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Browsing by Author "Stephen Tollman"

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A community mobilization intervention to improve engagement in HIV testing, linkage to care, and retention in care in South Africa: a cluster-randomized controlled trial
(2022-09) Sheri A. Lippman; Audrey Pettifor; Mi-Suk Kang Dufour; Chodziwadziwa Whiteson Kabudula; Rhian Twine; Dean Peacock; Rhandzekile Mathebula; Aimée Julien; Rebecca West; Torsten B. Neilands; Ryan Wagner; Ann Gottert; F. Xavier Gómez Olivé; Dumisani Rebombo; Nicole Haberland; Julie Pulerwitz; Louis Pappie Majuba; Stephen Tollman; Kathleen Kahn
Background: Community Mobilization (CM), engaging communities in a process to collectively enact change, could improve HIV testing and care engagement. We assessed whether CM increased HIV testing, linkage to, and retention in care over time in intervention relative to control communities. Methods: Fifteen communities in Mpumalanga, South Africa were randomized to either a CM intervention engaging residents to address social barriers to HIV testing and treatment or to control. Implementation occurred from August 2015-July 2018. Outcomes included quarterly rates of HIV testing, linkage to care, and retention in care documented from health facility records among 18-49 year-old residents of intervention and control communities over the three years of study. Intention-to-treat analyses employed generalized estimating equations stratified by sex. ClinicalTrials.gov number NCT02197793. Findings: Residents in eight intervention communities (N=20,544) and seven control communities (N=17,848) contributed data. Among men, HIV testing increased quarterly by 12·1% (Relative Change (RC):1·121, 95%CI:1·099-1·143) in intervention communities and 9·5% (RC:1·095, 95%CI:1·075-1·114) in control communities; differences by arm were marginally significant (exponentiated interaction coefficient:1·024, 95%CI:0·997-1·052, p-value=0·078). Among women, HIV testing increased quarterly by 10·6% (RC:1·106, 95%CI:1·097-1·114) in intervention and 9·3% (RC:1·093, 95%CI:1·084-1·102) in control communities; increases were greater in intervention communities (exponentiated interaction coefficient:1·012, 95%CI:1·001-1·023, p-value=0·043). Quarterly linkage increased significantly among intervention community women (RC:1·013, 95%CI:1·002-1·023) only. Quarterly retention fell among women in both arms; however, reductions were tempered among intervention women (exponentiated interaction coefficient:1·003, 95%CI:<1·000-1·006, p-value=0·062). No significant differences were detected in linkage or retention among men. Interpretation: CM was associated with modest improvements in select trial outcomes. The sum of these incremental, quarterly improvements achieved by addressing social barriers to HIV care engagement can impact epidemic control. However, achieving optimal impacts will likely require integrated efforts addressing both social barriers through CM and provision of improved service delivery.
Adiposity phenotypes and subclinical atherosclerosis in adults from subSaharan Africa a H3AfricaAWIGen study
E Nonterah; M Bots; A Oduro; G Agongo; Cassandra Soo; Lisa Micklesfield; Alisha Wade; Shane Norris; Stephen Tollman; Michele Ramsay; Kerstin Klipstein-Grobusch; Nigel Crowther
Apolipoprotein E Genetic Variation and Its Association With Cognitive Function in RuralDwelling Older South Africans
Cassandra Soo; MT Farrell; Stephen Tollman; Lisa Berkman; Almut Nebel; Michele Ramsay
Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis
(2018-11-11) Richard J Munthali; Mercy Manyema; Rihlat Said-Mohamed; Juliana Kagura; Stephen Tollman; Kathleen Kahn; F Xavier Gómez-Olivé; Lisa K Micklesfield; David Dunger; Shane A Norris
Objectives Varying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa. Therefore, this study aimed to compare blood pressure (BP) levels and investigate the extent to which socioeconomic status (SES) is associated with BP, in rural and urban South Africa women. Setting Rural and urban South Africa. Design Cross-sectional. Participants Cross-sectional data on SES, total moderate and vigorous physical activity (MVPA), anthropometric and BP were collected on rural (n=509) and urban (n=510) young black women (18–23 years age). Pregnant and mentally or physically disabled women were excluded from the study. Results The prevalence of combined overweight and obesity (46.5% vs 38.8%) and elevated BP (27.0% vs 9.3%) was higher in urban than rural women, respectively. Results from the structural equation modelling showed significant direct positive effects of body mass index (BMI) on systolic BP (SBP) in rural, urban and pooled datasets. Negative direct effects of SES on SBP and positive total effects of SES on SBP were observed in the rural and pooled datasets, respectively. In rural young women, SES had direct positive effects on BMI and was negatively associated with MVPA in urban and pooled analyses. BMI mediated the positive total effects association between SES and SBP in pooled analyses (ß 0.46; 95% CI 0.15 to 0.76). Conclusions Though South Africa is undergoing nutritional and epidemiological transitions, the prevalence of elevated BP still varies between rural and urban young women. The association between SES and SBP varies considerably in economically diverse populations with BMI being the most significant mediator. There is a need to tailor prevention strategies to take into account optimizing BMI when designing strategies to reduce future risk of hypertension in young women. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the license is given, and indication of whether changes were made.
