Dataset : A consolidated and harmonised Verbal Autopsy dataset from Health and Demographic Surveillance Sites in South Africa [version 1; peer review: awaiting peer review]

Acknowledgements The authors acknowledge the South African Population Research Infrastructure Network (SAPRIN), the African Health Research Institute (AHRI) and the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) for their support. The authors gratefully acknowledge Chodwizadziwa Kabudula, Daniel Mahlangu, Dickman Gareta, Siyabonga Nxumalofrom and Joseph Tlouyamma from the Agincourt, AHRI and DIMAMO HDSSs who supported with data, and individuals who supported the development and maintenance of the OpenVA software. Grant information: Conceptualisation of COMCAT was supported through a parent study funded by the Joint Health Systems Research Initiative from Department for International Development (DFID)/Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/ P014844/1). Support was also provided through the UKRI Covid-19 Extension Allocation Fund (RG15639-15) and by the University of Aberdeen and the Scottish Funding Council (SFC) (SF10206-45). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscriptNon peer reviewedPublisher PD

Refining Circumstances of Mortality Categories (COMCAT) : a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making

Acknowledgments The authors acknowledge the South African Population Research Infrastructure Network (SAPRIN), the African Health Research Institute (AHRI) and the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) for their support. The authors gratefully acknowledge Chodwizadziwa Kabudula, Daniel Mahlangu, Dickman Gareta and Siyabonga Nxumalofrom from the Agincourt and AHRI HDSSs who supported with data, and individuals who supported the development and main- tenance of the OpenVA software, particularly Dr Jason Thomas from Ohio State University who assisted in the development of the ‘referral’ COMCAT. The authors would also like to thank Professor Sam Clark for support and advice. Funding information Conceptualisation of COMCAT was supported through a parent study funded by the Joint Health Systems Research Initiative from Department for International Development (DFID)/Medical Research Council (MRC)/ Wellcome Trust/Economic and Social Research Council (ESRC) (Medical Research Charities Group MR/ P014844/1). Support was also provided through the UKRI Covid-19 Extension Allocation Fund (RG15639-15) and by the University of Aberdeen and the Scottish Funding Council (SFC) (SF10206-45).Peer reviewedPublisher PD

Cost of living/cost of smoking : a demonstration study of cooperative action learning to understand and address smoking in deprived communities within the cost-of-living crisis

This study represents a collective commitment to transforming unfair and unnecessary burdens of smoking related-illness, suffering and loss in rural communities living with deprived social circumstances. We dedicate the study to community partners and members disproportionately affected by the cost of smoking and cost of living. Their willingness, vulnerability, and commitment to share personal, lived experience made the work possible. Moreover, the resulting ‘community intelligence’ reinforces the need to expand community consultation into fuller forms of ongoing community dialogue, and demonstrates the potential of community power as a driving force for needed social changePeer reviewe

Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making

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 Socio-Demographic 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

Understanding non-communicable diseases: Combining health surveillance with local knowledge to improve rural primary health care in South Africa

Sophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Background: NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries.Objective: The aims were:develop methods to provide integrated biosocial accounts of NCD mortality; and explore the practical utility of extended mortality data for the primary health care system.Methods: We drew on data from research programmes in the study area. Data were analysed in three steps: [a]analysis of levels, causes and circumstances of NCD mortality [n = 4,166] from routine census updates including Verbal Autopsy and of qualitative data on lived experiences of NCDs in rural villages from participatory research; [b] identifying areas of convergence and divergence between the analyses; and [c]exploration of the practical relevance of the data drawing on engagements with health systems stakeholders.Results: NCDs constituted a significant proportion of mortality in this setting [36%]. VA data revealed multiple barriers to access in end-of-life care. Many deaths were attributed to problems with resources and health systems [21%;19% respectively]. The qualitative research provided rich complementary detail on the processes through which risk originates, accumulates and is expressed in access to end-of-life care, related to chronic poverty and perceptions of poor quality care in clinics. The exploration of practical relevance revealed chronic under-funding for NCD services, and an acute need for robust, timely data on the NCD burden.Conclusions: VA data allowed a significant burden of NCD mortality to be quantified and revealed barriers to access at and around the time of death. Qualitative research contextualised these barriers, providing explanations of how and why they exist and persist. Health systems analysis revealed shortages of resources allocated to NCDs and a need for robust research to provide locally relevant evidence to organise and deliver care. Pragmatic interdisciplinary and mixed method analysis provides relevant renditions of complex problems to inform more effective responses.This study was funded by the Joint Health Systems Research Initiative from Department for International Development/MRC/Welcome Trust/Economic and Social Research Council (MR/N005597/1 and MR/P014844/1). The work was nested within the South African Medical Research Council / Wits University Rural Public Health and Health Transitions Research Unit, supported by the University of the Witwatersrand and Medical Research Council, South Africa. The Agincourt Health and Socio-Demographic Surveillance System, a node of the South African Population Research Infrastructure Network (SAPRIN), is supported by the National Department of Science and Innovation.https://doi.org/10.1080/16549716.2020.1852781pubpu

Recruiting older men to walking football: A pilot feasibility study

Item previously deposited in UWS repository at: https://research-portal.uws.ac.uk/en/publications/recruiting-older-men-to-walking-football-a-pilot-feasibility-studItem not available in this repository.Rosie Arthur - ORCID: 0000-0003-0651-4056 https://orcid.org/0000-0003-0651-4056Context Walking football (soccer) has recently emerged as a physical activity option targeted at older males to enhance health and wellbeing. Design This pilot study aimed to examine the feasibility of recruiting and retaining males aged 50 years and over to an 8-week walking football programme in a professional football club. Intervention Participants were recruited via social media and assigned to an intervention group or a wait-list control group. The intervention group engaged in 1 h of walking football a week led by a community coach from the professional football club, followed by an optional social session in the club facility. Physiological and psychological outcome measures were obtained onsite at the football club facility (aiding compliance and retention) at baseline and following 8-weeks, from both groups. Semi-structured interviews were conducted after the 8-week programme and 1 year later, to explore motivations for engagement and the social impact. Results The opportunity to engage in football and the link to a professional football club were key attractions. All participants recruited were overweight, sedentary, exhibited blood pressures outside normal ranges, and all but two were hypertensive. Adherence to the programme was 90% over 8 weeks, and of the participants who were contacted after one year, all (n = 6) had maintained engagement in walking football. Walking football is therefore a feasible, cost-effective method of recruiting and retaining males aged 50 years and over to a physical activity programme, though attrition is to be expected.https://doi.org/10.1016/j.explore.2018.12.00115pubpub

Individual and neighbourhood-level deprivation, kidney disease, and long-term mortality in the "Core determinants and Equity Grampian Laboratory Outcomes Morbidity and Mortality Study” (GLOMMS-CORE)

Prospective cohort studies of kidney equity are limited by a focus on advanced rather than early disease; and selective recruitment. Whole population studies frequently rely on area-level measures of deprivation as opposed to individual measures of social disadvantage.We linked kidney health and individual census records in the North of Scotland, 2011-2021 (GLOMMS-CORE). We identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) <60 (mild/early), <45 (moderate), <30 ml/min/1.73m2 (advanced), and acute kidney disease (AKD). We compare household and neighbourhood socioeconomic measures, living circumstances, and long-term mortality. We used case-mix adjusted multivariable logistic regression (for living circumstances), and Cox models (for mortality) incorporating an interaction between household and neighbourhood.Among 458897 census respondents, there were 48546, 29081, 16116, 28097 incident presentations of eGFR <60, <45, <30 and AKD; mean ages 70-77; 52-55% female. Classifications of socioeconomic position by household and neighbourhood were related but complex, and frequently did not match. Compared to households of “professionals”, people with early kidney disease in “unskilled” or “unemployed” households had increased mortality (adjusted hazard ratios, HR, and 95% confidence intervals, CI: 1.26, 1.19-1.32 and 1.77, 1.60-1.96). Those with either a deprived household or deprived neighbourhood experienced greater mortality, but those with both dimensions had the poorest outcomes. “Unskilled” and “unemployed” households more frequently reported being “limited a lot” by ill health, adverse mental health, living alone, basic accommodation, no car, English language difficulties, visual and hearing impairments.The impacts of deprivation on kidney health are spread throughout society, complex, serious, and not confined to those living in deprived neighbourhoods

