Evidence map›Paper›PMID 35046100›Full record

ArticleJournal of epidemiology and community health2022

Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study.

Tom Achoki, Benn Sartorius, David Watkins, Scott D Glenn, Andre Pascal Kengne, Tolu Oni, Charles Shey Wiysonge, Alexandra Walker, Olatunji O Adetokunboh, Tesleem Kayode Babalola and 35 more

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Article in Journal of epidemiology and community health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
62citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

62 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  7. Emergency Medicine in South Africa: Progress, challenges, and future directions from a qualitative inquiry.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2026
    Article
  8. A scoping review of global approaches to education in adult critical care retrieval.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2026
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  19. Perceived readiness of South African community service speech-language therapists to manage complex paediatric dysphagia.The South African journal of communication disorders = Die Suid-Afrikaanse tydskrif vir Kommunikasieafwykings · 2025
    Article
  20. Article

2 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

45 authors.

Tom AchokiResearch, Africa Institute for Health Policy, Nairobi, Kenya.ORCID http://orcid.org/0000-0001-6309-8904
Benn SartoriusCentre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.ORCID http://orcid.org/0000-0001-6761-2325
David WatkinsDepartment of Medicine, University of Washington, Seattle, WA, USA.
Scott D GlennInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Andre Pascal KengneDepartment of Medicine, University of Cape Town, Cape Town, South Africa.
Tolu OniMRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
Charles Shey WiysongeSchool of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa.
Alexandra WalkerInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Olatunji O AdetokunbohCentre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa.ORCID http://orcid.org/0000-0002-4608-3951
Tesleem Kayode BabalolaDiscipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
Obasanjo Afolabi BolarinwaDiscipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.ORCID http://orcid.org/0000-0002-9208-6408
Mareli M ClaassensDepartment of Biochemistry and Microbiology, University of Namibia, Windhoek, Namibia.ORCID http://orcid.org/0000-0002-5927-284X
Richard G CowdenDepartment of Psychology, University of the Free State, Park WEst, Free State, South Africa.
Candy T DayHealth Systems Research Unit, Health System Trust, Westville, South Africa.
Oluchi EzekannaghaIndependent Consultant, Awka, Nigeria.
Themba G GinindzaDiscipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
Chidozie C D IwuSchool of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
Chinwe Juliana IwuDepartment of Global Health, Stellenbosch University, Stellenbosch, South Africa.ORCID http://orcid.org/0000-0003-0765-7497
Innocent KarangwaDepartment of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa.
Patrick Dmc KatotoDepartment of Global Health, Stellenbosch University, Stellenbosch, South Africa.ORCID http://orcid.org/0000-0002-0553-201X
Nuworza KugbeyUniversity of Environment and Sustainable Development, Somanya, Ghana.
Desmond KuupielSchool of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Phetole Walter MahashaGrants, Innovation and Product Development Unit, South African Medical Research Council, Cape Town, South Africa.
Tivani Phosa Mashamba-ThompsonFaculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
George A MensahDepartment of Medicine, University of Cape Town, Cape Town, South Africa.
Duduzile Edith NdwandweCochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
Chukwudi A NnajiSchool of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa.
Mpiko NtsekheDivision of Cardiology, University of Cape Town, Rondebosch, Western Cape, South Africa.
Thomas Elliot NyirendaDepartment of Global Health, Stellenbosch University, Stellenbosch, South Africa.ORCID http://orcid.org/0000-0003-4727-7130
Julius Nyerere OdhiamboDiscipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.ORCID http://orcid.org/0000-0002-9817-1849
Kwaku Oppong AsanteDepartment of Psychology, University of Ghana, Accra, Ghana.
Charles D H ParryAlcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
Julian David PillayDepartment of Basic Medical Sciences, Durban University of Technology, Durban, South Africa.
Aletta Elisabeth SchutteSchool of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0001-9217-4937
Soraya SeedatDepartment of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.ORCID http://orcid.org/0000-0002-5118-786X
Karen SliwaHatter Institute Department of Medicine, University of Cape Town, Cape Town, South Africa.
Dan J SteinUnit on Risk and Resilience in Mental Disorders, South African Medical Research Council, Cape Town, South Africa.
Frank C TanserUniversity of KwaZulu-Natal, Durban, South Africa.
Ushotanefe UsehHealth Sciences Department, North-West University, Mmbatho, South Africa.
Heather J ZarDepartment of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Liesl J ZühlkeDepartment of Medicine, University of Cape Town, Cape Town, South Africa.
Bongani M MayosiUniversity of Cape Town, Cape Town, South Africa.
Simon I HayDepartment of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA.
Christopher J L MurrayDepartment of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA.
Mohsen NaghaviDepartment of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA nagham@uw.edu.ORCID http://orcid.org/0000-0002-6209-1513

Funding

University of Pittsburgh HIV-Comorbidities Research Training Program in South AfricaD43TW010937 · FIC · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI NACHEGA, JEAN BISIMWA, SEEDAT, SORAYA · 2019 to 2023
$1.2M
FIC NIH HHS D43 TW010937Medical Research Council MR/S005242/1
6 · The paper itself

Abstract

backgroundOver the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019.

methodsWe analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance.

resultsAcross the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces.

conclusionsReductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.

Indexed as

healthcare disparitieshealth policyHIVpublic health

Identifiers

PMID35046100
PMCPMC8995905

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.