S outh A frican N ational H ealth A nd S outh A frican N ational H - - PDF document

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South African National Health And Nutrition Examination Survey (SANHANES-1) South African National Health And Nutrition Examination Survey (SANHANES-1)

SANHANES TEAM FUNDERS

SANHANES

Purpose Purpose

The South African National Health And Nutrition Examination Survey (SANHANES) was established as a repeated population health survey in order to address the changing health needs in the country and provide a broader and more comprehensive platform to study the health and nutritional status of the nation on a regular basis.

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Objectives Objectives

To investigate the:

• Knowledge, attitudes and behaviour of South Africans with

respect to non-communicable and communicable diseases.

• Nutritional status of South Africans as it relates to food

security, dietary intake/behaviour including the consumption of alcohol, and body weight management.

• Behavioural (smoking, diet, physical inactivity) and social

determinants of health and nutrition (demographic, socioeconomic status and geolocation) and relate these to the health and nutritional status of the SA population.

• General perceptions of health and health care services.

SANHANES

METHODS METHODS

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• SANHANES-1 was a cross-sectional survey providing

baseline data for repeated surveys and also for future longitudinal (prospective) analysis.

• A prospective cohort approach will be able to

address the relationships between medical, nutritional and behavioural/societal risk factors assessed in the first survey phase (SANHANES-1) and subsequent morbidity, mortality and changes in risk factors at the national level.

Study Design Study Design

SANHANES

• Individuals of all age groups living in SA households,

excluding those living in institutions

• Multi-stage disproportionate, stratified cluster

sampling

• 500 enumeration areas (EA)
• 20 households per EA
• All persons in the household were eligible to

participate

Population and Sampling Population and Sampling

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Geographic distribution of EAs selected Geographic distribution of EAs selected

SANHANES

• SANHANES-1 obtained data through:
• Interviews based on questionnaires administered by

fieldworkers

• Clinical examination by doctors, nurses and clinic

assistants (free-of-charge) in a variety of settings measuring:

• Physical examinations: blood pressure, step fitness

test, anthropometry

• Laboratory tests: blood samples for biomarker testing

(full blood count, HbA1c, cholesterol, triglycerides, C-reactive protein, cotinine, vitamin A, ferritin)

Data collection Data collection

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Data management and analyses Data management and analyses

• Questionnaire data: Children (0-14 years), adults (15 years

and older) double entered and verified using Census Survey Processing System

• Clinical Examination data: custom-designed forms
• Laboratory data: blood samples for biomarker analysis using

for serum lipids, ferritin [Roche Modular, Immulite 2000, BioRad D10, Abbott Architect]); High Performance Liquid Chromatography (HPLC) (HbA1c, vitamin A, cotinine)

• Analytical quality control documentation indicated that the

coefficient of variation for the analyses ranged from 0.5– 3.75%

• All data were analysed using SPSS and STATA
• Data were weighed and benchmarked against the 2012 mid-

year population estimate SANHANES

Laboratory tests Laboratory tests

PATHCARE Laboratories LANCET Laboratories

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RESULTS RESULTS

SANHANES

Individual level of participation in SANHANES-1 Individual level of participation in SANHANES-1

8 168 valid households were realised in the survey and 77.2% agreed to be interviewed 27 580 individuals were eligible 27 580 individuals were eligible

92.6%

25 532 completed interviews 25 532 completed interviews

43.6%

12 025 completed a physical examination 12 025 completed a physical examination 8078 blood specimens were collected 8078 blood specimens were collected

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Representativity of the sample compared to 2012 mid-year estimates Representativity of the sample compared to 2012 mid-year estimates

Demographics Weighted sample Midyear population 2012 n % n % Age 0–14 15 460 322 29.6 15 459 959 29.6 15–24 10 130 722 19.4 10 130 660 19.4 25–34 9 009 761 17.2 9 009 713 17.2 35–44 7 041 054 13.5 7 041 024 13.5 45–54 4 840 748 9.3 4 840 720 9.3 55–64 3 153 832 6.0 3 153 804 6.0 65+ 2 639 079 5.0 2 639 066 5.0 Total 52 275 518 100.0 52 274 945 100.0 Race African 41 624 748 79.6 41 624 670 79.6 White 4 622 376 8.8 4 622 373 8.8 Coloured 4 716 488 9.0 4 716 471 9.0 Asian/Indian 1 311 441 2.5 1 311 431 2.5 Total 52 275 053 100.0 52 274 945 100.0