Individual and neighbourhood-level deprivation, kidney disease, and long-term mortality in the “Core determinants and Equity Grampian Laboratory Outcomes Morbidity and Mortality Study” (GLOMMS-CORE)

Prospective cohort studies of kidney equity are limited by a focus on advanced rather than early disease; and selective recruitment. Whole population studies frequently rely on area-level measures of deprivation as opposed to individual measures of social disadvantage. We linked kidney health and individual census records in the North of Scotland, 2011-2021 (GLOMMS-CORE). We identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) <60 (mild/early), <45 (moderate), <30 ml/min/1.73m 2 (advanced), and acute kidney disease (AKD). We compare household and neighbourhood socioeconomic measures, living circumstances, and long-term mortality. We used case-mix adjusted multivariable logistic regression (for living circumstances), and Cox models (for mortality) incorporating an interaction between household and neighbourhood. Among 458897 census respondents, there were 48546, 29081, 16116, 28097 incident presentations of eGFR <60, <45, <30 and AKD; mean ages 70-77; 52-55% female. Classifications of socioeconomic position by household and neighbourhood were related but complex, and frequently did not match. Compared to households of “professionals”, people with early kidney disease in “unskilled” or “unemployed” households had increased mortality (adjusted hazard ratios, HR, and 95% confidence intervals, CI: 1.26, 1.19-1.32 and 1.77, 1.60-1.96). Those with either a deprived household or deprived neighbourhood experienced greater mortality, but those with both dimensions had the poorest outcomes. “Unskilled” and “unemployed” households more frequently reported being “limited a lot” by ill health, adverse mental health, living alone, basic accommodation, no car, English language difficulties, visual and hearing impairments. The impacts of deprivation on kidney health are spread throughout society, complex, serious, and not confined to those living in deprived neighbourhoods

Individual and neighborhood-level social and deprivation factors impact kidney health in the GLOMMS-CORE study

Prospective cohort studies of kidney equity are limited by a focus on advanced rather than early disease and selective recruitment. Whole population studies frequently rely on area-level measures of deprivation as opposed to individual measures of social disadvantage. Here, we linked kidney health and individual census records in the North of Scotland (Grampian area), 2011-2021 (GLOMMS-CORE) and identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) under 60 (mild/early), under 45 (moderate), under 30 ml/min/1.73m2(advanced), and acute kidney disease (AKD). Household and neighborhood socioeconomic measures, living circumstances, and long-term mortality were compared. Case-mix adjusted multivariable logistic regression (living circumstances), and Cox models (mortality) incorporating an interaction between the household and the neighborhood were used. Among census respondents, there were 48546, 29081, 16116, 28097 incident presentations of each respective eGFR cohort and AKD. Classifications of socioeconomic position by household and neighborhood were related but complex, and frequently did not match. Compared to households of professionals, people with early kidney disease in unskilled or unemployed households had increased mortality (adjusted hazard ratios: 95% confidence intervals) of (1.26: 1.19-1.32) and (1.77: 1.60-1.96), respectively with adjustment for neighborhood indices making little difference. Those within either a deprived household or deprived neighborhood experienced greater mortality, but those within both had the poorest outcomes. Unskilled and unemployed households frequently reported being limited by illness, adverse mental health, living alone, basic accommodation, lack of car ownership, language difficulties, visual and hearing impairments. Thus, impacts of deprivation on kidney health are spread throughout society, complex, serious, and not confined to those living in deprived neighborhoods