Who dies from what? Determining cause of death in South Africa's rural north-east

Information on cause of death is essential for rational public health plann ing, yet mortality data in South Africa is limited. In the Agincourt subdis trict, verbal autopsies (VA) have been used to determine cause of death. A VA is conducted on all deaths recorded during annual demographic and health surveillance. Trained lay fieldworkers interview a close caregiver to elic it signs and symptoms of the terminal illness. Each questionnaire is review ed by three medical practitioners blind to each other's assessment, who ass ign a 'probable cause of death' where possible. Of 1001 deaths of adults an d children identified between 1992 and 1995, 932 VAs were completed. The pr ofile of deaths reflects a mixed picture: the 'unfinished agenda' of commun icable disease and malnutrition (diarrhoea and kwashiorkor predominantly) a re responsible for over half of deaths in under-fives, accidents are promin ent in the 5-14 age-group, while the 'emerging agenda' of violence and chro nic degenerative disease (particularly circulatory disease) is pronounced a mong the middle-aged and elderly This profile shows the social and demograp hic transition to be well underway within a rural, underdeveloped populatio n. Validation of VA findings demonstrate that the: cause of death profile d erived from VA can be used with confidence for planning purposes. Findings of note include the high death rates from kwashiorkor and violence, emergin g AIDS and pulmonary tuberculosis, and circulatory deaths in the middle-age d and young elderly. A deeper understanding of the causal factors underlyin g these critical health problems is needed to strengthen policy and better target interventions.