Building knowledge, optimising physical and mental health and setting up healthier life trajectories in South African women (Bukhali): a preconception randomised control trial part of the Healthy Life Trajectories Initiative (HeLTI)
(2022-03-25) Shane A Norris; Catherine E Draper; Alessandra Prioreschi; CM Smuts; Lisa Jayne Ware; CindyLee Dennis; Philip Awadalla; D Bassani; Zulfiqar Bhutta; Laurent Briollais; D William Cameron; Tobias Chirwa; B Fallon; CM Gray; Jill Hamilton; J Jamison; Heather Jaspan; Jennifer Jenkins; Kathleen Kahn; AP Kengne; Estelle V Lambert; Naomi Levitt; Marie-Claude Martin; Michele Ramsay; Daniel Roth; Stephen Scherer; Daniel Sellen; Wiedaad Slemming; Deborah Sloboda; M Szyf; Stephen Tollman; Mark Tomlinson; Suzanne Tough; Stephen G Matthews; Linda Richter; Stephen Lye
is challenging due to a persistent infectious disease, burgeoning obesity, most notably among women and rising rates of non-communicable diseases (NCDs). With two thirds of women presenting at their first antenatal visit either overweight or obese in urban South Africa (SA), the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and NCDs. Methods and analysis Bukhali is the first individual randomised controlled trial in Africa to test the efficacy of a complex continuum of care intervention and forms part of the Healthy Life Trajectories Initiative (HeLTI) consortium implementing harmonised trials in Canada, China, India and SA. Starting preconception and continuing through pregnancy, infancy and childhood, the intervention is designed to improve nutrition, physical and mental health and health behaviours of South African women to offset obesity-risk (adiposity) in their offspring. Women aged 18–28 years (n=6800) will be recruited from Soweto, an urban-poor area of Johannesburg. The primary outcome is dual-energy X-ray absorptiometry derived fat mass index (fat mass divided by height2 ) in the offspring at age 5 years. Community health workers will deliver the intervention randomly to half the cohort by providing health literacy material, dispensing a multimicronutrient supplement, providing health services and feedback, and facilitating behaviour change support sessions to optimise: (1) nutrition, (2) physical and mental health and (3) lay the foundations for healthier pregnancies and early child development. Ethics and dissemination Ethical approval has been obtained from the Human Ethics Research Committee University of the Witwatersrand, Johannesburg, South Africa (M1811111), the University of Toronto, Canada (19-0066-E) and the WHO Ethics Committee (ERC.0003328). Data and biological sample sharing policies are consistent with the governance policy of the HeLTI Consortium (https://helti.org) and South African government legislation (POPIA). The recruitment and research team will obtain informed consent.
