Browsing by Author "Kobus Herbst"

Now showing 1 - 6 of 6
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    Cohort Profile: South African Population Research Infrastructure Network (SAPRIN)
    (2021-12-30) Mark A Collinson; Taurayi Mudzana; Tinofa Mutevedzi; Kathleen Kahn; Eric Maimela; F Xavier Go´ mez-Olive´; Thobeka Mngomezulu; Dickman Gareta; Chodziwadziwa W Kabudula; Rathani Nemuramba; Joseph Tlouyamma; Stephen Tollman; Kobus Herbst
    South Africa is striving to emerge from a legacy of gross social injustice and consequent health and socioeconomic inequality, to becoming a country where all residents have opportunities to build productive lives. However, recent declines in economic performance and unemployment, exacerbated by weaknesses in national and provincial level governance, coupled with colliding epidemics of HIV/ AIDS and non-communicable diseases, have left the country’s leadership with serious, seemingly intractable challenges. Moreover as with most countries, the effects of stringent sociobehavioural responses to the coronavirus disease 2019 (COVID-19), with serious economic consequences, serve to amplify such challenges.
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    Household structure, composition and child mortality in the unfolding antiretroviral therapy era in rural South Africa: comparative evidence from population surveillance, 2000–2015
    (2023-03-15) Brian Houle; Chodziwadziwa Kabudula; Dickman Gareta; Kobus Herbst; Samuel J Clark
    Objectives The structure and composition of the household has important influences on child mortality. However, little is known about these factors in HIVendemic areas and how associations may change with the introduction and widespread availability of antiretroviral treatment (ART). We use comparative, longitudinal data from two demographic surveillance sites in rural South Africa (2000–2015) on mortality of children younger than 5 years (n=101 105). Design We use multilevel discrete time event history analysis to estimate children’s probability of dying by their matrilineal residential arrangements. We also test if associations have changed over time with ART availability. Setting Rural South Africa. Participants Children younger than 5 years (n=101 105). Results 3603 children died between 2000 and 2015. Mortality risks differed by co-residence patterns along with different types of kin present in the household. Children in nuclear households with both parents had the lowest risk of dying compared with all other household types. Associations with kin and child mortality were moderated by parental status. Having older siblings lowered the probability of dying only for children in a household with both parents (relative risk ratio (RRR)=0.736, 95%CI (0.633 to 0.855)). Only in the later ART period was there evidence that older adult kin lowered the probability of dying for children in single parent households (RRR=0.753, 95%CI (0.664 to 0.853)). Conclusions Our findings provide comparative evidence of how differential household profiles may place children at higher mortality risk. Formative research is needed to understand the role of other household kin in promoting child well-being, particularly in one-parent households that are increasingly prevalent.
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    Large age shifts in HIV-1 incidence patterns in KwaZulu-Natal, South Africa
    (2021-07-13) Adam Akullian; Alain Vandormael; Joel C Miller; Anna Bershteyn; Edward Wenger; Diego Cuadros; Dickman Gareta; Till Bärnighausen; Kobus Herbst; Frank Tanser
    Recent declines in adult HIV-1 incidence have followed the large-scale expansion of antiretroviral therapy and primary HIV prevention across high-burden communities of sub-Saharan Africa. Mathematical modeling suggests that HIV risk will decline disproportionately in younger adult age-groups as interventions scale, concentrating new HIV infections in those >age 25 over time. Yet, no empirical data exist to support these projections. We conducted a population-based cohort study over a 16-y period (2004 to 2019), spanning the early scale-up of antiretroviral therapy and voluntary medical male circumcision, to estimate changes in the age distribution of HIV incidence in a hyperepidemic region of KwaZulu-Natal, South Africa, where adult HIV incidence has recently declined. Median age of HIV seroconversion increased by 5.5 y in men and 3.0 y in women, and the age of peak HIV incidence increased by 5.0 y in men and 2.0 y in women. Incidence declined disproportionately among young men (64% in men 15 to 19, 68% in men 20 to 24, and 46% in men 25 to 29) and young women (44% in women 15 to 19, 24% in women 20 to 24) comparing periods pre- versus post-universal test and treat. Incidence was stable (<20% change) in women aged 30 to 39 and men aged 30 to 34. Age shifts in incidence occurred after 2012 and were observed earlier in men than in women. These results provide direct epidemiological evidence of the changing demographics of HIV risk in sub-Saharan Africa in the era of large-scale treatment and prevention. More attention is needed to address lagging incidence decline among older individuals.
