Hypertension incidence among middle-aged and older adults: findings from a 5-year prospective study in rural South Africa, 2010–2015

ObjectivesThere is a scarcity of longitudinal cohort studies in sub-Saharan Africa to understand the epidemiology of cardiovascular disease as a basis for intervention. We estimated incident hypertension and associated sociodemographic, health and behavioural risk factors in a population aged 40 years and older over a 5-year period.DesignWe assessed the association between incident hypertension and sociodemographic, health and behavioural factors using Poisson regression. We adjusted for non-response in 2015 using inverse probability sampling weights from a logistic regression including sex and age at baseline.SettingRural South Africa.ParticipantsWe used a population-based cohort of normotensive adults in 2010 who were aged 40 years and older at retest in 2015.ResultsOf 676 individuals completing baseline and 5-year follow-up, there were 193 incident cases of hypertension. The overall hypertension incidence rate was 8.374/100 person-years. In multivariable analyses, those who became hypertensive were more likely to be older, have a high waist circumference (incidence rate ratio (IRR): 1.557, 95% CI: 1.074 to 2.259) and be employed (IRR: 1.579, 95% CI: 1.071 to 2.329) at baseline. Being HIV positive and not on antiretroviral therapy at baseline was associated with lower risk of incident hypertension.ConclusionsOver a 5-year period, 29% of respondents developed hypertension. Given the high burden of hypertension in South Africa, continued longitudinal follow-up is needed to understand the complex interplay of non-communicable and infectious diseases and their underlying and modifiable risk factors to inform public health prevention strategies and programmes.

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Linkage to primary care after home-based blood pressure screening in rural KwaZulu-Natal, South Africa: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023369 ◽

2018 ◽

Vol 8 (12) ◽

pp. e023369 ◽

Cited By ~ 2

Author(s):

Mark J Siedner ◽

Kathy Baisley ◽

Joanna Orne-Gliemann ◽

Deenan Pillay ◽

Olivier Koole ◽

...

Keyword(s):

South Africa ◽

Blood Pressure ◽

Linkage To Care ◽

Sampling Weights ◽

Rural South ◽

Home Based ◽

Kwazulu Natal ◽

Blood Pressure Screening ◽

The Impact ◽

Rural South Africa

ObjectivesThe expanding burden of non-communicable diseases (NCDs) globally will require novel public health strategies. Community-based screening has been promoted to augment efficiency of diagnostic services, but few data are available on the downstream impact of such programmes. We sought to assess the impact of a home-based blood pressure screening programme on linkage to hypertension care in rural South Africa.SettingWe conducted home-based blood pressure screening withinin a population cohort in rural KwaZulu-Natal, using the WHO Stepwise Approach to Surveillance (STEPS) protocol.ParticipantsIndividuals meeting criteria for raised blood pressure (≥140 systolic or ≥90 diastolic averaged over two readings) were referred to local health clinics and included in this analysis. We defined linkage to care based on self-report of presentation to clinic for hypertension during the next 2 years of cohort observation. We estimated the population proportion of successful linkage to care with inverse probability sampling weights, and fit multivariable logistic regression models to identify predictors of linkage following a positive hypertension screen.ResultsOf 11 694 individuals screened, 14.6% (n=1706) were newly diagnosed with elevated pressure. 26.9% (95% CI 24.5% to 29.4%) of those sought hypertension care in the following 2 years, and 38.1% (95% CI 35.6% to 40.7%) did so within 5 years. Women (adjusted OR (aOR) 2.41, 95% CI 1.68 to 3.45), those of older age (aOR 11.49, 95% CI 5.87 to 22.46, for 45–59 years vs <30) and those unemployed (aOR 1.71, 95% CI 1.10 to 2.65) were more likely to have linked to care.ConclusionsLinkage to care after home-based identification of elevated blood pressure was rare in rural South Africa, particularly among younger individuals, men and the employed. Improved understanding of barriers and facilitators to NCD care is needed to enhance the effectiveness of blood pressure screening in the region.

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Young and vulnerable: Spatial-temporal trends and risk factors for infant mortality in rural South Africa (Agincourt), 1992-2007

BMC Public Health ◽

10.1186/1471-2458-10-645 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 21

Author(s):

Benn KD Sartorius ◽

Kathleen Kahn ◽

Penelope Vounatsou ◽

Mark A Collinson ◽

Stephen M Tollman

Keyword(s):

Risk Factors ◽

South Africa ◽

Infant Mortality ◽

Temporal Trends ◽

Rural South ◽

Rural South Africa

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Mortality and loss to follow-up among HAART initiators in rural South Africa

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/j.trstmh.2008.10.001 ◽

2009 ◽

Vol 103 (6) ◽

pp. 588-593 ◽

Cited By ~ 57

Author(s):

Peter MacPherson ◽

Mosa Moshabela ◽

Neil Martinson ◽

Paul Pronyk

Keyword(s):

South Africa ◽

Rural South ◽

Loss To Follow Up ◽

Rural South Africa

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Sources of social support and sexual behaviour advice for young adults in rural South Africa

BMJ Global Health ◽

10.1136/bmjgh-2018-000955 ◽

2018 ◽

Vol 3 (6) ◽

pp. e000955 ◽

Cited By ~ 2

Author(s):

Guy Harling ◽

Dumile Gumede ◽

Maryam Shahmanesh ◽

Deenan Pillay ◽

Till W Bärnighausen ◽

...