Burden of mortality linked to community-nominated priorities in rural South Africa
(2021-11-26) Pyry Mattila; Justine Davies; Denny Mabetha; Stephen Tollman; Lucia D’Ambruoso
Background: Community knowledge is a critical input for relevant health programmes and strategies. How community perceptions of risk reflect the burden of mortality is poorly understood. Objective: To determine the burden of mortality reflecting community-nominated health risk factors in rural South Africa, where a complex health transition is underway. Methods: Three discussion groups (total 48 participants) representing a cross-section of the community nominated health priorities through a Participatory Action Research process. A secondary analysis of Verbal Autopsy (VA) data was performed for deaths in the same community from 1993 to 2015 (n = 14,430). Using population attributable fractions (PAFs) extracted from Global Burden of Disease data for South Africa, deaths were categorised as ‘attributable at least in part’ to community-nominated risk factors if the PAF of the risk factor to the cause of death was >0. We also calculated ‘reducible mortality fractions’ (RMFs), defined as the proportions of each and all community-nominated risk factor(s) relative to all possible risk factors for deaths in the population . Results: Three risk factors were nominated as the most important health concerns locally: alcohol abuse, drug abuse, and lack of safe water. Of all causes of deaths 1993–2015, over 77% (n = 11,143) were attributable at least in part to at least one community-nominated risk factor. Causes of attributable deaths, at least in part, to alcohol abuse were most common (52.6%, n = 7,591), followed by drug abuse (29.3%, n = 4,223), and lack of safe water (11.4%, n = 1,652). In terms of the RMF, alcohol use contributed the largest percentage of all possible risk factors leading to death (13.6%), then lack of safe water (7.0%), and drug abuse (1.3%) . Conclusion: A substantial proportion of deaths are linked to community-nominated risk factors. Community knowledge is a critical input to understand local health risks.
Cohort Profile Migrant Health FollowUp Study MHFUS of internal migration in South Africa
(OXFORD UNIV PRESS) Carren Ginsburg; Mark Collinson; C Pheiffer; Francesc Gomez-Olive Casas; Sadson Harawa; S McGarvey; Daniel Ohene-Kwofie; AD Foster; T Myroniuk; Stephen Tollman; Michael White; E et al
Cohort Profile South African Population Research Infrastructure Network SAPRIN
Mark Collinson; T Mudzana; T Mutevedzi; Kathleen Kahn; E Maimela; Francesc Gomez-Olive Casas; T Mngomezulu; Chodziwadziwa Kabudula; Stephen Tollman; E et al
Cohort Profile Update Cognition and dementia in the Health and Aging in Africa Longitudinal Study of an INDEPTH community in South Africa HAALSI dementia
D T Bassil; M T Farrell; Ryan Wagner; A D Brickman; M M Glymour; Brent Tipping; Stephen Tollman; E et al
Cohort Profile Update: Cognition and dementia in the Health and Aging in Africa Longitudinal Study of an INDEPTH community in South Africa (HAALSI dementia)
(2022-08-10) Darina T Bassil; Meagan T Farrell; Ryan G Wagner; Adam M Brickman; M Maria Glymour; Kenneth M Langa; Jennifer J Manly; Joel Salinas; Brent Tipping; Stephen Tollman; Lisa F Berkman
The Health and Aging in Africa Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) is a harmonized sister study to the US Health and Retirement Study (HRS). Established in 2015, it includes 5059 individuals aged 40 and over, in a rural community in Agincourt, South Africa. • In light of the projected rise of dementia burden in sub-Saharan Africa, the HAALSI Dementia study was launched in 2019 to investigate the prevalence, incidence and risk factors of cognitive decline and dementia in South Africa. • The HAALSI Dementia sample includes 635 individuals, 50 years and older, of whom 99 also participated in an ancillary magnetic resonance imaging (MRI) sub-study. • The HAALSI Dementia study encompasses a comprehensive, culturally sensitive cognitive battery with multidomain psychometric scales, informant interviews and neurological evaluations, and has sufficient overlap with international Harmonized Cognitive Assessment Protocol (HCAP) and HRS studies to enable cross-calibration. • For new collaborative projects and data sharing, please contact Darina Bassil [dbassil@hsph.harvard.edu].
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.
