Burden of Mortality Linked to Community-nominated Priorities in Rural South Africa

Pyry Mattila* (Corresponding Author), Justine Davies, Denny Mabetha, Stephen Tollman, Lucia D'Ambruoso

*Corresponding author for this work

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Community knowledge is a critical input for relevant health programmes and strategies. How community perceptions of risk reflect the burden of mortality is poorly understood.

To determine the burden of mortality reflecting community-nominated health risk factors in rural South Africa, where a complex health transition is underway.

Three discussion groups (total 48 participants) representing a cross-section of the community nominated health priorities through a Participatory Action Research process. A secondary analysis of Verbal Autopsy (VA) data was performed for deaths in the same community from 1993 to 2015 (n = 14,430). Using population attributable fractions (PAFs) extracted from Global Burden of Disease data for South Africa, deaths were categorised as ‘attributable at least in part’ to community-nominated risk factors if the PAF of the risk factor to the cause of death was >0. We also calculated ‘reducible mortality fractions’ (RMFs), defined as the proportions of each and all community-nominated risk factor(s) relative to all possible risk factors for deaths in the population .

Three risk factors were nominated as the most important health concerns locally: alcohol abuse, drug abuse, and lack of safe water. Of all causes of deaths 1993–2015, over 77% (n = 11,143) were attributable at least in part to at least one community-nominated risk factor. Causes of attributable deaths, at least in part, to alcohol abuse were most common (52.6%, n = 7,591), followed by drug abuse (29.3%, n = 4,223), and lack of safe water (11.4%, n = 1,652). In terms of the RMF, alcohol use contributed the largest percentage of all possible risk factors leading to death (13.6%), then lack of safe water (7.0%), and drug abuse (1.3%) .

A substantial proportion of deaths are linked to community-nominated risk factors. Community knowledge is a critical input to understand local health risks.
Original languageEnglish
Article number2013599
Number of pages13
JournalGlobal Health Action
Issue number1
Early online date21 Jan 2022
Publication statusPublished - 2022

Bibliographical note

The authors would like to thank the community stakeholder study participants for agreeing to be part of the process, and for sharing their time, knowledge, and perspectives. Thanks also to the Verbal Autopsy with Participatory Action Research (VAPAR) team and staff of the Medical Research Council (MRC)/Wits Rural Public
Health and Health Transitions Research Unit (Agincourt), especially Simon Khoza, Sizzy Ngobeni and Ella Sihlangu.

Funding information
This work was supported by the medical research council (MRC) [MR/P014844/1].


  • Community participation
  • Participatory action research
  • Verbal Autopsy
  • Global Burden of Disease


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