Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

The State of South African Cities a Decade after Democracy

a vision of an inclusive non-racial city in which democracy is stable and development flourishes. But the 2004 report is different from preceding urban policy statements in a number of critical respects, not least that it is not a formal statement of government. In part, the relative autonomy of the Report’s sponsor, the South African Cities Network (a quango of state and non-state affiliates), explains its divergent analytical point of departure in the assessment of the state of the cities 10 years after democracy. The 2004 report is premised on the notion that changing the racial pattern of inequality hinges on systematic responses to the material forces, demographic, economic, environmental and institutional, that shaped the inherited apartheid city form. The 2004 report is also different from earlier government policy positions in that it argues that urban development is not just a site of national reconstruction and development, but that the urban question lies at the heart of achieving the national vision of a productive, democratic and non-racial society based on a vision of sustainable human settlements