Browsing by Author "Armstrong Dzomba"

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    Epidemiology of chronic multimorbidity and temporary migration in a rural South African community in health transition: A cross-sectional population-based analysis
    (2023-04-21) Armstrong Dzomba; Carren Ginsburg; Chodziwadziwa W. Kabudula; Rachel R. Yorlets; Pedzisai Ndagurwa; Sadson Harawa; Mark N. Lurie; Stephen T. McGarvey; Stephen Tollman; Mark A. Collinson; Michael J. White; Francesc X. Gomez-Olive
    Introduction: In sub-Saharan African settings, the increasing non-communicable disease mortality is linked to migration, which disproportionately exposes subpopulations to risk factors for co-occurring HIV and NCDs. Methods: We examined the prevalence, patterns, and factors associated with two or more concurrent diagnoses of chronic diseases (i.e., multimorbidity) among temporary within-country migrants. Employing a cross-sectional design, our study sample comprised 2144 residents and non-residents 18–40 years interviewed and with measured biomarkers in 2018 in Wave 1 of the Migrant Health Follow-up Study (MHFUS), drawn from the Agincourt Health and Demographic Surveillance System (AHDSS) in rural north-eastern South Africa. We used modified Poisson regression models to estimate the association between migration status and prevalent chronic multimorbidity conditional on age, sex, education, and healthcare utilisation. Results: Overall, 301 participants (14%; 95% CI 12.6–15.6), median age 31 years had chronic multimorbidity. Multimorbidity was more prevalent among non-migrants (14.6%; 95% CI 12.8–16.4) compared to migrants (12.8%; 95% CI 10.3–15.7). Nonmigrants also had the greatest burden of dual-overlapping chronic morbidities, such as HIV-obesity 5.7%. Multimorbidity was 2.6 times as prevalent (PR 2.65. 95% CI 2.07– 3.39) among women compared to men. Among migrants, men, and individuals with secondary or tertiary education manifested lower prevalence of two or more conditions. Discussion: In a rural community with colliding epidemics, we found low but significant multimorbidity driven by a trio of conditions: HIV, hypertension, and obesity. Understanding the multimorbidity burden associated with early adulthood exposures, including potential protective factors (i.e., migration coupled with education), is a critical first step towards improving secondary and tertiary prevention for chronic disease among highly mobile marginalised sub-populations.
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    Intersecting epidemics COVID19 and HIV in subSaharan Africa A systematic review 20202022
    Talent Tapera; Clifford Odimegwu; Rebaone Petlele; Matshidiso Sello; Armstrong Dzomba; Oluwatoyin Aladejebi; Million Phiri
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    Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)
    (2022) Armstrong Dzomba; Hae‑Young Kim; Andrew Tomita; Alain Vandormael; Kaymarlin Govender; Frank Tanser
    Globally, South Africa hosts the highest number of people living with HIV (PLHIV) and the unique legacy of inter‑ nal labour migration continues to be a major driver of the regional epidemic, interrupting treatment-as-prevention eforts. The study examined levels, trends, and predictors of migration in rural KwaZulu-Natal Province, South Africa, using population-based surveillance data from 2005 through 2017. We followed 69 604 adult participants aged 15–49 years and recorded their migration events (i.e., out-migration from the surveillance area) in 423 038 personyears over 525 397 observations. Multiple failure Cox-regression models were used to measure the risk of migration by socio-demographic factors: age, sex, educational status, marital status, HIV, and community antiretroviral therapy (ART) coverage. Overall, 69% of the population cohort experienced at least one migration event during the follow-up period. The average incidence rate of migration was 9.96 events and 13.23 events per 100 person-years in women and men, respectively. Migration rates declined from 2005 to 2008 then peaked in 2012 for both women and men. Adjusting for other covariates, the risk of migration was 3.4-times higher among young women aged 20–24 years compared to those aged≥40 years (adjusted Hazard Ratio [aHR]=3.37, 95% Confdence Interval [CI]: 3:19–3.57), and 2.9-times higher among young men aged 20–24 years compared to those aged≥40 years (aHR=2.86, 95% CI:2.69– 3.04). There was a 9% and 27% decrease in risk of migration among both women (aHR=0.91, 95% CI: 0.83 – 0.99) and men (aHR=0.73, 95% CI 0.66 – 0.82) respectively per every 1% increase in community ART coverage. Young unmar‑ ried women including those living with HIV, migrated at a magnitude similar to that of their male counterparts, and lowered as ART coverage increased over time, refecting the role of improved HIV services across space in reducing out-migration. A deeper understanding of the characteristics of a migrating population provides critical information towards identifying and addressing gaps in the HIV prevention and care continuum in an era of high mobility
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    Predictors of migration in an HIV hyperendemic rural South African community evidence from a populationbased cohort 20052017
    Armstrong Dzomba; Hae-Young Kim; Andrew Tomita; Alain Vandormael; Kaymarlin Govender; Frank Tanser