SANHANES

Non-Communicable Diseases Non-Communicable Diseases

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Rates (%) of self-reported personal history of NCDs by sex and age, SA 2012 Rates (%) of self-reported personal history of NCDs by sex and age, SA 2012

Males (n=6405) Females (n=9061)

10 20 30 40 50 60 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+ Percentage High blood Pressure Heart disease Stroke High blood cholesterol Diabetes 10 20 30 40 50 60 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+ Percentage High blood pressure Heart disease Stroke High blood cholesterol Diabetes

SANHANES

Clinical Examination: Hypertension Clinical Examination: Hypertension

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Prevalence of measured prehypertension and hypertension by age, SA 2012 Prevalence of measured prehypertension and hypertension by age, SA 2012

5.6 12.5 16 15.5 8.8 4.4 1.0 4.4 12.2 19.5 21.5 18.9 5 10 15 20 25 15-24 25-34 35-44 45-54 55-64 65+ Percentage Prehypertension BP >= 120-139/80-89mmHg Hypertension BP>=140/90mmHg

(n=7030) SANHANES

Prevalence of measured hypertension by province, SA 2012 Prevalence of measured hypertension by province, SA 2012

17.3 13 11.4 10.8 10.4 9.4 9.1 8.4 6.6 10.2 5 10 15 20 25 30 Percentage

(n=7030)

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Clinical Examination: Hyperlipidaemia Clinical Examination: Hyperlipidaemia

SANHANES

Prevalence of hyperlipidaemia by sex and age, SA 2012 Prevalence of hyperlipidaemia by sex and age, SA 2012

Males (n=1970)

10 20 30 40 50 60 70 15-24 25-34 35-44 45-54 55-64 65+ Percentage

Females (n=3461)

10 20 30 40 50 60 70 15-24 25-34 35-44 45-54 55-64 65+ Percentage

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Prevalence of hypercholesterolaemia (total cholesterol) by race, SA 2012 Prevalence of hypercholesterolaemia (total cholesterol) by race, SA 2012

15.3 27.2 41.2 18.9 24.9 40.6 45.3 28.1 10 20 30 40 50 60 70 African Coloured Asian/Indian Total Percentage

Males (n=1968) Females (n=3478)

Males Females

SANHANES

Clinical Examination: Diabetes (blood sugar) Clinical Examination: Diabetes (blood sugar)

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Prevalence of impaired glucose homeostasis and diabetes by age, SA 2012 Prevalence of impaired glucose homeostasis and diabetes by age, SA 2012

3.8 3.8 9 11.2 13.9 19.9 0.3 2.5 4.3 16.7 24.4 19 5 10 15 20 25 30 15-24 25-34 35-44 45-54 55-64 65+ Percentage HbA1c > 6.1% & < 6.5% HbA1c > 6.5%

(n=4750) SANHANES

Physical activity Physical activity

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Prevalence of aerobic fitness: percentage aged 18-40 years old unfit by sex and locality, SA 2012 Prevalence of aerobic fitness: percentage aged 18-40 years old unfit by sex and locality, SA 2012

33.5 17.9 22.6 18.2 27.9 52.9 34.8 37.3 41.4 45.2 10 20 30 40 50 60 70 80 90 100 Urban Formal Urban Informal Rural Formal Rural Informal Total Percentage Males Females

Males (n=917) Females (n=1524)

SANHANES

Prevalence of aerobic fitness: percentage aged 18-40 years old unfit by sex and race, SA 2012 Prevalence of aerobic fitness: percentage aged 18-40 years old unfit by sex and race, SA 2012

25.4 37.8 28.2 43.4 62.0 45.5 10 20 30 40 50 60 70 80 Black African Coloured Total Percentage

Males (n=886) Females (n=1496)

