The Agincourt field site evolution and current status

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Stroke in rural South Africa - contributing to the little known about a big problem

Objectives. To describe the extent of mortality from cerebrovascular accident (CVA) in a rural South African population.Design. Annual demographic and health surveillance with verbal autopsy of all deaths, 1992 - 1995.Outcome measures. Stroke mortality rate by age and sex.Results. Stroke mortality increased with age and is higher in men than women over age 35. Proportionate mortality ratio from CVA: 10.3% of deaths in the 35 - 64-year age group.Conclusion. Cerebrovascular disease is an important cause of death in South Africa's rural north-east. Community-based research is needed to inform policy and practice

Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa.

BACKGROUND: South Africa is experiencing a demographic and epidemiological transition with an increase in population aged 50 years and older and rising prevalence of non-communicable diseases. This, coupled with high HIV and tuberculosis prevalence, puts an already weak health service under greater strain. OBJECTIVE: To measure self-reported chronic health conditions and chronic disease risk factors, including smoking and alcohol use, and to establish their association with health care use in a rural South African population aged 50 years or older. METHODS: The Study on Global Ageing and Adult Health (SAGE), in collaboration with the INDEPTH Network and the World Health Organization, was implemented in the Agincourt sub-district in rural northeast South Africa where there is a long-standing health and socio-demographic surveillance system. Household-based interviews were conducted in a random sample of people aged 50 years and older. The interview included questions on self-reported health and health care use, and some physical measurements, including blood pressure and anthropometry. RESULTS: Four hundred and twenty-five individuals aged 50 years or older participated in the study. Musculoskeletal pain was the most prevalent self-reported condition (41.7%; 95% Confidence Interval [CI] 37.0-46.6) followed by hypertension (31.2%; 95% CI 26.8-35.9) and diabetes (6.1%; 95% CI 4.1-8.9). All self-reported conditions were significantly associated with low self-reported functionality and quality of life, 57% of participants had hypertension, including 44% of those who reported normal blood pressure. A large waist circumference and current alcohol consumption were associated with high risk of hypertension in men, whereas in women, old age, high waist-hip ratio, and less than 6 years of formal education were associated with high risk of hypertension. Only 45% of all participants reported accessing health care in the last 12 months. Those who reported higher use of the health facilities also reported lower levels of functioning and quality of life. CONCLUSIONS: Self-reported chronic health conditions, especially hypertension, had a high prevalence in this population and were strongly associated with higher levels of health care use. The primary health care system in South Africa will need to provide care for people with non-communicable diseases

The implications of long term community involvement for the production and circulation of population knowledge

Demographic surveillance systems (DSS) depend on community acceptance and involvement to produce high quality longitudinal data. Ensuring community support also exposes power relations usually concealed in the research process. We discuss the Agincourt Health and Demographic Surveillance System in South Africa to argue that: 1) long-term presence and community involvement contribute to high response rates and data quality, 2) to maintain community support the project must demonstrate its usefulness, 3) reporting to community members provides valuable checks on the local relevance and comprehension of questions, and 4) community opinion can modify both wording and content of research questions.community, demographic surveillance system, fertility, health, knowledge, longitudinal, migration, mortality, South Africa

A hidden menace: Cardiovascular disease in South Africa and the costs of an inadequate policy response

The cardiovascular disease (CVD) burden in South Africa (SA) is increasing amongst all age groups and is predicted to become the prime contributor to overall morbidity and mortality in the over 50-year age group. Several factors contribute to this – an epidemiological transition, which has seen a rise in chronic non-communicable disease, and a demographic transition with much reduced fertility and a growing proportion of the population above 60 years. In parallel with unfolding urbanisation, the population burden of vascular risk factors namely hypertension, hypercholesterolemia, diabetes and obesity has increased. The scale of CVD burden poses a threat to the health system and calls for timely intervention. This paper discusses the burden of CVD in SA and current initiatives to address it. Evidence is presented from studies that focus on prevention including salt reduction and trans-fatty acids legislation. The economic and clinical impact of an inadequate private and public sector response is summarised. The paper documents lessons from other countries and proposes health systems strengthening measures that could improve care of patients with CVD

Introducing visual participatory methods to develop local knowledge on HIV in rural South Africa

The authors would also like to acknowledge the field staff at the MRC/Wits Agincourt unit, particularly Ms Rirhandzu Debs and Dr Kerstin Edin from the Umeå Centre for Global Health Research, Umeå University, who facilitated data collection and made important contributions to the fieldwork.Peer reviewedPublisher PD

The stall in fertility decline in rural, northeast, South Africa: the contribution of a self-settled, Mozambican, refugee sub-population

Using longitudinal data from the Agincourt Health and socio-Demographic Surveillance System (HDSS) in rural South Africa, this paper examines the role of the fertility of self-settled, former Mozambican refugee sub-population on the stall in fertility decline in the Agincourt HDSS from 1993 to 2009. The Agincourt HDSS fertility trend is decomposed to quantify the relative contribution of the Mozambicans to fertility changes. Results show that fertility level declined by about 1.5 children per woman over the period and the level remain around 2.5 children per woman in the last eight years of the period examined suggesting a stall in fertility decline in the sub-district population covered by the HDSS. However, while the fertility of the Mozambicans fell consistently over the period, there was a reversal in the fertility decline of South African women residing in the area suggesting that the overall stalls are attributable to stalls in fertility decline among South African women.

Burden of Mortality Linked to Community-nominated Priorities in Rural South Africa

Acknowledgments The authors would like to thank the community stakeholder study participants for agreeing to be part of the process, and for sharing their time, knowledge, and perspectives. Thanks also to the Verbal Autopsy with Participatory Action Research (VAPAR) team and staff of the Medical Research Council (MRC)/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), especially Simon Khoza, Sizzy Ngobeni and Ella Sihlangu. Funding information This work was supported by the medical research council (MRC) [MR/P014844/1].Peer reviewedPublisher PD

Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 - 2013.

BACKGROUND: Literature is limited on the effects of high prevalence HIV on fertility in the absence of treatment, and the effects of the introduction of sustained access to antiretroviral therapy (ART) on fertility. We summarize fertility patterns in rural northeast South Africa over 21 years during dynamic social and epidemiological change. METHODS: We use data for females aged 15-49 from the Agincourt health and socio-demographic surveillance system (1993-2013). We use discrete time event history analysis to summarize patterns in the probability of any birth. RESULTS: Overall fertility declined in 2001-2003, increased in 2004-2011, and then declined in 2012-2013. South Africans showed a similar pattern. Mozambicans showed a different pattern, with strong declines prior to 2003 before stalling during 2004-2007, and then continued fertility decline afterwards. There was an inverse gradient between fertility levels and household socioeconomic status. The gradient did not vary by time or nationality. CONCLUSIONS: The fertility transition in rural South Africa shows a pattern of decline until the height of the HIV/AIDS pandemic, with a resulting stall until further decline in the context of ART rollout. Fertility patterns are not homogenous among groups