FATAL AND NEAR-FATAL ASTHMA IN SOUTH AFRICA

Advances in the understanding and management of asthma globally and better provision of health care in South Africa may have improved management for people with asthma. The incidence of fatal and near- fatal asthma can be used as measures of the quality and accessibility of health services. This article reviews the information on the epidemiology of fatal and near-fatal asthma in South Africa and the associ- ation with particular risk factors. Over the past two decades, there has been a steady decline in asthma mortality; however, rates still remain much higher than those in developed coun- tries. Although South Africa has been ranked 25th worldwide for the prevalence of clinical asthma, it has been ranked 4th for asthma mortality in the 5-34 year-old age group and 5th for asthma case fatality rates globally. In addition, mortality rates vary by eth- nic group, with the highest rates among people of mixed race descent. Asthma mortality is directly cor- related with socio-economic deprivation. In the Cape Town metropole area, most asthma deaths occur outside a health facility. There has been a steady decline in paediatric near- fatal asthma episodes as measured by admissions to paediatric intensive care units in Cape Town over the past two decades, but the adult admission rate to intensive care and use of positive pressure venti- lation have remained unchanged. There is a strong correlation between the incidence of near-fatal asth- ma and socio-economic deprivation, despite a lower prevalence of asthma among less affluent people. Socio-economic factors and access to care are important contributors to asthma mortality, near- fatal episodes and to the severity of asthma symp- toms. Future asthma interventions need to address these inequities and target historically deprived groups.