1
|
Pengpid S, Peltzer K. Chronic conditions and incident and persistent depressive symptoms among ageing adults in rural South Africa. PSYCHOL HEALTH MED 2024; 29:712-720. [PMID: 36941203 PMCID: PMC10509316 DOI: 10.1080/13548506.2023.2190595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
The study aimed to assess associations between chronic diseases and incident and persistent depressive symptoms (DSs) in a cohort study of ageing adults in South Africa. Participants in the baseline survey (in 2014/2015) were 5,059 persons (≥40 years) and at follow-up 4,176 (in 2018/2019). DSs were measured with the Center for Epidemiological Studies Depression scale. Logistic regression was used to estimate the associations between chronic conditions and incident and persistent DS. The prevalence of DS at baseline was 15.5%, incident DS (without DS and/or PTSD at baseline) was 25.1% and persistent DS (DS at both baseline and follow-up) was 4.8%. In unadjusted logistic regression analysis, diabetes had higher odds of incident DS. Participants with baseline heart attack/stroke/angina, dyslipidemia, tuberculosis, chronic bronchitis, kidney disease and three or more chronic conditions had a higher probability of persistent DS. In conclusion, of the eight chronic conditions evaluated, only diabetes (in unadjusted analysis) was associated with incident DS, and five chronic conditions (heart attack/stroke/angina, dyslipidaemia, tuberculosis, chronic bronchitis and kidney disease) and three or more chronic conditions were associated with persistent DS.
Collapse
Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| |
Collapse
|
2
|
Jock J, Kobayashi L, Chakraborty R, Chen X, Wing C, Berkman L, Canning D, Kabudula CW, Tollman S, Rosenberg M. Effects of Pension Eligibility Expansion on Men's Cognitive Function: Findings from Rural South Africa. J Aging Soc Policy 2023:1-20. [PMID: 36975023 PMCID: PMC10533724 DOI: 10.1080/08959420.2023.2195785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/11/2022] [Indexed: 03/29/2023]
Abstract
Two-thirds of people living with Alzheimer's disease and related dementias (ADRD) live in low- and middle-income countries, and this figure is expected to rise as these populations are rapidly aging. Since evidence demonstrates links between socioeconomic status and slower rates of cognitive decline, protecting older adults' cognitive function in resource-limited countries that lack the infrastructure to cope with ADRD is crucial to reduce the burden it places on these populations and their health systems. While cash transfers are a promising intervention to promote healthy cognitive aging, factors such as household wealth and level of education often confound the ability to make causal inferences on the impact of cash transfers and cognitive function. This study uses a quasi-experimental design, leveraging an exogenous expansion to the Old Age Pension for men in South Africa, to approximate causal associations with cognitive function. We found evidence that there is a potential benefit of cash transfers at an earlier age for older individuals. As such, transfers such as pensions or other forms of direct basic income transfers may hold promise as potential interventions to promote healthy cognitive aging.
Collapse
Affiliation(s)
- Janet Jock
- O'Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, U.S.A
| | - Lindsay Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, U.S.A
| | - Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, U.S.A
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, U.S.A
| | - Coady Wing
- O'Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, U.S.A
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Cambridge, U.S.A
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa
| | - David Canning
- Harvard Center for Population and Development Studies, Cambridge, U.S.A
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Health and Population Research Center, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, U.S.A
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
3
|
Matseke MG, Ruiter RAC, Rodriguez VJ, Peltzer K, Jones DL, Sifunda S. Male Partner Involvement and Development of HIV-exposed Infants in Rural South Africa. AIDS Behav 2021; 25:2712-2719. [PMID: 34097210 PMCID: PMC8373750 DOI: 10.1007/s10461-021-03326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/10/2022]
Abstract
Male partner involvement (MPI) during the prenatal and postnatal periods has been proven to have a beneficial effect on infant development. Infants born to HIV seropositive mothers with lacking or no prenatal and postnatal male partner support may be at a higher risk for adverse developmental outcomes. This study examined the effect of MPI on cognitive, communicative, fine, and gross motor development in 160 infants born to HIV seropositive mothers attending Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in rural South Africa. Results of the bivariate logistic regression showed that both prenatal (OR 1.13; 95% CI 1.01, 1.26; p < 0.05) and postnatal MPI (at 12 months) (1.19; 1.07, 1.31; p < 0.005) were associated with risk for delayed gross motor development in HIV exposed infants. Decreased postnatal MPI (0.85; 0.75, 0.98; p < 0.05) was significantly associated with risk for delayed cognitive development. Not living together with a male partner (2.01; 1.06, 3.80; p < 0.05) was significantly associated with risk for delayed cognitive development. In the multivariate logistic regression analysis, decreased postnatal MPI (0.85; 0.75, 0.98; p < 0.05) was significantly associated with risk for delayed cognitive development. On the other hand, postnatal MPI (1.30; 1.12, 1.50; p < 0.005) was associated with risk for delayed gross motor development among HIV exposed infants. Increased MPI can have beneficial effects on infants’ cognitive development. Interventions in PMTCT programs should promote increased prenatal and postnatal MPI to improve cognitive development in HIV exposed infants.
