摘要：Background: There is a lack of reliable data in developing countries to inform policy and optimise resource allocation. Health and socio-demographic surveillance sites (HDSS) have the potential to address this gap. Mortality levels and trends have previously been documented in rural South Africa. However, complex spacetime clustering of mortality, determinants, and their impact has not been fully examined.Objectives: To integrate advanced methods enhance the understanding of the dynamics of mortality in space time, to identify mortality risk factors and population attributable impact, to relate disparities in risk factor distributions to spatial mortality risk, and thus, to improve policy planning and resource allocation. Methods: Agincourt HDSS supplied data for the period 1992-2008. Advanced spatial techniques were used to identify significant age-specific mortality ‘hotspots’ in spacetime. Multivariable Bayesian models were used to assess the effects of the most significant covariates on mortality. Disparities in risk factor profiles in identified hotspots were assessed. Results: Increasing HIV-related mortality and a subsequent decrease possibly attributable to antiretroviral therapy introduction are evident in this rural population. Distinct spacetime clustering and variation (even in a small geographic area) of mortality were observed. Several known and novel risk factors were identified, and population impact was quantified. Significant differences in the risk factor profiles of the identified ‘hotspots’ included ethnicity; maternal, partner, and household deaths; household head demographics; migrancy; education; and poverty.Conclusions: A complex interaction of highly attributable multilevel factors continues to demonstrate differential spacetime influences on mortality risk (especially for HIV). High-risk households and villages displayed differential risk factor profiles. This integrated approach could prove valuable to decision makers. Tailored interventions for specific child and adult high-risk mortality areas are needed, such as preventing vertical transmission, ensuring maternal survival, and improving water and sanitation infrastructure. This framework can be applied in other settings within the region. Keywords: mortality; spacetime risk; determinants; population attributable fractions; demographic surveillance system; rural; South Africa(Published: 24 January 2013)Citation: Glob Health Action 2013, 6: 19239 - http://dx.doi.org/10.3402/gha.v6i0.19239This article has also been published in Supplement 1, 2013 ‘’Building new knowledge’’. Read the supplement here.This article has been commented on by Elisabeth Dowling Root. Read this commentary here.Access the supplementary material to this article – see Supplementary files under Article Tools online.
