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Changes in fatal and near-fatal asthma in an urban area of South Africa from 1980–1997

¹ Dept of Paediatrics and Child Health and ² Respiratory Clinic, Dept of Medicine, University of Cape Town, Cape Town, South Africa

CORRESPONDENCE: H.J. Zar, Child Health Unit, Dept of Paediatrics, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa. Fax: 27216895403

Keywords: mortality, near-fatal asthma, South Africa

Received: September 18, 2000
Accepted March 4, 2001

This study was supported by The Medical Research Council, South Africa and 3M Pharmaceuticals.

Over the past two decades, changes in the health services designed to improve access to and quality of asthma care have occurred in South Africa. The aim of this study was to investigate the incidence of fatal and near-fatal asthma (NFA) from 1980–1997 in an urban part of South Africa.

A retrospective analysis of fatal asthma and NFA in the Cape Town City Council area was performed. Mortality data were obtained from death notification records. Data on NFA were obtained from the records of patients admitted for asthma to intensive care units (ICUs) at major academic hospitals serving the area.

There were 1,506 deaths (mean age 56 yrs) from asthma reported; 39 and 3% occurred in people under 55 and 15 yrs, respectively. Average annual asthma mortality rate (8.1±1.9 per 100,000 population) was highest amongst people of mixed race (10.1±2.0), followed by Blacks (6.8±3.1) and Whites (5.0±1.9, p<0.001). Asthma mortality declined by 0.28 deaths per 100,000 population per year; rates decreased in all ethnic groups. Most deaths (72.3%) were outside a health facility and a higher number of deaths occurred on weekends (223 deaths·day^–1) than weekdays (207 deaths·day^–1, p=0.014). Paediatric asthma ICU admissions declined by 1.81 children·yr^–1. The annual number of adults admitted to ICU for asthma, and the proportion requiring intermittent positive pressure ventilation did not change.

These results indicate that the incidence of fatal and near-fatal asthma in this area has declined over the period and this may reflect improved asthma management. However, the relatively high asthma mortality rate in people of mixed race and the predominance of deaths outside health facilities and on weekends suggest problems with access to care.