 13.1 (Mahikeng)RS Mompati 17.7 14.3 (Kagisano-Molopo) 19.7 (Greater Taung)
Western Cape Cape Town 6.1 6.1 (Cape Town) 6.1 (Cape Town)Cape Winelands 10.5 9.2 (Stellenbosch) 13.1 (Witzenberg)Central Karoo 13.6 3.8 (Laingsburg) 15.7 (Beaufort West)Eden 10.3 4.0 (Hessequa) 15.6 (Kannaland)Overberg 9.4 7.9 (Theewaterskloof) 11.6 (Cape Agulhas)West Coast 10.1 4.5 (Bergrivier) (Cederberg)
12.2 Diabetes incidenceDiabetes mellitus (here referred to as ‘diabetes’) is a major condition of growing concern worldwide and in South Africa. It is associated with many complications, which can be prevented or have a delayed onset with timely diagnosis and appropriate treatment, management and control. Similar to the hypertension indicators, the diabetes incidence indicator as determined by the NIDS used here is not the true population incidence of diabetes in the population. It estimates the number of people newly diagnosed with diabetes and started on treatment in the public health sector, per 1 000 population, per year. The numerator is ‘diabetes client treatment new’ and the denominator ‘total population’.
National overview
The national diabetes incidence in 2016/17 was 2.5 cases per 1 000 total population (Figure 7). Between 2013/14 and 2014/15, diabetes incidence declined from 2.0 to 1.4 cases per 1 000 population, and sustainably increased thereafter.
Figure 7: National diabetes incidence, 2013/14–2016/17
Diabetes incidence by province, 2016/17
per 1 000 population [Source: DHIS]
GP
MP
KZN
EC
FS
LP
NC
NW
WC
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1.1
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ProvincesECFSGPKZNLPMPNCNWWC
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Provincial overview
The diabetes incidence per 1 000 total population ranged from 1.1 cases in Western Cape to 3.2 in Gauteng (Figure 8). Compared with 2015/16, the incidence decreased in Limpopo, showed a slight increase in North West and Western Cape and larger increases in the remaining provinces, with a doubling in Gauteng from 1.5 cases in 2015/16 to 3.2 cases per 1 000 total population in 2016/17. The pattern of changes in incidence from 2013/14 to 2016/17 by province is depicted in Figure 9.
Figure 8: Diabetes incidence by province, 2016/17
Diabetes incidence yy (Monthly data: loess and linear regression)
Time period
per 1
000
pop
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ion
2
4
6
EC
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FS GP
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WC
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Figure 9: Annual trends for diabetes incidence by province, 2013/14‒2016/17
District overview
Across districts, the diabetes incidence per 1 000 total population ranged from 0.5 cases in Central Karoo (WC) to 8.3 cases in uMgungundlovu (KZN), as shown in Figure 10 and Map 2. The incidence was mostly similar in metro and non-metro districts between 2013/14 and 2016/17, and similarly varied across years by socio-economic status (Figure 11).
Diabetes incidence by district, 2016/17
per 1 000 population [Source: DHIS]
uMgungundlovu: DC22G Sibande: DC30
C Hani: DC13OR Tambo: DC15Sedibeng: DC42
T Mofutsanyana: DC19Johannesburg: JHB
Tshwane: TSHUgu: DC21
Zululand: DC26Ekurhuleni: EKUEhlanzeni: DC32Mangaung: MAN
King Cetshwayo: DC28Mopani: DC33
West Rand: DC48Waterberg: DC36
NM Molema: DC38Amathole: DC12
Xhariep: DC16eThekwini: ETH
Fezile Dabi: DC20ZF Mgcawu: DC8
iLembe: DC29Harry Gwala: DC43
uThukela: DC23Buffalo City: BUF
Sekhukhune: DC47Vhembe: DC34
Dr K Kaunda: DC40Namakwa: DC6
Joe Gqabi: DC14N Mandela Bay: NMA
Nkangala: DC31Capricorn: DC35
JT Gaetsewe: DC45Frances Baard: DC9
S Baartman: DC10uMkhanyakude: DC27
Overberg: DC3Amajuba: DC25
Cape Town: CPTWest Coast: DC1
Lejweleputswa: DC18Cape Winelands: DC2
A Nzo: DC44Eden: DC4
Bojanala: DC37RS Mompati: DC39
uMzinyathi: DC24Pixley ka Seme: DC7
Central Karoo: DC5
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SA: 2.5
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Figure 10: Diabetes incidence by district, 2016/2017
Diabetes incidence yy
FY 2014 FY 2015 FY 2016 FY 2017Financial year
per 1
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Indicator value by SEQ (weighted average of data by district quintile)
SEQSEQ 1 (most deprived)
SEQ 2 (deprived)
SEQ 3
SEQ 4 (well off)
SEQ 5 (least deprived)
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Map 2: Diabetes incidence by sub-district, 2016/17
Figure 11: Trends in average district values by socio-economic quintile for diabetes incidence, 2013/14–2016/17
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Sub-district overview
Diabetes incidence per 1 000 total population across sub-districts ranged from 0.1 cases in Mookgophong (Waterberg (LP)) to 29.2 case in Richmond (uMgungundlovu (KZN)). Variations within districts in certain provinces such as Gauteng and Limpopo are less pronounced than variations within districts in other provinces such as KwaZulu-Natal and Mpumalanga.