Collapse
|
4
|
Tlou B, Sartorius B, Tanser F. Effect of timing of mother's death on child survival in a rural HIV hyper-endemic South African population. BMC Public Health 2018; 18:1237. [PMID: 30400789 PMCID: PMC6220497 DOI: 10.1186/s12889-018-6152-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 10/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background Maternal mortality remains a tragedy and a key determinant for child survival. There is increasing evidence that the hazard ratio of demising for young children escalates after the death of their mothers, but few studies has been done in rural areas were HIV/AIDS is more prevalent. The aim of this study is to investigate the survival of children who lost their mothers soon or after their births in a rural setup with high HIV prevalence in South Africa. Methods This study used a data set from Africa Health Research Institute in rural South Africa.The study population comprised children (0–10 years of age) from 2000 to 2014. We employed a Cox regression modelling approach to estimate greatest temporal hazard of the child after the death of their mothers, accounting for the confounding influence of wealth index of the household and HIV status of the mother. Results We found 62,600 live births, and that 2191 children died when they were less than or equal to 10 years old. The mortality rates for < 5 and 5–9 years is 882.25 and 117.75 per 1000 live births respectively, with a maternal mortality rate of 447.3 deaths per 100,000 live births from 2000 to 2004. Child mortality risk was very high in less than 6 weeks after their mother’s death (HR 3.45 [95%CI: 1.3–6.54]), and decreased drastically after 3 years following her death (HR 0.8 [0.2–6.3]). This increased risk was more pronounced among children aged less than 1 month and living in poor households. Conclusions Children (less than 10 years) in rural households are at their highest risk of dying within 6 weeks of mother’s death and this risk decreases substantially after the highly vulnerable window. This indicates that the period of mother’s death does play a critical role on the survival of her children.Thus, understanding this risk and its timing in relation to a mother’s death is critical to guide interventions and stress the relevance of assessing the interaction between clinical care and socio-economic programs in addressing the needs of orphans.
Collapse
Affiliation(s)
- Boikhutso Tlou
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.,Centre for the AIDS Programme of Research in South Africa -CAPRISA, University of KwaZulu-Natal, Durban, South Africa.,Research Department of Infection & Population Health, University College London, London, UK
| |
Collapse
|
5
|
Larmarange J, Diallo MH, McGrath N, Iwuji C, Plazy M, Thiébaut R, Tanser F, Bärnighausen T, Pillay D, Dabis F, Orne‐Gliemann J. The impact of population dynamics on the population HIV care cascade: results from the ANRS 12249 Treatment as Prevention trial in rural KwaZulu-Natal (South Africa). J Int AIDS Soc 2018; 21 Suppl 4:e25128. [PMID: 30027600 PMCID: PMC6053480 DOI: 10.1002/jia2.25128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/17/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The universal test and treat strategy (UTT) was developed to maximize the proportion of all HIV-positive individuals on antiretroviral treatment (ART) and virally suppressed, assuming that it will lead to a reduction in HIV incidence at the population level. The evolution over time of the cross-sectional HIV care cascade is determined by individual longitudinal trajectories through the HIV care continuum and underlying population dynamics. The purpose of this paper is to quantify the contribution of each component of population change (in- and out-migration, HIV seroconversion, ageing into the cohort and definitive exit such as death) on the HIV care cascade in the context of the ANRS 12249 Treatment as Prevention (TasP) cluster-randomized trial, investigating UTT in rural KwaZulu-Natal, South Africa, between 2012 and 2016. METHODS HIV test results and information on clinic visits, ART prescriptions, viral load and CD4 count, migration and deaths were used to calculate residency status, HIV status and HIV care status for each individual on a daily basis. Position within the HIV care continuum was considered as a score ranging from 0 (undiagnosed) to 4 (virally suppressed). We compared the cascade score of each individual joining or leaving the population of resident adults living with HIV with the average score of their cluster at the time of entry or exit. Then, we computed the contribution of each entry or exit on the average cascade score and their annualized total contribution, by component of change. RESULTS While the average cascade score increased over time in all clusters, that increase was constrained by population dynamics. Permanent exits and ageing into the people living with HIV cohort had a marginal effect. Both in-migrants and out-migrants were less likely to be retained at each step of the HIV care continuum. However, their overall impact on the cross-sectional cascade was limited as the effect of in- and out-migration balanced each other. The contribution of HIV seroconversions was negative in all clusters. CONCLUSIONS In a context of high HIV incidence, the continuous flow of newly infected individuals slows down the efforts to increase ART coverage and population viral suppression, ultimately attenuating any population-level impact on HIV incidence. CLINICAL TRIAL NUMBER NCT01509508 (clinicalTrials.gov)/DOH-27-0512-3974 (South African National Clinical Trials Register).
