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Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study.
Wong, Emily B; Olivier, Stephen; Gunda, Resign; Koole, Olivier; Surujdeen, Ashmika; Gareta, Dickman; Munatsi, Day; Modise, Tshwaraganang H; Dreyer, Jaco; Nxumalo, Siyabonga; Smit, Theresa K; Ording-Jespersen, Greg; Mpofana, Innocentia B; Khan, Khadija; Sikhosana, Zizile E L; Moodley, Sashen; Shen, Yen-Ju; Khoza, Thandeka; Mhlongo, Ngcebo; Bucibo, Sanah; Nyamande, Kennedy; Baisley, Kathy J; Cuadros, Diego; Tanser, Frank; Grant, Alison D; Herbst, Kobus; Seeley, Janet; Hanekom, Willem A; Ndung'u, Thumbi; Siedner, Mark J; Pillay, Deenan.
  • Wong EB; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA; Division of Infection and Immunity, University College Lond
  • Olivier S; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Gunda R; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
  • Koole O; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK.
  • Surujdeen A; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Gareta D; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Munatsi D; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Modise TH; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Dreyer J; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Nxumalo S; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Smit TK; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Ording-Jespersen G; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Mpofana IB; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Khan K; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Sikhosana ZEL; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Moodley S; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Shen YJ; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Khoza T; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Mhlongo N; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Bucibo S; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
  • Nyamande K; Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Hospital, Durban, South Africa; Department of Respiratory Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
  • Baisley KJ; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK.
  • Cuadros D; Department of Geography, University of Cincinnati, USA.
  • Tanser F; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Lincoln International Institute for Rural Health, University of Lincoln, UK; Centre for the AIDS Programme of Res
  • Grant AD; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of the Witwatersrand, J
  • Herbst K; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Department of Science and Innovation, Medical Research Council, South African Population Research Infrastructure, Durban, South Africa.
  • Seeley J; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK.
  • Hanekom WA; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK.
  • Ndung'u T; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa;
  • Siedner MJ; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
  • Pillay D; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK.
Lancet Glob Health ; 9(7): e967-e976, 2021 07.
Article in English | MEDLINE | ID: covidwho-1271838
ABSTRACT

BACKGROUND:

There has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and non-communicable diseases in such a population in rural South Africa.

METHODS:

We did a cross-sectional study of eligible adolescents and adults from the Africa Health Research Institute demographic surveillance area in the uMkhanyakude district of KwaZulu-Natal, South Africa. The participants, who were 15 years or older, were invited to participate at a mobile health camp. Medical history for HIV, tuberculosis, hypertension, and diabetes was established through a questionnaire. Blood pressure measurements, chest x-rays, and tests of blood and sputum were taken to estimate the population prevalence and geospatial distribution of HIV, active and lifetime tuberculosis, elevated blood glucose, elevated blood pressure, and combinations of these.

FINDINGS:

17 118 adolescents and adults were recruited from May 25, 2018, to Nov 28, 2019, and assessed. Overall, 52·1% (95% CI 51·3-52·9) had at least one active disease. 34·2% (33·5-34·9) had HIV, 1·4% (1·2-1·6) had active tuberculosis, 21·8% (21·2-22·4) had lifetime tuberculosis, 8·5% (8·1-8·9) had elevated blood glucose, and 23·0% (22·4-23·6) had elevated blood pressure. Appropriate treatment and optimal disease control was highest for HIV (78·1%), and lower for elevated blood pressure (42·5%), active tuberculosis (29·6%), and elevated blood glucose (7·1%). Disease prevalence differed notably by sex, across age groups, and geospatially men had a higher prevalence of active and lifetime tuberculosis, whereas women had a substantially high prevalence of HIV at 30-49 years and an increasing prevalence of multiple and poorly controlled non-communicable diseases when older than 50 years.

INTERPRETATION:

We found a convergence of infectious and non-communicable disease epidemics in a rural South African population, with HIV well treated relative to all other diseases, but tuberculosis, elevated blood glucose, and elevated blood pressure poorly diagnosed and treated. A public health response that expands the successes of the HIV testing and treatment programme to provide multidisease care targeted to specific populations is required to optimise health in such settings in sub-Saharan Africa.

FUNDING:

Wellcome Trust, Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network. TRANSLATION For the isiZulu translation of the abstract see Supplementary Materials section.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis / HIV Infections / Rural Health / Diabetes Mellitus / Epidemics / Hypertension Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adolescent / Adult / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: Lancet Glob Health Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis / HIV Infections / Rural Health / Diabetes Mellitus / Epidemics / Hypertension Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adolescent / Adult / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: Lancet Glob Health Year: 2021 Document Type: Article