Table 2: Sub-districts with the lowest and the highest diabetes incidences by district and by province, 2016/17
Province DistrictDiabetes incidence per 1 000 total population
Average Lowest (sub-district) Highest (sub-district)Eastern Cape Alfred Nzo 1.0 0.4 (Mbizana) 1.5 (Umzimvubu)
Amathole 2.4 0.5 (Great Kei) 8.1 (Nkonkobe)Buffalo City 1.9 1.9 (Buffalo City) 1.9 (Buffalo City)Chris Hani 4.4 1.1 (Inxuba Yethemba) 12.3 (Engcobo)Joe Gqabi 1.7 1.0 (Senqu) 2.7 (Elundini)Nelson Mandela Bay 1.7 1.7 (N Mandela Bay) 1.7 (N Mandela Bay)OR Tambo 3.9 1.5 (Nyandeni) 11.1 (Port St Johns)Sarah Baartman 1.4 0.8 (Makana) 3.6 (Ikwezi)
Free State Fezile Dabi 2.1 0.8 (Mafube) 4.7 (Ngwathe)Lejweleputswa 1.1 0.2 (Tokologo) 1.2 (Matjhabeng)Mangaung 2.7 2.7 (Mangaung) 2.7 (Mangaung)Thabo Mofutsanyana 3.6 1.6 (Phumelela) 5.0 (Setsoto)Xhariep 2.2 1.3 (Naledi) 4.6 (Mohokare)
Gauteng Ekurhuleni 3.0 3.0 (Ekurhuleni) 3.0 (Ekurhuleni)Johannesburg 3.5 3.5 (Johannesburg) 3.5 (Johannesburg)Sedibeng 3.8 2.2 (Lesedi) 12.0 (Midvaal)Tshwane 3.2 3.2 (Tshwane) 3.2 (Tshwane)West Rand 2.5 1.2 (Merafong) 4.0 (Mogale City)
KwaZulu-Natal Amajuba 1.4 0.7 (Dannhauser) 3.5 (Emadlangeni)eThekwini 2.1 2.1 (eThekwini) 2.1 (eThekwini)iLembe 1.9 0.7 (Ndwedwe) 3.6 (KwaDukuza)Ugu 3.2 0.8 (Ezinqoleni) 5.4 (Vulamehlo)uMgungundlovu 8.3 0.6 (uMngeni) 29.2 (Richmond)uMkhanyakude 1.4 0.4 (Jozini) 3.5 (Hlabisa)uMzinyathi 0.9 0.8 (Nquthu/ Msinga) 1.2 (Endumeni)uThukela 1.9 0.9 (Imbabazane) 3.6 (Indaka)Zululand 3.1 0.5 (Abaqulusi) 6.5 (Nongoma)Harry Gwala 1.9 1.0 (Kwa Sani) 4.1 (Gr Kokstad)King Cetshwayo 2.6 0.2 (Mthonjaneni) 5.9 (uMlalazi)
Limpopo Capricorn 1.6 0.6 (Blouberg) 2.1 (Polokwane)Mopani 2.6 1.8 (Ba-Phalaborwa) 3.5 (Greater Giyani)Vhembe 1.8 0.4 (Mutale) 2.1 (Makhado)Waterberg 2.4 0.1 (Mookgophong) 4.1 (Mogalakwena)Sekhukhune 1.8 0.7 (Fetakgomo) 2.6 (Makhuduthamaga)
Mpumalanga Ehlanzeni 3.0 1.1 (Umjindi/ Nkomazi) 5.3 (Bushbuckridge)Gert Sibande 5.4 2.2 (Lekwa) 14.8 (Msukaligwa)Nkangala 1.6 1.1 (Steve Tshwete) 3.2 (Emakhazeni)
Northern Cape Frances Baard 1.5 0.8 (Sol Plaatjie) 4.1 (Phokwane)JT Gaetsewe 1.5 0.9 (Ga-Segonyana) 3.7 (Gamagara)Namakwa 1.8 0.8 (Kamiesberg) 4.7 (Khâi-Ma)Pixley Ka Seme 0.7 0.4 (Siyancuma) 1.3 (Kareeberg)ZF Mgcawu 2.0 0.5 (Kai !Garib) 10.5 (Kgatelopele)
North West Bojanala 0.9 0.6 (Rustenburg) 1.4 (Kgetleng Rivier)Dr K Kaunda 1.8 1.1 (Matlosana) 5.3 (Maquassi Hills)NM Molema 2.4 1.5 (Ratlou/ Ditsobotla) 4.1 (Tswaing)RS Mompati 0.9 0.3 (Naledi/ Lekwa-Teemane) 1.4 (Mamusa / Greater Taung)
Western Cape Cape Town 1.2 1.2 (Cape Town) 1.2 (Cape Town)Cape Winelands 1.1 0.8 (Witzenberg) 1.2 (Drakenstein)Central Karoo 0.5 0.3 (Laingsburg) 1.0 (Prince Albert)Eden 1.0 0.6 (Hessequa) 1.3 (Mossel Bay)Overberg 1.4 1.1 (Overstrand/ Swellendam) 2.0 (Cape Agulhas)West Coast 1.1 0.6 (Bergrivier) 1.7 (Cederberg)
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Section A: Non-communicable diseases
Key findings ✦ The incidences of diagnosed hypertension and diabetes are increasing at the national level, reflecting the
combination of heterogeneous patterns at provincial and district levels.
✦ The incidences tend to vary less across sub-districts within the same district, suggesting possible district-specific effects to be harnessed for future improvement.
✦ The observed incidences suggest that the detection efforts for hypertension and diabetes are not enough to close the detection gaps previously reported in community-based surveys.
Recommendations ✦ Data from the recently completed South Africa Demographic Health Surveyf should be analysed to provide
contemporary population-level data to assist in understanding the factors driving the increase of hypertension at the population level.
✦ High-risk screening for diabetes should be implemented at all facilities to ensure early detection, diagnosis, appropriate management and control of patients to avoid primary and secondary complications.