Coronavirus Host Genomics Study: South Africa (COVIGen-SA)
(2022-10-06) Andrew K. May; Heather Seymour; Harriet Etheredge; Heather Maher; Marta C. Nunes; ShabirA.Madhi; SimisoM. Sokhela; W. D. FrancoisVenter; Neil Martinson; Firdaus Nabeemeeah; Cheryl Cohen; Jocelyn Moyes; Sibongile Walaza; Stefano Tempia; Jackie Kleynhans; Anne von Gottberg; Jeremy Nel; Halima Dawood; Ebrahim Variava; Stephen Tollman; Kathleen Kahn; KobusHerbst; EmilyB.Wong; CarolineT.Tiemessen; Alex van Blydenstein; Lyle Murray; Michelle Venter; June Fabian; Miche´le Ramsay
However, continental Africans are yet to be adequately represented in such studies despite the importance of genetic factors in understanding Africa’s response to the pandemic. We describe the development of a research resource for coronavirus host genomics studies in South Africa known as COVIGen-SA—a multicollaborator strategic partnership designed to provide harmonised demographic, clinical, and genetic information specific to Black South Africans with COVID-19. Over 2,000 participants have been recruited to date. Preliminary results on 1,354 SARS-CoV-2 positive participants from four participating studies showed that 64.7% were female, 333 had severe disease, and 329 were people living with HIV. *rough this resource, we aim to provide insights into host genetic factors relevant to African-ancestry populations, using both genome-wide association testing and targeted sequencing of important genomic loci. *is project will promote and enhance partnerships, build skills, and develop resources needed to address the COVID-19 burden and associated risk factors in South African communities.
COVID-19 vaccine hesitancy in rural South Africa: Deepening understanding to increase uptake and access
(2022-05-22) Kathleen Kahn; Audrey Pettifor; Palesa Mataboge; Nicole K Kelly; Duduzile P Mashinini; Harish Nair; Harry Campbell; Cheryl Cohen; F Xavier Gómez-Olivé; Stephen Tollman
Background: To date, COVID-19 vaccine coverage in the African region falls far too short of global goals. Increasing vaccination rates requires understanding barriers to vaccination so that effective interventions that sensitively and effectively address barriers to vaccination can be implemented. Methods: To assess COVID-19 vaccination levels and identify major barriers to vaccine uptake we conducted a population-based, cross-sectional survey among 1662 adults 18 and older from August 25 to October 29 2021 in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) area, Mpumalanga, South Africa. Results: Half of participants reported receiving a COVID-19 vaccine (50.4%) with 41.1% being fully vaccinated and 9.3% being partially vaccinated; 49.6% were unvaccinated. More women than men were vaccinated (55.5% vs 42.8%, P < 0.001), and older age groups were more likely to be vaccinated than younger age groups (P < 0.001). Among the unvaccinated, 69.0% planned to get vaccinated as soon as possible, while 14.7% reported definitely not wanting the vaccine. Major barriers to vaccination included lacking information on eligibility (12.3%) or where to get vaccinated (13.0%), concerns about side effects (12.5%), and inconvenient hours and locations for vaccination (11.0%). Confidence in the safety and efficacy of COVID-19 vaccines was higher among those vaccinated than unvaccinated (75.3% vs 51.2%, 75.8% vs 51.0%, both P < 0.001, respectively). Conclusions: Increasing vaccination in South Africa beyond current levels will require a concerted effort to address concerns around vaccine safety and increase confidence in vaccine efficacy. Clarifying eligibility and ensuring access to vaccines at times and places that are convenient to younger populations, men, and other vulnerable groups is necessary.
