Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study

Emily B Wong; Stephen Olivier; Resign Gunda; Olivier Koole; Ashmika Surujdeen; Dickman Gareta; Day Munatsi; Tshwaraganang H Modise; Jaco Dreyer; Siyabonga Nxumalo; Theresa K Smit; Greg Ording-Jespersen; Innocentia B Mpofana; Khadija Khan; Zizile E L Sikhosana; Sashen Moodley; Yen-Ju Shen; Thandeka Khoza; Ngcebo Mhlongo; Sanah Bucibo; Kennedy Nyamande; Kathy J Baisley; Diego Cuadros; Frank Tanser; Alison D Grant; Kobus Herbst; Janet Seeley; Willem A Hanekom; Thumbi Ndung'u; Mark J Siedner; Deenan Pillay; Vukuzazi Team

doi:10.1016/S2214-109X(21)00176-5

Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study

Lancet Glob Health. 2021 Jul;9(7):e967-e976. doi: 10.1016/S2214-109X(21)00176-5.

Authors

Emily B Wong¹, Stephen Olivier², Resign Gunda³, Olivier Koole⁴, Ashmika Surujdeen², Dickman Gareta², Day Munatsi², Tshwaraganang H Modise², Jaco Dreyer², Siyabonga Nxumalo², Theresa K Smit², Greg Ording-Jespersen², Innocentia B Mpofana², Khadija Khan², Zizile E L Sikhosana², Sashen Moodley², Yen-Ju Shen², Thandeka Khoza², Ngcebo Mhlongo², Sanah Bucibo², Kennedy Nyamande⁵, Kathy J Baisley⁴, Diego Cuadros⁶, Frank Tanser⁷, Alison D Grant⁸, Kobus Herbst⁹, Janet Seeley⁴, Willem A Hanekom¹⁰, Thumbi Ndung'u¹¹, Mark J Siedner¹², Deenan Pillay¹⁰; Vukuzazi Team

Collaborators

Vukuzazi Team:
Emily B Wong, Stephen Olivier, Resign Gunda, Olivier Koole, Ashmika Surujdeen, Dickman Gareta, Day Munatsi, Tswaraganang H Modise, Jaco Dreyer, Siyabonga Nxumalo, Theresa K Smit, Greg Ording-Jespersen, Innocentia B Mpofana, Khadija Khan, Zizile E L Sikhosana, Sashen Moodley, Yen-Ju Shen, Thandeka Khoza, Ngcebo Mhlongo, Sana Bucibo, Kennedy Nyamande, Kathy J Baisley, Diego Cuadros, Frank Tanser, Alison D Grant, Kobus Herbst, Janet Seeley, Willem A Hanekom, Thumbi Ndung'u, Mark J Siedner, Deenan Pillay, Mosa Suleman, Jaikrishna Kalideen, Ramesh Jackpersad, Kgaugelo Moropane, Boitsholo Mfolo, Khabonina Malomane, Hlolisile Khumalo, Nompilo Buthelezi, Nozipho Mbonambi, Hloniphile Ngubane, Thokozani Simelane, Khanyisani Buthelezi, Sphiwe Ntuli, Nombuyiselo Zondi, Siboniso Nene, Bongumenzi Ndlovu, Talente Ntimbane, Mbali Mbuyisa, Xolani Mkhize, Melusi Sibiya, Ntombiyenkosi Ntombela, Mandisi Dlamini, Hlobisile Chonco, Hlengiwe Dlamini, Doctar Mlambo, Nonhlahla Mzimela, Zinhle Buthelezi, Zinhle Mthembu, Thokozani Bhengu, Sandile Mtehmbu, Phumelele Mthethwa, Zamashandu Mbatha, Welcome Petros Mthembu, Anele Mkhwanazi, Mandlakayise Sikhali, Phakamani Mkhwanazi, Ntombiyenhlahla Mkhwanazi, Rose Myeni, Fezeka Mfeka, Hlobisile Gumede, Nonceba Mfeka, Ayanda Zungu, Hlobisile Gumede, Nonhlahla Mfekayi, Smangaliso Zulu, Mzamo Buthelezi, Senzeni Mkhwanazi, Mlungisi Dube, Philippa Matthews, Siphephelo Dlamini, Hosea Kambonde, Lindani Mthembu, Seneme Mchunu, Sibahle Gumbi, Tumi Madolo, Thengokwakhe Nkosi, Sibusiso Mkhwanazi, Simbusio Nsibande, Mpumelelo Steto, Sibusiso Mhlongo, Velile Vellem, Pfarelo Tshivase, Jabu Kwinda, Bongani Magwaza, Siyabonga Nsibande, Skhumbuzo Mthombeni, Sphiwe Clement Mthembu, Antony Rapulana, Jade Cousins, Thabile Zondi, Nagavelli Padayachi, Freddy Mabetlela, Simphiwe Ntshangase, Nomfundo Luthuli, Sithembile Ngcobo, Kayleen Brien, Sizwe Ndlela, Nomfundo Ngema, Nokukhanya Ntshakala, Anupa Singh, Rochelle Singh, Logan Pillay, Kandaseelan Chetty, Asthentha Govender, Pamela Ramkalawon, Nondumiso Mabaso, Kimeshree Perumal, Senamile Makhari, Nondumiso Khuluse, Nondumiso Zitha, Hlengiwe Khati, Mbuti Mofokeng, Nomathamsanqa Majozi, Nceba Gqaleni, Hannah Keal, Phumla Ngcobo, Costa Criticos, Raynold Zondo, Dilip Kalyan, Clive Mavimbela, Anand Ramnanan, Sashin Harilall

Affiliations

¹ 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 London, London, UK. Electronic address: [email protected].
² Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
³ 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.
⁴ Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK.
⁵ 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.
⁶ Department of Geography, University of Cincinnati, USA.
⁷ 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 Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.
⁸ 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, Johannesburg, South Africa.
⁹ 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.
¹⁰ Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK.
¹¹ 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; The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard Medical School, Cambridge, MA, USA; Max Planck Institute for Infection Biology, Berlin, Germany.
¹² 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.

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.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Cross-Sectional Studies
Diabetes Mellitus / epidemiology*
Epidemics*
Female
HIV Infections / epidemiology*
Humans
Hypertension / epidemiology*
Male
Middle Aged
Multimorbidity
Prevalence
Rural Health / statistics & numerical data*
South Africa / epidemiology
Tuberculosis / epidemiology*

Abstract

Publication types

MeSH terms

Grants and funding