Collapse
Affiliation(s)
- Joseph Larmarange
- Centre Population et DéveloppementInstitut de Recherche pour le DéveloppementUniversité Paris DescartesInsermParisFrance
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
| | - Mamadou Hassimiou Diallo
- Centre Population et DéveloppementInstitut de Recherche pour le DéveloppementUniversité Paris DescartesInsermParisFrance
| | - Nuala McGrath
- School of Nursing and Public HealthAfrica Health Research InstituteUniversity of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
- Faculty of Medicine and Faculty of Social, Human and Mathematical SciencesUniversity of SouthamptonSouthamptonUK
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - Collins Iwuji
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
- Department of Global Health & InfectionBrighton and Sussex Medical SchoolFalmerBrightonUK
| | - Mélanie Plazy
- ISPEDInsermBordeaux Population Health Research CenterUniversité de BordeauxBordeauxFrance
| | - Rodolphe Thiébaut
- ISPEDInsermBordeaux Population Health Research CenterUniversité de BordeauxBordeauxFrance
| | - Frank Tanser
- School of Nursing and Public HealthAfrica Health Research InstituteUniversity of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
| | - Till Bärnighausen
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Department of Global Health & PopulationHarvard School of Public HealthHarvard UniversityBostonMAUSA
- Institute of Public HealthFaculty of MedicineHeidelberg UniversityHeidelbergGermany
| | - Deenan Pillay
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | - François Dabis
- ISPEDInsermBordeaux Population Health Research CenterUniversité de BordeauxBordeauxFrance
| | - Joanna Orne‐Gliemann
- ISPEDInsermBordeaux Population Health Research CenterUniversité de BordeauxBordeauxFrance
| | | |
Collapse
|
6
|
Payne CF, Wade A, Kabudula CW, Davies JI, Chang AY, Gomez-Olive FX, Kahn K, Berkman LF, Tollman SM, Salomon JA, Witham MD. Prevalence and correlates of frailty in an older rural African population: findings from the HAALSI cohort study. BMC Geriatr 2017; 17:293. [PMID: 29281995 PMCID: PMC5745732 DOI: 10.1186/s12877-017-0694-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background Frailty is a key predictor of death and dependency, yet little is known about frailty in sub-Saharan Africa despite rapid population ageing. We describe the prevalence and correlates of phenotypic frailty using data from the Health and Aging in Africa: Longitudinal Studies of an INDEPTH Community cohort. Methods We analysed data from rural South Africans aged 40 and over. We used low grip strength, slow gait speed, low body mass index, and combinations of self-reported exhaustion, decline in health, low physical activity and high self-reported sedentariness to derive nine variants of a phenotypic frailty score. Each frailty category was compared with self-reported health, subjective wellbeing, impairment in activities of daily living and the presence of multimorbidity. Cox regression analyses were used to compare subsequent all-cause mortality for non-frail (score 0), pre-frail (score 1–2) and frail participants (score 3+). Results Five thousand fifty nine individuals (mean age 61.7 years, 2714 female) were included in the analyses. The nine frailty score variants yielded a range of frailty prevalences (5.4% to 13.2%). For all variants, rates were higher in women than in men, and rose steeply with age. Frailty was associated with worse subjective wellbeing, and worse self-reported health. Both prefrailty and frailty were associated with a higher risk of death during a mean 17 month follow up for all score variants (hazard ratios 1.29 to 2.41 for pre-frail vs non-frail; hazard ratios 2.65 to 8.91 for frail vs non-frail). Conclusions Phenotypic frailty could be measured in this older South African population, and was associated with worse health, wellbeing and earlier death. Electronic supplementary material The online version of this article (10.1186/s12877-017-0694-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Collin F Payne
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Alisha Wade
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa W Kabudula
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justine I Davies
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Population Sciences and Health Services Research, Faculty of Life Sciences and Medicine, Centre for Global Health, King's College London, London, UK
| | - Angela Y Chang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - F Xavier Gomez-Olive
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,INDEPTH Network, Accra, Ghana
| | - Lisa F Berkman
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,INDEPTH Network, Accra, Ghana
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Miles D Witham
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Ageing and Health, School of Medicine, University of Dundee, Scotland, UK.
