Summary 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.

have limited ecological knowledge and understanding of resources occurring within the parks. People within these communities rate relationships with their neighbouring parks as relatively poor. Despite this, these communities are keen to support conservation and management of biodiversity through national parks. The study further revealed that two types of communities occur around the national parks of South Africa. These are neighbouring and the distant communities. The distant communities are more urban in character than the neighbouring communities. These communities are heterogeneous with people from a variety of cultures. The varying lifestyle, age groups, cultural backgrounds and income levels lead to differences in expectations from the national parks by these communities. This, which is critical in determining the level of appreciation of conservation of biodiversity by communities around conservation areas, requires the attention of the park managers. They need to ensure that when distributing the benefits or opportunities linked to conservation, cultural, income and education differences among communities are considered and used as the basis for development and implementation of community development projects.

No abstract

Grazing is one of the key processes in terrestrial ecosystems and this can be provided by both indigenous and domestic ungulates. However, a question remains whether or not traditional forms of land use such as the grazing of domestic animals support the maintenance of biodiversity. If it does not, then the second question becomes to what extent does grazing of domestic animals alter the systems and processes that support biodiversity? This study demonstrates that in attempting to answer this question, small organisms like dung beetles are ideal indicators that can be used to express significant differences between conserved (indigenous) and non‐conserved (domestic) land. As a general trend, studies that investigated these differences displayed differences through analysis of the diversity indices. This method has in most cases demonstrated a lack of contrast between conserved and non‐conserved land. In the existence of such uncertainty this study has demonstrated that in such cases, where the analysis of biodiversity indices fail to demonstrate significant differences a closer examination of actual species such as guilds and functional groups could confirm significant differences between conserved and non‐conserved land. These apparently conflicting findings reflect the need to consider the actual elements of biodiversity (e.g. species) when assessing conservation issues rather than just the statistical measures of biodiversity.