Males Females

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Tobacco Use Tobacco Use

SANHANES

Prevalence of tobacco smoking (current smokers), SA 2012 Prevalence of tobacco smoking (current smokers), SA 2012

Yes, daily 16.2% Yes, less than daily 2% Yes, but not now 2.6% No, not all 79.2% Ever smokers (20.8%)

(n=15 377)

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Mean age of tobacco initiation, smoking duration and number of cigarettes smoked per day (current smokers) , SA 2012 Mean age of tobacco initiation, smoking duration and number of cigarettes smoked per day (current smokers) , SA 2012

Age of initiation of tobacco smoking (years) Duration of smoking (years) Mean number of cigarettes smoked per day Males 17.9 17.5 8 Females 16.4 19.4 10 Total 17.4 17.9 8.5 SANHANES

Prevalence of the use of other tobacco products (current smokers), SA 2012 Prevalence of the use of other tobacco products (current smokers), SA 2012

Yes, daily 4.9% Yes, less than daily 1.8% No, not at all 93.3%

Ever users of other tobacco products (6.7%)

}

(n=14 948)

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33.4 30.5 25.5 19 16.5 16.5 13.7 13.3 10.7 17.7 10 20 30 40 50 Percentage

Percentage of daily exposure to smoking inside the home by province, SA 2012 Percentage of daily exposure to smoking inside the home by province, SA 2012

(n=14 569)

SANHANES

28.5 35.7 32.2 35.2 25 29.9 10 20 30 40 50 Males Females Total Percentage Cotinine < 10 Cotinine > 10

Prevalence of exposure to tobacco as measured by serum cotinine by sex, SA 2012 Prevalence of exposure to tobacco as measured by serum cotinine by sex, SA 2012

(n=5500)

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30 26.1 34.6 38.9 32.2 29.9 28.4 46.9 24.9 29.9 10 20 30 40 50 60 Urban formal Urban informal Rural formal Rural informal Total Percentage Cotinine < 10ng/ml Cotinine > 10ng/ml

Prevalence of exposure to tobacco as measured by serum cotinine by locality, SA 2012 Prevalence of exposure to tobacco as measured by serum cotinine by locality, SA 2012

(n=5500)

SANHANES

Tobacco cessation by gender, SA 2012 Tobacco cessation by gender, SA 2012

26.1 50.3 47.4 15.4 23.6 13.9 38.7 46.5 50.4 29.5 23.6 11.4 28.8 49.4 48.1 19 23.6 12.9 10 20 30 40 50 60 Advised to quit smoking Health warning prompted quitting Tried to quit Quiting tobacco smoking Quiting other tobacco products Time elapsed since quitting (years) Percentage Males Females Totals

(n=2667)

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Household Alcohol Use Household Alcohol Use

SANHANES

Perceptions of household alcohol consumption patterns, SA 2012 Perceptions of household alcohol consumption patterns, SA 2012

31 9.3 2.3 0.6 53.2 1.2 10 20 30 40 50 60 Adult men Adult women Teenage boys Teenage girls Nobody Don't know Percentage Household members

(n = 6 554)

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Perceived seriousness of problems of alcohol misuse amongst members of the household, SA 2012 Perceived seriousness of problems of alcohol misuse amongst members of the household, SA 2012

Very serious, 8.8% Serious, 8.4% Not very serious, 20.8% Not a problem, 61.3% Don't know, 0.7%

(n=2410)

SANHANES

63.4 80.7 82.6 68.2 67.1 20 40 60 80 100 African White Coloured Indian Total Percentage Race

Extent of snacking while drinking alcohol in households by race, SA 2012 Extent of snacking while drinking alcohol in households by race, SA 2012

(n=2384)

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Anthropometry (adults) Anthropometry (adults)

SANHANES

Prevalence of underweight, overweight and obesity by sex and age, SA 2012 Prevalence of underweight, overweight and obesity by sex and age, SA 2012

10 20 30 40 50 60 70 15-17 18-24 25-34 35-44 45-54 55-64 65+ Percentage

Females (n=4695)

10 20 30 40 50 60 70 15-17 18-24 25-34 35-44 45-54 55-64 65+ Percentage

Males (n=2572)

