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

Abstract

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.

Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa

“…Our study noted attrition at all stages of the HCC. The gaps in diagnosis, treatment and control are consistent with studies conducted in rural South Africa ( Addo, Smeeth & Leon, 2007 ; Adeniyi et al, 2016 ; Siedner et al, 2018 ; Wong et al, 2021 ). Hypertension care cascade gaps in South Africa have been attributed to long distances to health centres, poor health-seeking behaviour and perceived low quality of services, including lengthy waiting periods ( Nulu, Aronow & Frishman, 2016 ).…”

“…Although healthcare services are publicly provided, transport costs hinder the utilisation of healthcare services in rural KwaZulu-Natal ( Chimbindi et al, 2015 ). UMkhanyakude district has a high prevalence of communicable and noncommunicable diseases ( Sharman & Bachmann, 2019 ; Wong et al, 2021 ), and in mid-2021, it was among the districts with the least cumulative cases (11,548) and fatalities (422) of COVID-19 in KwaZulu-Natal province ( KZN_Department_of_Health, 2021 ).…”

Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future

“…Currently, the highest prevalence worldwide for both infectious diseases and non-communicable diseases (NCDs), as well as patients with multiple co-morbidities, including both infectious and non-infectious diseases, is found in Africa [ 1 , 2 , 3 , 4 , 5 , 6 ]. The prevention and management of these patients, especially those with multiple co-morbidities, will require an improved understanding of the causal determinants of individual and overlapping diseases, including potential genetic factors [ 7 ]. Alongside this, there can be co-payment issues in a number of African countries, which can also have catastrophic consequences on patients and their families [ 8 , 9 , 10 , 11 , 12 ].…”

“…Adequate training of physicians and pharmacists is essential to deal with increasingly complex cases across Africa given the increasing prevalence of diseases and patients with co-morbidities [ 7 , 52 , 53 , 54 , 55 ]. This is seen as particularly important during the COVID-19 pandemic given the extent of misinformation that exists regarding possible medicines for the prevention and treatment of COVID-19 and their consequences [ 9 , 56 ].…”

Aging with HIV: Increased Risk of HIV Comorbidities in Older Adults

“…A decade prior, researchers were predicting the negative impacts associated with the collision of these two epidemics in South Africa [ 9 ]. More recently, studies have found a high and overlapping prevalence of disease conditions such as HIV, tuberculosis and NCDs in both community settings [ 10 , 11 , 12 ] and health facilities in the country [ 13 ].…”