| |
Collapse
|
7
|
Etta EM, Mavhandu L, Manhaeve C, McGonigle K, Jackson P, Rekosh D, Hammarskjold ML, Bessong PO, Tebit DM. High level of HIV-1 drug resistance mutations in patients with unsuppressed viral loads in rural northern South Africa. AIDS Res Ther 2017; 14:36. [PMID: 28750647 PMCID: PMC5531022 DOI: 10.1186/s12981-017-0161-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/19/2017] [Indexed: 02/07/2023] Open
Abstract
Background Combination antiretroviral therapy (cART) has significantly reduced HIV morbidity and mortality in both developed and developing countries. However, the sustainability of cART may be compromised by the emergence of viral drug resistance mutations (DRM) and the cellular persistence of proviruses carrying these DRM. This is potentially a more serious problem in resource limited settings. Methods DRM were evaluated in individuals with unsuppressed viral loads after first or multiple lines of cART at two sites in rural Limpopo, South Africa. Seventy-two patients with viral loads of >1000 copies/ml were recruited between March 2014 and December 2015. Complete protease (PR) and partial Reverse Transcriptase (RT) sequences were amplified from both plasma RNA and paired proviral DNA from 35 of these subjects. Amplicons were directly sequenced to determine subtype and DRM using the Stanford HIV Drug Resistance Interpretation algorithm. Results Among the 72 samples, 69 could be PCR amplified from RNA and 35 from both RNA and DNA. Sixty-five (94.2%) viruses were subtype C, while one was subtype B (1.4%), one recombinant K/C, one recombinant C/B and one unclassified. Fifty-eight (84%) sequences carried at least one DRM, while 11 (15.9%) displayed no DRM. DRM prevalence according to drug class was: NRTI 60.8% NNRTI 65.2%, and PI 5.8%. The most common DRMs were; M184V (51.7%), K103N (50%), V106M (20.6%), D67N (13.3%), K65R (12%). The frequency of the DRM tracked well with the frequency of use of medications to which the mutations were predicted to confer resistance. Interestingly, a significant number of subjects showed predicted resistance to the newer NNRTIs, etravirine (33%) and rilpivirine (42%), both of which are not yet available in this setting. The proportion of DRM in RNA and DNA were mostly similar with the exception of the thymidine analogue mutations (TAMs) D67N, K70R, K219QE; and K103N which were slightly more prevalent in DNA than RNA. Subjects who had received cART for at least 5 years were more likely to harbour >2 DRM (p < 0.05) compared to those treated for a shorter period. DRM were more prevalent in this rural setting compared to a neighbouring urban setting. Conclusion We found a very high prevalence of NRTI and NNRTI DRM in patients from rural Limpopo settings with different durations of treatment. The prevalence was significantly higher than those reported in urban settings in South Africa. The dominance of NNRTI based mutations late in treatment supports the use of PI based regimens for second line treatment in this setting. The slight dominance of TAMs in DNA from infected PBMCs compared to plasma virus requires further studies that should include cART subjects with suppressed virus. Such studies will improve our understanding of the pattern of drug resistance and dynamics of viral persistence in these rural settings.