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Waist circumference by sex and age, SA 2012 Waist circumference by sex and age, SA 2012

32.1 52.4 67.2 74.6 81.7 85.5 79.8 15.2 32.9 48.1 54.9 69.9 70 60.3 20 40 60 80 100 15-19 20-24 25-34 35-44 45-54 55-64 65+ Percentage

Females (n=4692

>=80cm >=88cm 1.5 5.7 11.3 18.9 39.9 34.1 39.7 0.5 2.3 6.1 8.6 22.1 16.3 16.1 20 40 60 80 100 15-19 20-24 25-34 35-44 45-54 55-64 65+ Percentage

Males (n=2592)

>=94cm >=102cm

SANHANES

Waist-hip ratio by sex and age, SA 2012 Waist-hip ratio by sex and age, SA 2012

1.1 3 3.3 13.1 14.2 15.6 20 40 60 80 15-24 25-34 35-44 45-54 55-64 65+ Percentage

Males (n = 2 580)

WHR >=1.0 22.1 44.1 48.1 61.8 62.5 67.8 20 40 60 80 15-24 25-34 35-44 45-54 55-64 65+ Percentage

Females (n = 4 685)

WHR >= 0.85

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Food security Food security

SANHANES

Prevalence of food secure households by locality, SA 2012 Prevalence of food secure households by locality, SA 2012

(n=6115)

55.4 31.5 50.9 30.2 45.6 10 20 30 40 50 60 70 Urban formal Urban informal Rural formal Rural informal Total Percentage Food secure

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Prevalence of food insecure households (experiencing hunger) by locality, SA 2012 Prevalence of food insecure households (experiencing hunger) by locality, SA 2012

(n=6115)

19 32.4 28.8 37 26 10 20 30 40 50 60 70 Urban formal Urban informal Rural formal Rural informal Total Percentage Experience hunger

SANHANES

Prevalence of food insecurity (experiencing hunger) by province, SA 2012 Prevalence of food insecurity (experiencing hunger) by province, SA 2012

36.2 30.8 29.5 29.5 28.8 28.3 20.7 19.2 16.4 26.0 10 20 30 40 50 Percentage Province

(n=6115)

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Trends in Food Security status: SA 1999-2012 Trends in Food Security status: SA 1999-2012

Variable NFCS 1999 NFCS 2005 SASAS 2008 SANHANES- 1, 2012 (n = 2735) (n = 2413) (n = 1150) (n = 6306) % % % % Food Secure 25 19.8 48 45.6 At risk of hunger 23 27.9 25 28.3 Experienci ng hunger 52.3 52 25.9 26.0

SANHANES

Prevalence of dietary risk factors for NCDs (high fat and sugar intake) by locality, SA 2012 Prevalence of dietary risk factors for NCDs (high fat and sugar intake) by locality, SA 2012

23.1 15.1 11.3 9.8 18.3 23.1 18.2 14.7 11.7 19.7 5 10 15 20 25 30 Urban formal Urban informal Rural informal Rural formal Total Percentage High fat score (11-20) High sugar score (5-8)

(n=15 332)

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Factors influencing grocery shopping by sex, SA 2012 Factors influencing grocery shopping by sex, SA 2012

35.9 10 7.3 7.4 7 5.2 6.4 4.7 54.4 64.5 17.5 14.3 14.1 14.1 9.6 9.6 7.1 23.6 10 20 30 40 50 60 70 80 The price of the food item Taste of the food item Health considerations The nutrient content of the food item How well / how long the food item keeps Safety (hygiene) of the food item Convenience How easy the food item is to prepare Don't do grocery shopping Percentage Females Males Males (n = 6267) Females (n = 8884)

SANHANES

Nutritional status of adults Nutritional status of adults

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Prevalence of anaemia by sex, SA 2012 Prevalence of anaemia by sex, SA 2012

10.6 1.5 0.2 12.4 8.5 1.1 5 10 15 Mild anaemia Moderate anaemia Severe anaemia Percentage Males Females

