RESUMEN
BACKGROUND: Malaria elimination is on global agendas following successful transmission reductions. Nevertheless moving from low to zero transmission is challenging. South Africa has an elimination target of 2018, which may or may not be realised in its hypoendemic areas. METHODS: The Agincourt Health and Demographic Surveillance System has monitored population health in north-eastern South Africa since 1992. Malaria deaths were analysed against individual factors, socioeconomic status, labour migration and weather over a 21-year period, eliciting trends over time and associations with covariates. RESULTS: Of 13 251 registered deaths over 1.58 million person-years, 1.2% were attributed to malaria. Malaria mortality rates increased from 1992 to 2013, while mean daily maximum temperature rose by 1.5 °C. Travel to endemic Mozambique became easier, and malaria mortality increased in higher socioeconomic groups. Overall, malaria mortality was significantly associated with age, socioeconomic status, labour migration and employment, yearly rainfall and higher rainfall/temperature shortly before death. CONCLUSIONS: Malaria persists as a small but important cause of death in this semi-rural South African population. Detailed longitudinal population data were crucial for these analyses. The findings highlight practical political, socioeconomic and environmental difficulties that may also be encountered elsewhere in moving from low-transmission scenarios to malaria elimination.
RESUMEN
The HIV/AIDS pandemic has had dramatic influence on the demographic dynamics of many of the world's less economically developed regions. Today, an estimated 33 million individuals are living with HIV, and recent data suggest that, every day, over 6800 persons become HIV-infected and over 5700 persons die from AIDS (UNAIDS 2006). The age profile of HIV infection is well known, with new cases impacting primarily prime-age adults. Sub-Saharan Africa remains the world's most affected region with recent population-based surveys suggesting that adult prevalence rates (age 15-49) reaches as high as 25% in Botswana and over 23% in Lesotho (UNAIDS 2006). Still, HIV/AIDS also impacts children, with over 2 million HIV+ individuals under age 15 in sub-Saharan Africa; And the disease profile now includes many individuals over age 50 due to the positive impact on life expectancy of recent treatment advances (UNAIDS 2006).Of course, HIV/AIDS' impacts at the individual and household levels are difficult to discern from aggregate data although ethnographic research provides insights into nuanced household survival strategies (e.g., Evans 2005; Schatz and Ogunmefun 2007). Such work reveals household efforts to maintain a sense of "normality" in response to the impacts of HIV/AIDS, otherwise known as "the disease" (Bohman et al. 2007).