Collapse
|
8
|
Tlou B, Sartorius B, Tanser F. Space-time patterns in maternal and mother mortality in a rural South African population with high HIV prevalence (2000-2014): results from a population-based cohort. BMC Public Health 2017; 17:543. [PMID: 28578674 PMCID: PMC5457561 DOI: 10.1186/s12889-017-4463-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 05/24/2017] [Indexed: 01/01/2023] Open
Abstract
Background International organs such as, the African Union and the South African Government view maternal health as a dominant health prerogative. Even though most countries are making progress, maternal mortality in South Africa (SA) significantly increased between 1990 and 2015, and prevented the country from achieving Millennium Development Goal 5. Elucidating the space-time patterns and risk factors of maternal mortality in a rural South African population could help target limited resources and policy guidelines to high-risk areas for the greatest impact, as more generalized interventions are costly and often less effective. Methods Population-based mortality data from 2000 to 2014 for women aged 15–49 years from the Africa Centre Demographic Information System located in the Umkhanyakude district of KwaZulu-Natal Province, South Africa were analysed. Our outcome was classified into two definitions: Maternal mortality; the death of a woman while pregnant or within 42 days of cessation of pregnancy, regardless of the duration and site of the pregnancy, from any cause related to or exacerbated by the pregnancy or its management but not from unexpected or incidental causes; and ‘Mother death’; death of a mother whilst child is less than 5 years of age. Both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection respectively were used to identify clusters of maternal mortality events in both space and time. Results The overall maternal mortality ratio was 650 per 100,000 live births, and 1204 mothers died while their child was less than or equal to 5 years of age, of a mortality rate of 370 per 100,000 children. Maternal mortality declined over the study period from approximately 600 per 100,000 live births in 2000 to 400 per 100,000 live births in 2014. There was no strong evidence of spatial clustering for maternal mortality in this rural population. However, the study identified a significant spatial cluster of mother deaths in childhood (p = 0.022) in a peri-urban community near the national road. Based on our multivariable logistic regression model, HIV positive status (Adjusted odds ratio [aOR] = 2.5, CI 95%: [1.5–4.2]; primary education or less (aOR = 1.97, CI 95%: [1.04–3.74]) and parity (aOR = 1.42, CI 95%: [1.24–1.63]) were significant predictors of maternal mortality. Conclusions There has been an overall decrease in maternal and mother death between 2000 and 2014. The identification of a clear cluster of mother deaths shows the possibility of targeting intervention programs in vulnerable communities, as population-wide interventions may be ineffective and too costly to implement.
Collapse
Affiliation(s)
- B Tlou
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - B Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - F Tanser
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute University of KwaZulu-Natal, Mtubatuba, South Africa.,Centre for the AIDS Programme of Research in South Africa- CAPRISA, University of KwaZulu-Natal, Congella, South Africa
| |
Collapse
|
9
|
Leslie HH, Ahern J, Pettifor AE, Twine R, Kahn K, Gómez-Olivé FX, Lippman SA. Collective efficacy, alcohol outlet density, and young men's alcohol use in rural South Africa. Health Place 2015; 34:190-8. [PMID: 26071651 PMCID: PMC4497916 DOI: 10.1016/j.healthplace.2015.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/25/2015] [Accepted: 05/25/2015] [Indexed: 12/13/2022]
Abstract
Alcohol use contributes to morbidity and mortality in developing countries by increasing the risk of trauma and disease, including alcohol dependence. Limited research addresses determinants of alcohol use beyond the individual level in sub-Saharan Africa. We test the association of community collective efficacy and alcohol outlet density with young men's drinking in a cross-sectional, locally representative survey conducted in rural northeast South Africa. Informal social control and cohesion show protective associations with men's heavy drinking, while alcohol outlet density is associated with more potential problem drinking. These findings provide initial support for intervening at the community level to promote alcohol reduction.
Collapse
Affiliation(s)
- Hannah H Leslie
- MPH-University of California, Berkeley, Division of Epidemiology, School of Public Health, Berkeley, CA, USA.
| | - Jennifer Ahern
- University of California, Berkeley, Division of Epidemiology, School of Public Health, Berkeley, CA, USA
| | - Audrey E Pettifor
- MPH-University of North Carolina at Chapel Hill, Department of Epidemiology, School of Public Health, Chapel Hill, North Carolina, USA and Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt); School of Public Health, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, South Africa
| | - Rhian Twine
- MPH-Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt); School of Public Health, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, South Africa
| | - Kathleen Kahn
- MPH, MBBCh-Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt); School of Public Health, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MBBCh, PhD, MSc-Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt); School of Public Health, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, South Africa
| | - Sheri A Lippman
- MPH-University of California, San Francisco, Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, San Francisco, CA, USA
| |
Collapse
|