Keyword(s):

Social Support ◽

South Africa ◽

Young Adults ◽

Hiv Prevention ◽

Sexual Behaviour ◽

Sub Saharan Africa ◽

Social Connections ◽

Cross Sectional ◽

Rural South ◽

Rural South Africa

IntroductionWhile young people in sub-Saharan Africa (SSA) are at greatest risk of HIV acquisition, uptake of HIV prevention interventions among them has been limited. Interventions delivered through social connections have changed behaviour in many settings, but not to date in SSA. There is little systematic evidence on whom young SSA adults turn to for advice. We therefore conducted an exploratory cross-sectional study from whom young rural South Africans received support and sexual behaviour-specific advice.MethodsWe asked 119 18–34 year olds in rural KwaZulu-Natal about the important people in their lives who provided emotional, informational, financial, physical, social or other support. We also asked whether they had discussed sex or HIV prevention with each contact named. We used descriptive statistics and logistic regression to analyse support and advice provision patterns.ResultsRespondents named 394 important contacts, each providing a mean of 1.7 types of support. Most contacts were relatives, same-gender friends or romantic partners. Relatives provided most informational, financial and physical support; friends and partners more social support and sexual advice. Respondents reported discussing sexual matters with 60% of contacts. Sources of support changed with age, from friends and parents, towards siblings and partners.DiscussionSexual health interventions for young adults in rural South Africa may be able to harness friend and same-generation kin social ties through which sex is already discussed, and parental ties through which other forms of support are transmitted. The gender-segregated nature of social connections may require separate interventions for men and women.

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844. Engagement in HIV Care as an Avenue to Primary Care in Rural South Africa: Results from the Vukuzazi Population Health Platform

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.029 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S13-S14 ◽

Cited By ~ 3

Author(s):

Itai M`yambo Magodoro ◽

Stephen Oliver ◽

Dickman Gareta ◽

Tshwaraganang H Modise ◽

Olivier Koole ◽

...

Keyword(s):

South Africa ◽

Regression Models ◽

Noncommunicable Disease ◽

Sub Saharan Africa ◽

Hiv Care ◽

Rural South ◽

Art Programs ◽

The Past ◽

Rural South Africa ◽

Hiv Negative

Abstract Background The healthcare infrastructure developed in response to the HIV epidemic in sub-Saharan Africa has been proposed as a model to respond to the emerging noncommunicable disease (NCD) burden in the region. However, the evidence for the effectiveness of such a strategy is equivocal. Methods We conducted a population-wide health screening among adults ≥15 years within a demographic and health surveillance site (DHSS) in rural South Africa. We collected blood pressure (BP), glycated hemoglobin (HbA1c), HIV disease indicators, and healthcare utilization data. We defined hypertension (HTN) as BP ≥140/90mmHg or use of antihypertensive medication in the past 2 weeks, and diabetes (DM) as HbA1c ≥6.5% or use of hypoglycemic medication in the past two weeks. Cascade of care indicators included: (1) awareness of NCD diagnosis, (2) seeing a provider within the past 6 months; (3) reported use of medication; and (4) disease control, defined as BP <140/90 mmHg or HbA1c <6.5%. We fit regression models to NCD care indicators between people with HIV on ART (PWHA) and HIV negatives. To make population-level estimates, we used inverse probability sampling weights derived from sex- and age-adjusted regression models drawn from the entire DHSS population. Results Of 7,992 individuals, 5,911 (74.2%) were HIV-negative and 2,080 (25.8%) were PWHA (Table 1). PWHA had lower prevalence of both DM (6.8% vs. 10.4%) and HTN (18.0% vs. 24.8%). In multivariable models, linkage to HIV care was associated with improved HTN care cascade indicators, but not DM indicators (Figure 1). PWHA had lower systolic BP and HbA1c than HIV negatives (Figures 2 and 3). Conclusion Linkage to ART programs may be associated with better HTN but not DM care in rural South Africa. Future work should explore how to translate success in ART programs to other NCDs, and for HIV-negative individuals. Disclosures All Authors: No reported Disclosures.

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Cognitive function and cardiometabolic disease risk factors in rural South Africa: baseline evidence from the HAALSI study

BMC Public Health ◽

10.1186/s12889-019-7938-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Brian Houle ◽

Thomas Gaziano ◽

Meagan Farrell ◽

F. Xavier Gómez-Olivé ◽

Lindsay C. Kobayashi ◽

...

