Understanding the differential impacts of COVID-19 among hospitalised patients in South Africa for equitable response

Background. There are limited in-depth analyses of COVID-19 differential impacts, especially in resource-limited settings such as South Africa (SA).Objectives. To explore context-specific sociodemographic heterogeneities in order to understand the differential impacts of COVID-19. Methods. Descriptive epidemiological COVID-19 hospitalisation and mortality data were drawn from daily hospital surveillance data, National Institute for Communicable Diseases (NICD) update reports (6 March 2020 - 24 January 2021) and the Eastern Cape Daily Epidemiological Report (as of 24 March 2021). We examined hospitalisations and mortality by sociodemographics (age using 10-year age bands, sex and race) using absolute numbers, proportions and ratios. The data are presented using tables received from the NICD, and charts were created to show trends and patterns. Mortality rates (per 100 000 population) were calculated using population estimates as a denominator for standardisation. Associations were determined through relative risks (RRs), 95% confidence intervals (CIs) and p-values <0.001. Results. Black African females had a significantly higher rate of hospitalisation (8.7% (95% CI 8.5 - 8.9)) compared with coloureds, Indians and whites (6.7% (95% CI 6.0 - 7.4), 6.3% (95% CI 5.5 - 7.2) and 4% (95% CI 3.5 - 4.5), respectively). Similarly, black African females had the highest hospitalisation rates at a younger age category of 30 - 39 years (16.1%) compared with other race groups. Whites were hospitalised at older ages than other races, with a median age of 63 years. Black Africans were hospitalised at younger ages than other race groups, with a median age of 52 years. Whites were significantly more likely to die at older ages compared with black Africans (RR 1.07; 95% CI 1.06 - 1.08) or coloureds (RR 1.44; 95% CI 1.33 - 1.54); a similar pattern was found between Indians and whites (RR 1.59; 95% CI 1.47 - 1.73). Women died at older ages than men, although they were admitted to hospital at younger ages. Among black Africans and coloureds, females (50.9 deaths per 100 000 and 37 per 100 000, respectively) had a higher COVID-19 death rate than males (41.2 per 100 000 and 41.5 per 100 000, respectively). However, among Indians and whites, males had higher rates of deaths than females. The ratio of deaths to hospitalisations by race and gender increased with increasing age. In each age group, this ratio was highest among black Africans and lowest among whites.Conclusions. The study revealed the heterogeneous nature of COVID-19 impacts in SA. Existing socioeconomic inequalities appear to shape COVID-19 impacts, with a disproportionate effect on black Africans and marginalised and low socioeconomic groups. These differential impacts call for considered attention to mitigating the health disparities among black Africans.

Gender disparity in risk factors for chronic kidney disease in a rural community in Southern Nigeria

Background: The evidence for gender disparity in prevalence of CKD is conflicting; while some studies report male preponderance, others have report female preponderance or no difference. Reasons for gender disparities in CKD prevalence may be related to differences in the occurrence of risk factors across the gender, amongst other factors. This study was to determine gender disparities in the risk factors for CKD. Method: This study is based on data from a community based cross-sectional study carried out in Ogbona, a rural community in Southern Nigeria. The WHO STEPS for surveillance of chronic diseases risk factors and chronic disease-specific morbidity and mortality questionnaire was adapted for this study. Four hundred and seventy-six participants were selected from 142 housing units in the community using multi-stage cluster sampling. Clinical examinations and laboratory investigations including serum creatinine, and urinalysis were performed. Results: Majority of participants were females (66.2%). CKD was commoner in females compared to males (14.3% vs. 12.7%, P= 0.06). More females than males had high body fat percentages (65.7% vs. 40.9%, P=<0.0001), high waist-hip ratio (99.7% vs 73.3%, P=<0.0001) and central obesity (43.1% and 4.3% P=<0.0001). More males compared to females used alcohol (56% vs. 9.2%, P=<0.0001), were overweight (42.2% vs 28.9%, P=0.004), and had proteinuria (6.2% vs 2.5%, P=0.054). The odds of females having central obesity are 16.7 times the odds of males having central obesity; similarly, the odds of females having high BF are 2.7 times the odds of males having high BF. Females had 122-fold the odds of men having high WHR. The odds of drinking alcohol are 92% less compared to males. There were no statistically significant gender differences regarding hypertension, diabetes mellitus, and use of nephrotoxins (NSAIDS, skin lightening agents, herbal medications). No female smoked cigarettes. Conclusion: This study shows that there is no statistically significant gender difference as regards prevalence of CKD, however several risk factors of CKD show gender disparity. The odds for central obesity, high WHR, high body fat percentages are significantly greater in females; while smoking, alcohol use, and over weightness, are commoner in males. There were no statistically significant gender differences regarding hypertension, diabetes mellitus, and use of nephrotoxins (NSAIDS, skin lightening agents, herbal medications)

Rural­urban health disparities among older adults in South Africa

Background: There are limited studies assessing rural­urban disparities among older adults in Africa including South Africa. Aim: This study explores rural­urban health disparities among older adults in a population-based survey in South Africa. Setting: Data for this study emanated from the 2008 study on 'Global Ageing and Adult Health (SAGE) wave 1' (N= 3280) aged 50 years or older in South Africa. Methods: Associations between exposure variables and outcome variables (health status variables and chronic conditions) were examined through bivariate analyses and multivariable logistic regression. Results: Rural dwellers were more likely to be older, black African and had lower education and wealth than urban dwellers. Rural and urban dwellers reported a similar prevalence of self-rated health status, quality of life, severe functional disability, arthritis, asthma, lung disease, hypertension, obesity, underweight, stroke and/or angina, low vision, depression, anxiety and nocturnal sleep problems. Adjusting for socio-demographic and health risk behaviour variables, urban dwellers had a higher prevalence of diabetes (OR: 2.36, 95%CI:1.37, 4.04), edentulism (OR: 2.79, 95% CI: 1.27, 6.09) and cognitive functioning (OR: 1.91, 95% CI: 1.27, 2.85) than rural dwellers. Conclusion: There are some rural­urban health disparities in South Africa, that is, urban dwellers had a higher prevalence of diabetes, edentulism and cognitive functioning than rural ones. Understanding these rural­urban health variations may help in developing better strategies to improve health across geolocality in South Africa

A review of interprovincial variations in HIV prevalence rates in Zimbabwe

Despite the proven remarkable decline of HIV prevalence in the sub-Saharan Africa region, both sub-regional and within-country disparities in HIV prevalence persist. This paper is a survey of literature on HIV prevalence and spread in Zimbabwe, focusing on provincial differences within the national picture of a decline in new infections. In particular, it raises the question of why prevalence and infection rates seem to be disproportionately higher in Matabeleland relative to other provinces of the country. This disparity cannot be adequately explained on the basis of national behavioural analyses as has been the case. The paper suggests possible additional nuances in the forms of analysis and proposes a change of focus in HIV-prevention strategies from national level to provincial considerations of the multiple factors influencing variations in HIV infection rates at provincial level. Using the different contextual conditions between provinces as a way to examine what might be the additional significant variables, the paper brings variations that go beyond sexual behaviour