Total Anaemia Males: 12.2% Total Anaemia Females: 22.0%

Males (n = 1 889) Females (n = 3 299)

SANHANES

VARIABLE NFCS-2005 SANHANES-1

Anaemia (Hb < 12 g/dL)

29.4% 23.1%

Iron depletion (Hb ≥ 12 g/dL and Ferritin < 15 ng/mL)

7.7% 5.9%

Iron deficiency anaemia (Hb <12 g/dL and Ferritin < 15 ng/mL)

10.5% 9.7%

Trends in anaemia and iron status: women of reproductive age (16-35 years), SA 2005 - 2012 Trends in anaemia and iron status: women of reproductive age (16-35 years), SA 2005 - 2012

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Perceived versus actual BMI (15 years and older) by sex, SA 2012 Perceived versus actual BMI (15 years and older) by sex, SA 2012

32.4 37.3 7.3 43.2 20.8 7.9 10 20 30 40 50 60 Perceived BMI equals actual BMI Perceived BMI higher than actual BMI Perceived BMI lower than actual BMI Percentage Males Females

Males (n=2499) Females (n=4575)

SANHANES

Anthropometry (children) Anthropometry (children)

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Prevalence of overweight and obesity of children aged 2-14 years by sex & age, SA 2012 Prevalence of overweight and obesity of children aged 2-14 years by sex & age, SA 2012

18.9 12.3 16.7 4.9 4.1 5.6 5 10 15 20 25 2-5 6-9 10-14 Percentage

Females (n=2155)

17.5 4.5 7.5 4.4 2.7 2.7 5 10 15 20 25 2-5 6-9 10-14 Percentage

Males (n=2123)

SANHANES

23.4 6.4 5.1 0.9 11 1.2 26.5 9.5 2.2 1.1 6.1 1.7 5 10 15 20 25 30

%

NFCS-2005 SANHANES

Trends in the prevalence of undernutrition in children aged 1-3 years, SA 2005-2012 Trends in the prevalence of undernutrition in children aged 1-3 years, SA 2005-2012

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16.4 5.1 5 1.5 8.6 0.8 11.9 2.2 2 0.8 4.5 0.6 2 4 6 8 10 12 14 16 18 Stunting Severe Stunting Wasting Severe Wasting Underweight Severe Underweight Percentage NFCS-2005 SANHANES

Trends in the prevalence of undernutrition in children aged 4-6 years, SA 2005-2012 Trends in the prevalence of undernutrition in children aged 4-6 years, SA 2005-2012

SANHANES

Child Health and Nutrition Status Child Health and Nutrition Status

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VARIABLE SAVACG NFCS-2005 SANHANES-1 Mean Vitamin A 0.84 µmol/L 0.62 µmol/L 0.75 µmol/L Vitamin A deficiency (serum retinol < 0.70 µmol/L) 33.3% 63.6% 43.6%

Trends in vitamin A status in children under five years of age, SA 1994-2012 Trends in vitamin A status in children under five years of age, SA 1994-2012

SANHANES VARIABLE SAVACG NFCS-2005 SANHANES-1 Anaemia (Hb < 11 g/dL) 21.4% 28.9% 10.7% Iron depletion (Hb ≥ 11 g/dL and Ferritin < 12 ng/mL) 4.8% 7.8% 8.1% Iron deficiency anaemia (Hb <11 g/dL and Ferritin < 12 ng/mL) 5.0% 11.3% 1.9%

Trends in anaemia, and iron status in children under five years of age, SA 1994-2012 Trends in anaemia, and iron status in children under five years of age, SA 1994-2012

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Dietary behaviour of children 10-14 years in relation to eating breakfast, SA 2012 Dietary behaviour of children 10-14 years in relation to eating breakfast, SA 2012

• 19% of children do not eat breakfast at home in the morning

39.2 33.9 33 19.2 15.3 10 20 30 40 50 Not hungry in the morning No food in the house to eat for breakfast People at home do not eat breakfast Cannot get up early enough to have breakfast Cannot make their own breakfast Percentage

(n=2408)

SANHANES

Dietary behaviour of children aged 10-14 years in relation to taking lunchboxes, SA 2012 Dietary behaviour of children aged 10-14 years in relation to taking lunchboxes, SA 2012