Data Set : Prevalence, characterization and response to chronic kidney disease in an urban and rural setting in South Africa
(2016-11-18) Naicker, Saraladevi; Fabian, June; Jaya A George; Harriet R Etheredge; Manuel van Deventer; Robert Kalyesubula; Alisha N Wade; Laurie A Tomlinson; Stephen Tollman
Globally, chronic kidney disease (CKD) is an emerging public health challenge but accurate data on its true prevalence are scarce, particularly in poorly resourced regions such as sub-Saharan Africa (SSA). Limited funding for population-based studies, poor laboratory infrastructure and the absence of a validated estimating equation for kidney function in Africans are contributing factors. Consequently, most available studies used to estimate population prevalence are hospital-based, with small samples of participants who are at high risk for kidney disease. While serum creatinine is most commonly used to estimate glomerular filtration, there is considerable potential bias in the measurement of creatinine that might lead to inaccurate estimates of kidney disease at individual and population level. To address this, the Laboratory Working Group of the National Kidney Disease Education Program published recommendations in 2006 to standardize the laboratory measurement of creatinine. The primary objective of this review was to appraise implementation of these recommendations in studies conducted in SSA after 2006. Secondary objectives were to assess bias relating to choice of estimating equations for assessing glomerular function in Africans and to evaluate use of recommended diagnostic criteria for CKD. This study was registered with Prospero (CRD42017068151), and using PubMed, African Journals Online and Web of Science, 5845 abstracts were reviewed and 252 full-text articles included for narrative analysis. Overall, two-thirds of studies did not report laboratory methods for creatinine measurement and just over 80% did not report whether their creatinine measurement was isotope dilution mass spectroscopy (IDMS) traceable. For those reporting a method, Jaffe was the most common (93%). The four-variable Modification of Diet in Renal Disease (4-v MDRD) equation was most frequently used (42%), followed by the CKD Epidemiology Collaboration (CKD-EPI) equation for creatinine (26%). For the 4-v MDRD equation and CKD-EPI equations, respectively, one-third to one half of studies clarified use of the coefficient for African-American (AA) ethnicity. When reporting CKD prevalence, <15% of studies fulfilled Kidney Disease: Improving Global Outcomes criteria and even fewer used a population-based sample. Six studies compared performance of estimating equations to measured glomerular filtration rate (GFR) demonstrating that coefficients for AA ethnicity used in the 4-v MDRD and the CKD-EPI equations overestimated GFR in Africans. To improve on reporting in future studies, we propose an 'easy to use' checklist that will standardize reporting of kidney function and improve the quality of studies in the region. This research contributes some understanding of the factors requiring attention to ensure accurate assessment of the burden of kidney disease in SSA. Many of these factors are difficult to address and extend beyond individual researchers to health systems and governmental policy, but understanding the burden of kidney disease is a critical first step to informing an integrated public health response that would provide appropriate screening, prevention and management of kidney disease in countries from SSA. This is particularly relevant as CKD is a common pathway in both infectious and non-communicable diseases, and multimorbidity is now commonplace, and even more so when those living with severe kidney disease have limited or no access to renal replacement therapy.
Digital delivery of behavioural activation therapy to overcome depression and facilitate social and economic transitions of adolescents in South Africa (the DoBAt study): protocol for a pilot randomised controlled trial
(2022-12-05) Bianca D Moffett; Julia R Pozuelo; Alastair van Heerden; Heather A O'Mahen; Michelle Craske; Tholene Sodi; Crick Lund; Kate Orkin; Emma J Kilford; Sarah-Jayne Blakemore; Mahreen Mahmud; Eustasius Musenge; Meghan Davis; Zamakhanya Makhanya; Tlangelani Baloyi; Daniel Mahlangu; Gabriele Chierchia; Sophie L Fielmann; F Xavier Gómez-Olivé; Imraan Valodia; Stephen Tollman; Kathleen Kahn; Alan Stein
Introduction Scalable psychological treatments to address depression among adolescents are urgently needed. This is particularly relevant to low-income and middle-income countries where 90% of the world’s adolescents live. While digital delivery of behavioural activation (BA) presents a promising solution, its feasibility, acceptability and effectiveness among adolescents in an African context remain to be shown. Methods and analysis This study is a two-arm singleblind individual-level randomised controlled pilot trial to assess the feasibility, acceptability and initial efficacy of digitally delivered BA therapy among adolescents with depression. The intervention has been coproduced with adolescents at the study site. The study is based in the rural northeast of South Africa in the Bushbuckridge subdistrict of Mpumalanga province. A total of 200 adolescents with symptoms of mild to moderately severe depression on the Patient Health Questionnaire Adolescent Version will be recruited (1:1 allocation ratio). The treatment group will receive BA therapy via a smartphone application (the Kuamsha app) supported by trained peer mentors. The control group will receive an enhanced standard of care. The feasibility and acceptability of the intervention will be evaluated using a mixed methods design, and signals of the initial efficacy of the intervention in reducing symptoms of depression will be determined on an intention-to-treat basis. Secondary objectives are to pilot a range of cognitive, mental health, risky behaviour and socioeconomic measures; and to collect descriptive data on the feasibility of trial procedures to inform the development of a further larger trial.