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    Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa: an analysis of verbal autopsy data from six countries
    (2023-06-25) Ursula Gazeley; Georges Reniers; Julio E. Romero-Prieto; Clara Calvert; Momodou Jasseh; Kobus Herbst; Sammy Khagayi; David Obor; Daniel Kwaro; Albert Dube; Merga Dheresa; Chodziwadziwa W. Kabudula; Kathleen Kahn; Mark Urassa; Amek Nyaguara; Marleen Temmerman; Laura A. Magee; Peter von Dadelszen; Veronique Filippi
    Objective: To compare the causes of death for women who died during pregnancy and within the first 42days postpartum with those of women who died between >42days and within 1 year postpartum. Design: Open population cohort (Health and Demographic Surveillance Systems). Setting: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. Population: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. Methods: InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42days versus 43–365days postpartum adjusting for HDSS and time period (2000– 2009 and 2010–2019). Main outcome measures: Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). Results: Of 2114 deaths, 1212 deaths occurred within 42days postpartum and 902 between 43 and 365days postpartum. Compared with deaths within 42days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42days postpartum did not change significantly between 2000–2009 and 2010–2019. Conclusions: Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration of non-obstetric care with ante-, intra- and postpartum care in high-burden settings.
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    Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa: an analysis of verbal autopsy data from six countries
    (2023-07-19) Ursula Gazeley; Georges Reniers; Julio E. Romero-Prieto; Clara Calvert; Momodou Jasseh; Kobus Herbst; Sammy Khagayi; David Obor; Daniel Kwaro; Albert Dube; Merga Dheresa; Chodziwadziwa W. Kabudula; Kathleen Kahn; Mark Urassa; Amek Nyaguara; Marleen Temmerman; Laura A. Magee; Peter von Dadelszen; Veronique Filipp
    Abstract Objective: To compare the causes of death for women who died during pregnancy and within the first 42days postpartum with those of women who died between >42days and within 1 year postpartum. Design: Open population cohort (Health and Demographic Surveillance Systems). Setting: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. Population: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. Methods: InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42days versus 43–365days postpartum adjusting for HDSS and time period (2000–2009 and 2010–2019). Main outcome measures: Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). Results: Of 2114 deaths, 1212 deaths occurred within 42days postpartum and 902 between 43 and 365days postpartum. Compared with deaths within 42days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42days postpartum did not change significantly between 2000–2009 and 2010–2019. Conclusions: Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration of non-obstetric care with ante-, intra- and postpartum care in high-burden settings.
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    Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making
    (2021-10-25) Lucia D’Ambruoso; Jessica Price; Eilidh Cowan; Gerhard Goosenf; Edward Fottrell; Kobus Herbst; Maria van der Merwe; Jerry Sigudla; Justine Davies; Kathleen Kahn
    Background: Recognising that the causes of over half the world’s deaths pass unrecorded, the World Health Organization (WHO) leads development of Verbal Autopsy (VA): a method to understand causes of death in otherwise unregistered populations. Recently, VA has been developed for use outside research environments, supporting countries and communities to recognise and act on their own health priorities. We developed the Circumstances of Mortality Categories (COMCATs) system within VA to provide complementary circumstantial categorisations of deaths. Objectives: Refine the COMCAT system to (a) support large-scale population assessment and (b) inform public health decision-making. Methods: We analysed VA data for 7,980 deaths from two South African Health and SocioDemographic Surveillance Systems (HDSS) from 2012 to 2019: the Agincourt HDSS in Mpumalanga and the Africa Health Research Institute HDSS in KwaZulu-Natal. We assessed the COMCAT system’s reliability (consistency over time and similar conditions), validity (the extent to which COMCATs capture a sufficient range of key circumstances and events at and around time of death) and relevance (for public health decision-making). Results: Plausible results were reliably produced, with ‘emergencies’, ‘recognition, ‘accessing care’ and ‘perceived quality’ characterising the majority of avoidable deaths. We identified gaps and developed an additional COMCAT ‘referral’, which accounted for a significant proportion of deaths in sub-group analysis. To support decision-making, data that establish an impetus for action, that can be operationalised into interventions and that capture deaths outside facilities are important. Conclusions: COMCAT is a pragmatic, scalable approach enhancing functionality of VA providing basic information, not available from other sources, on care seeking and utilisation at and around time of death. Continued development with stakeholders in health systems, civil registration, community and research environments will further strengthen the tool to capture social and health systems drivers of avoidable deaths and promote use in practice settings.