• 51% of children do not take a lunchbox to school

37.2 29.8 18.3 18 17.1 10 20 30 40 50 Food at school is enough for the whole day Nothing at home to put in the lunchbox No-one at home to help make a lunchbox Other children will want their food Do not have a nice container to put lunch in Percentage

(n=2406)

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Body image of children aged 10-14 years, SA 2012 Body image of children aged 10-14 years, SA 2012

15.9 10.3 14 16.7 5 10 15 20 25 30 Gain weight Lose weight Percentage

Attempts to gain or lose weight

82.2 7.4 8.8 78.3 7 13.8 20 40 60 80 100 Happy Somewhat happy Unhappy Percentage

Happiness with current weight

Males Females

Males (n=1125) Females (n=1192) Males (n=1127) Females (n=1200)

SANHANES

Perceived versus actual BMI of children 10-14 years by sex, SA 2012 Perceived versus actual BMI of children 10-14 years by sex, SA 2012

3.9 12.7 0.2 5.1 16.2 0.6 10 20 30 40 50 60 Perceived BMI equals actual BMI Perceived BMI higher than actual BMI Perceived BMI lower than actual BMI Percentage Males Females

Males (n=2219) Females (n=2235)

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General Health Perception: Physical health General Health Perception: Physical health

SANHANES

Self-rated health status of adults 15 years and older by sex , SA 2012 Self-rated health status of adults 15 years and older by sex , SA 2012

40.4 40.1 14.9 4.6 34.2 42.7 17.5 5.6 37.1 41.5 16.2 5.1 5 10 15 20 25 30 35 40 45 50 Very good Good Moderate Bad & very bad Percentage Levels of Health Males Females Total

Males (n=6287) Females (n=8908)

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Self-rated difficulty with work or household activities in the last 30 days in adults 15 years and

• lder by locality, SA 2012

Self-rated difficulty with work or household activities in the last 30 days in adults 15 years and

• lder by locality, SA 2012

13.6 17.1 19.9 13.6 15.5 5 10 15 20 25 Urban formal Urban informal Rural informal Rural formal Total Percentage

(n=15 121)

SANHANES

Self-reported prevalence of impaired hearing in adults 15 years and older by locality and race, SA 2012 Self-reported prevalence of impaired hearing in adults 15 years and older by locality and race, SA 2012

9.5 10.8 7.1 9.6 9.5 5 10 15 20 Urban formal Urban Informal Rural formal Rual Informal Total Percentage

(n=14 527)

9.2 12.7 7.2 13.5 9.5 5 10 15 20 25 30 Percentage

(n=14 479)

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Self-Reported prevalence of impaired vision (15 years and older) by locality and race, SA 2012 Self-Reported prevalence of impaired vision (15 years and older) by locality and race, SA 2012

16.2 5.2 9.4 6.2 12.1 17.4 8.2 11.8 9.6 14.1 5 10 15 20 25 Urban formal Urban Informal Rural formal Rual Informal Total Percentage

(n=15 035)

7.8 32.7 18.9 32 12.1 10.3 31.4 22 31.8 14.1 10 20 30 40 50 Percentage

(n=15 061)

SANHANES

General Health Perception: Mental Health General Health Perception: Mental Health

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Prevalence of psychological distress in adults 15 years and older by sex and age, SA 2012 Prevalence of psychological distress in adults 15 years and older by sex and age, SA 2012

19.7 26.6 23.9 27.8 28.8 37.8 25.8 28.9 28.3 35.4 41.4 45.3 10 20 30 40 50 60 15-24 25-34 35-44 45-54 55-64 65+ Percentage Males Females

Males (n=6242) Females (n=8819)

SANHANES

Experience of traumatic events by locality and type of trauma, SA 2012 Experience of traumatic events by locality and type of trauma, SA 2012

7.4 8.3 3.6 6.2 6.9 15.3 14.8 8.2 14.7 14.5 10.7 13 5.4 10.6 10.5 5 10 15 20 25 Urban formal Urban informal Rural formal Rural informal Total Percentage Personal assault Family-related Other