Dimensions of internal migration and their relationship to blood pressure in South Africa
(2019-11) Chantel F. Pheiffer; Stephen T. McGarvey; Carren Ginsburg; Mark Collinson; F. Xavier Gómez-Olivé; Stephen Tollman; Michael J. White
Hypertension prevalence is on the rise in low and middle income countries like South Africa, and migration and concomitant urbanization are often considered to be associated with this rise. However, relatively little is known about the relationship between blood pressure (BP) and internal migration - a highly prevalent population process in LMICs. This study employs data for a group of 194 adult men and women from an original pilot dataset drawn from the Agincourt Health and Demographic Surveillance System in northeast South Africa. Migrants in the sample are identified, tracked, and interviewed. The relationship between BP and migration distance and the number of months an individual spends away from his/her home village is estimated using robust OLS regression, controlling for a series of socioeconomic, health, and behavioral characteristics. This study finds migrants who move further distances and for longer durations to have significantly higher systolic and diastolic BP compared with shorter-term migrants and those who remain nearby or in their home village. These associations remain robust and statistically significant when adjusting for measures of socioeconomic conditions, as well as body mass index (BMI), and the number of meals consumed per day. Migration, both in terms of distance and time away, explains significant variation in BP among migrants in a typical South African context. This finding suggests the need for further studies of nutritional and psychosocial factors associated with geographic mobility that may be important factors for understanding rising hypertension in LMICs.
Double malnutrition and associated factors in a middleaged and older rural South African population
Faheem Seedat; Stephen Tollman; Wayne Twine; Anne R. Cappola; Alisha Wade
Effect of a cash transfer intervention on memory decline and dementia probability in older adults in rural South Africa
Molly Rosenberg; E Beidelman; X Chen; Chodziwadziwa Kabudula; Audrey Pettifor; D Bassil; Lisa Berkman; Kathleen Kahn; Stephen Tollman; Lindsay Kobayashi
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.
Essential health services delivery in South Africa during COVID-19: Community and healthcare worker perspectives
(2022-12-08) Samanta T. Lalla-Edward; Atiya Mosam; Jennifer Hove; Agnes Erzse; Teurai Rwafa-Ponela; Jessica Price; Athini Nyatela; Sizwe Nqakala; Kathleen Kahn; Stephen Tollman; Karen Hofman; Susan Goldstein
Background: Between May 2020 and February 2022, South Africa’s health system bore strain as it battled mitigating the coronavirus pandemic. The country’s pandemic response was scrutinized. This period also brought into focus pre-existing shortcomings in the healthcare system and its governing bodies. Contextually, there is a paucity in literature on the experiences of healthcare providers and users. This study aimed to contribute information on COVID-19, with the intention of providing guidance on preparing for future infectious disease outbreaks. Methods: Cross sectional exploratory qualitative methodology was employed using semi-structured interviews and focus group discussions with community members (CM) and healthcare workers (HCW) from two South African study sites: (a) rural Bushbuckridge (run by Agincourt Health and Socio-Demographic Surveillance Site) and (b), Regions D and F in Johannesburg Metropole. Results: After interviewing 42 CMs and 43 HCWs, it emerged that mandated process changes while minimizing COVID-19 exposure, necessitated healthcare personnel focusing on critical care treatment at the expense of less acute ones. COVID-19 isolation protocols, extensive absenteeism and HCWs with advanced skills being perceived as more adept to treat COVID-19 patients contributed to HCWs experiencing higher workloads. Fears regarding contracting and transmitting COVID-19, suering financial losses, and not being able to provide adequate advice to patients were recurrent themes. Dissemination of relevant information among healthcare facility personnel and communities suered due to breakdowns in communication. Conclusion: Concessions and novel strategies to avail medication to patients had to be created. Since providence was lacking, government needs to formulate health intervention strategies that embrace health literacy, alternate methods of chronic medication dispensation, improved communication across health care platforms and the use of telehealth, to circumvent the threats of possible further infectious disease outbreaks.

Browsing by Author "Stephen Tollman"

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