Keyword(s):

Risk Factors ◽

South Africa ◽

Cognitive Function ◽

Cardiometabolic Risk ◽

Disease Risk ◽

Cardiometabolic Risk Factors ◽

Cardiometabolic Disease ◽

Rural South ◽

Rural South Africa ◽

Cardiometabolic Disease Risk

Abstract Background Evidence on cognitive function in older South Africans is limited, with few population-based studies. We aimed to estimate baseline associations between cognitive function and cardiometabolic disease risk factors in rural South Africa. Methods We use baseline data from “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI), a population-based study of adults aged 40 and above in rural South Africa in 2015. Cognitive function was measured using measures of time orientation, immediate and delayed recall, and numeracy adapted from the Health and Retirement Study cognitive battery (overall total cognitive score range 0–26). We used multiple linear regression to estimate associations between cardiometabolic risk factors (including BMI, hypertension, dyslipidemia, diabetes, history of stroke, alcohol frequency, and smoking status) and the overall cognitive function score, adjusted for potential confounders. Results In multivariable-adjusted analyses (n = 3018; male = 1520; female = 1498; median age 59 (interquartile range 50–67)), cardiometabolic risk factors associated with lower cognitive function scores included: diabetes (b = − 1.11 [95% confidence interval: − 2.01, − 0.20] for controlled diabetes vs. no diabetes); underweight BMI (b = − 0.87 [CI: − 1.48, − 0.26] vs. normal BMI); and current and past smoking history compared to never smokers. Factors associated with higher cognitive function scores included: obese BMI (b = 0.74 [CI: 0.39, 1.10] vs. normal BMI); and controlled hypertension (b = 0.53 [CI: 0.11, 0.96] vs. normotensive). Conclusions We provide an important baseline from rural South Africa on the associations between cardiometabolic disease risk factors and cognitive function in an older, rural South African population using standardized clinical measurements and cut-offs and widely used cognitive assessments. Future studies are needed to clarify temporal associations as well as patterns between the onset and duration of cardiometabolic conditions and cognitive function. As the South African population ages, effective management of cardiometabolic risk factors may be key to lasting cognitive health.

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Mobility and structural barriers in rural South Africa contribute to loss to follow up from HIV care

AIDS Care ◽

10.1080/09540121.2020.1808567 ◽

2020 ◽

pp. 1-9

Author(s):

Alisse Hannaford ◽

Anthony P. Moll ◽

Thuthukani Madondo ◽

Bulelani Khoza ◽

Sheela V. Shenoi

Keyword(s):

South Africa ◽

Hiv Care ◽

Structural Barriers ◽

Rural South ◽

Loss To Follow Up ◽

Rural South Africa

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Investigating risk factors for under-five mortality in an HIV hyper-endemic area of rural South Africa, from 2000-2014

PLoS ONE ◽

10.1371/journal.pone.0207294 ◽

2018 ◽

Vol 13 (11) ◽

pp. e0207294 ◽

Cited By ~ 2

Author(s):

B. Tlou ◽

B. Sartorius ◽

F. Tanser

Keyword(s):

Risk Factors ◽

South Africa ◽

Endemic Area ◽

Rural South ◽

Under Five ◽

Rural South Africa

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Incident Cognitive Impairment During Aging in Rural South Africa: Evidence From the HAALSI Cohort, 2014 to 2019

Innovation in Aging ◽

10.1093/geroni/igaa057.511 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 157-157

Author(s):

Lindsay Kobayashi ◽

Meagan Farrell ◽

Kenneth Langa ◽

Nomsa Mahlahela ◽

Ryan Wagner ◽

...

Keyword(s):

South Africa ◽

Cognitive Impairment ◽

Incidence Rates ◽

Sub Saharan Africa ◽

Health Related ◽

Household Assets ◽

Sub Saharan ◽

Rate Ratios ◽

Rural South Africa

Abstract We estimated the incidence of cognitive impairment and its key sociodemographic, social, and health-related predictors at the first longitudinal follow-up of the population-representative “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) cohort of adults aged ≥40 in rural Agincourt, South Africa. Cognitive impairment was defined as scoring ≥1.5 SD below the baseline mean composite time orientation and episodic memory score, or requiring a proxy interview with “fair” or “poor” proxy-reported memory. Activity of daily living (ADL) limitations were compared according to incident cognitive impairment status. Incidence rates (IRs) and rate ratios (IRRs) for cognitive impairment according to sociodemographic, social, and health-related predictors were estimated using Poisson regression with robust standard errors, and weighted to account for mortality. Over a 3.7-year mean follow-up, 309/3,861 at-risk participants newly developed cognitive impairment (IR=24.0/1000 person-years (PY); 95% CI: 21.6-26.8). Incidence increased from IR=9.1/1000 PY (95% CI: 5.5-16.1) among those aged 40-44 at baseline to IR=76.5/1000 PY (95% CI: 63.2-93.4) among those aged 80+. At least one ADL limitation was prevalent in 39% of those with incident cognitive impairment, compared to 7% of non-impaired participants. Incident cognitive impairment did not vary by sex/gender, HIV status, or cardiovascular factors, but was strongly graded according to education, literacy, household assets, employment, marital status, and frequency of alcohol consumption. This study presents one of the first incidence rate estimates for cognitive impairment in sub-Saharan Africa. Social disparities in cognitive impairment were apparent in patterns similar to many high-income countries.

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