(n=15 196)

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Prevalence of symptoms and diagnosis of post traumatic stress disorder, SA 2012 Prevalence of symptoms and diagnosis of post traumatic stress disorder, SA 2012

• No significant differences for both symptoms and diagnosis by sex, age,

province and race

41.4 11.1 10 20 30 40 50 60 PTSD Symptoms PTSD Diagnosis Percentage

(n=1644)

SANHANES

Quality of Health Care Services Quality of Health Care Services

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Satisfaction at outpatient health care facilities, SA 2012 Satisfaction at outpatient health care facilities, SA 2012

Factor Public Private

Very good and good Very bad and bad Very good and good Very bad and bad

Treated respectfully 80.4% 6.4% 95.5% 0.6% Clarity of explanations 80.9% 5.6% 95.1% 1.1% Involvement in decision making 77.6% 6.9% 92.6% 2.1% Privacy 83.7% 4.8% 95.4% 1.2% Choice of health care provider 79.5% 5.5% 92.4% 0.5% Cleanliness 85.2% 3.7% 95.2% 0.2% Availability of medication 77.6% 9.4% 96.0% 0.5% Availability of tests 76.2% 8.1% 95.9% 0.4% Waiting times 59.5% 24.4% 87.7% 4.5%

SANHANES

Satisfaction at in-patient health care facilities, SA 2012 Satisfaction at in-patient health care facilities, SA 2012

Factor Public Private

Very good and good Very bad and bad Very good and good Very bad and bad

Treated respectfully 84.9% 4.6% 97.6% 0.7% Clarity of explanations 85.0% 6.4% 96.8% 1.6% Involvement in decision making 81.5% 9.0% 94.4% 2.8% Privacy 81.6% 5.6% 97.4% 0.6% Choice of health care provider 82.9% 4.2% 96.9% 1.6% Cleanliness 84.9% 3.4% 97.9% 1.4% Availability of medication 85.0% 3.9% 97.3% 0.5% Availability of tests 84.5% 5.2% 98.8% 0.1% Waiting times 72.4% 13.4% 93.0% 3.1%

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Tuberculosis: Social Determinants Tuberculosis: Social Determinants

SANHANES

Perception of seriousness of TB by race, SA 2012 Perception of seriousness of TB by race, SA 2012

93.0 91.0 93.4 89.1 91.4 5.6 6.9 6.2 9.0 6.7 20 40 60 80 100 Coloured African White Asian/Indian Total Percentage

(n=14 693)

Very serious Somewhat serious

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Knowledge of TB being curable by province, SA 2012 Knowledge of TB being curable by province, SA 2012

96.4 93.8 93.5 93.3 91.5 91.4 91.2 89.7 89.5 92.2 70 80 90 100 Percentage

n=14 909

SANHANES

Expression of concern for TB presence in HIV positive people, by province, SA 2012 Expression of concern for TB presence in HIV positive people, by province, SA 2012

30.4 27.7 22.9 21.4 21.3 21.1 20.8 20.1 15.8 22.3 10 20 30 40 Percentage

(n=14 670)

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Prevalence of stigma associated with TB (avoidance of people with TB) by province, SA 2012 Prevalence of stigma associated with TB (avoidance of people with TB) by province, SA 2012

16.9 15.1 14.4 11.8 11.6 9.3 7.6 7.2 4.6 12.1 5 10 15 20 25 Percentage

(n=14 950)

SANHANES

SUMMARY SUMMARY

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Summary Summary

The successfully completed SANHANES-1:

• Is representative of the population
• Provides baseline values and informs policy in a number of

heath and nutrition domains

• Provides evidence on the impact of current interventions,

and

• Creates the basis on which the population’s health and

nutritional status can be monitored longitudinally SANHANES

Overall Summary Overall Summary

• South Africa indeed has a huge burden of disease that is

fuelled by a multiplicity of risk factors requiring multi- sectoral action and healthy public policies

• The underlying socio-economic, cultural, behavioural and

environmental determinants of health are significant

• Self-reported levels of morbidity are high

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THANK YOU THANK YOU THANK YOU