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. 2021 Jul;9(7):e967-e976.
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

Emily B Wong  1 , Stephen Olivier  2 , Resign Gunda  3 , Olivier Koole  4 , Ashmika Surujdeen  2 , Dickman Gareta  2 , Day Munatsi  2 , Tshwaraganang H Modise  2 , Jaco Dreyer  2 , Siyabonga Nxumalo  2 , Theresa K Smit  2 , Greg Ording-Jespersen  2 , Innocentia B Mpofana  2 , Khadija Khan  2 , Zizile E L Sikhosana  2 , Sashen Moodley  2 , Yen-Ju Shen  2 , Thandeka Khoza  2 , Ngcebo Mhlongo  2 , Sanah Bucibo  2 , Kennedy Nyamande  5 , Kathy J Baisley  4 , Diego Cuadros  6 , Frank Tanser  7 , Alison D Grant  8 , Kobus Herbst  9 , Janet Seeley  4 , Willem A Hanekom  10 , Thumbi Ndung'u  11 , Mark J Siedner  12 , Deenan Pillay  10 ; Vukuzazi Team
Collaborators, Affiliations

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

Emily B Wong et al. Lancet Glob Health. 2021 Jul.

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.

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Conflict of interest statement

Declaration of interests TN reports grants from the Wellcome Trust, the African Academy of Sciences, and the South African National Research Foundation, during the conduct of the study. ADG reports grants from the Wellcome Trust, during the conduct of the study. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Participation in the Vukuzazi study Individuals aged 15 years or older and living in the Africa Heath Research Institute Demographic and Health Surveillance area were eligible for Vukuzazi. The flow chart shows the rates of contact by the research team, acceptance of an invitation to Vukuzazi, enrolment at the mobile health camp, and participation in the study components required to define four common and treatable diseases (HIV, tuberculosis, elevated blood pressure, and elevated blood glucose).
Figure 2
Figure 2
Population prevalence and spatial distribution of communicable and non-communicable diseases in rural KwaZulu-Natal, South Africa Population prevalence estimates by sex and age category (years) shown in the graphs, and continuous surface maps of the demographic surveillance area showing areas of lowest (blue) and highest (red) prevalence for HIV (A), lifetime tuberculosis (B), elevated blood glucose (C), and elevated blood pressure (D).
Figure 3
Figure 3
Disease control and multimorbidity Population prevalence of uncontrolled and controlled (A) HIV, (B) active tuberculosis, (C) elevated blood glucose, (D) elevated blood pressure, (E) multimorbidity by sex and age categories, and (F) a continuous surface map of the demographic surveillance area showing areas of lowest (blue) and highest (red) prevalence of the highest degree of multimorbidity (ie, the presence of two or more diseases, at least one of which was uncontrolled). M=male participants. F=female participants.
Figure 4
Figure 4
Multimorbidity across the lifespan Granular visualisation of the individual contributions of controlled or uncontrolled HIV, active tuberculosis, elevated blood glucose, and elevated blood pressure to multimorbidity across the adult lifespan of (A) women and (B) men who participated in Vukuzazi.
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Comment in

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