Assessing the effectiveness of a longitudinal knowledge dissemination intervention: Sharing research findings in rural South Africa

Knowledge dissemination interventions (KDIs) are integral to knowledge brokerage activities in research as part of the ethics of practice, but are seldom evaluated. In this case study, we critically reflect on an annual KDI as part of knowledge brokerage activities in the MRC/Wits-Agincourt Unit health and demographic surveillance system (HDSS) in rural South Africa from 2001 to 2015. The HDSS findings on births, deaths and migrations, as well as nested research project results, were shared with villagers, village leaders and service providers. The data used for this case study comprised secondary analysis of 13 reports and 762 evaluation forms of annual village-based meetings; records of requests for data from stakeholders; and qualitative analysis of 15 individual and five focus group interviews with local leaders and service providers involving 60 people. Over time, the KDI evolved from taking place over one week a year to being extended over six months, and to include briefings with service providers and local leaders. Attendance at village-level meetings remained low at an average of 3 per cent of the total adult population. Since 2011, the KDI village-based meetings have developed into an embedded community forum for discussion of topical village issues. There has been a decrease in requests for health-care and other services from the research unit, with a concurrent increase in research-related questions and requests for data from service providers, village leaders and political representatives. We conclude that, in this setting, the dissemination of research findings is not a linear exchange of information from the researchers to village residents and their leadership, but is increasingly multi-directional. KDIs are a key component of knowledge brokerage activities and involve, influence and are influenced by other aspects of knowledge brokerage, such as identifying, engaging and connecting with stakeholders and supporting sustainability

Causes and Risk Factors for Maternal Mortality in Rural Tanzania - Case of Rufiji Health and Demographic Surveillance Site (HDSS)

Complications of childbirth and pregnancy are leading causes of death among women of reproductive age. Developing countries account for 99% of maternal deaths. The aim of this study was to explore levels, causes and risk factors associated with maternal mortality in rural Tanzania. Longitudinal data (2002-2006) from Rufiji HDSS was used where a total of 26 427 women aged 15-49 years were included in the study; 64 died and there were 15 548 live births. Cox proportional hazards regression was used to assess the risk factors associated with maternal deaths. MMR was 412 per 100 000 live births. The main causes of death were haemorrhage (28%), eclampsia (19%) and puerperal sepsis (8%). An increased risk of 154% for maternal death was found for women aged 30-39 versus 15-19 years (HR=2.54, 95% CI=1.001-6.445). Married women had a protective effect of 62% over unmarried ones (HR=0.38, 95% CI=0.176-0.839). (Afr J Reprod Health 2013; 17[3]: 119-130).\u

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

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

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

Dilemmas of Ethics in Practice in Longitudinal Health Research: Identifying Opportunities for Widening Participation of Residents

Background: Mechanisms for widening participation of local participants in research studies can improve governance of public health research. Research conducted in longitudinal health study areas depends on there being mutual trust and respect over time between the local residents and researchers. Ethics in practice needs consideration alongside procedural ethics. By widening participation of the experimental public—local residents and resident service providers—ethics in practice and accountability are strengthened.Methods: The study was undertaken in a longitudinal health study area in rural South Africa using multiple qualitative methods. The sample included 35 individual and five group interviews with resident local leaders and service providers, 24 individual and eight group interviews with residents of the study area, and ten researchers' reflections on two critical incidents from ethnographic field notes on dilemmas of ethics in practice. The interviews were all audio-recorded (besides one where consent to record was not given) and then transcribed verbatim and translated from Shangaan into English. Thematic analysis was conducted.Results: Residents requested the reporting back of personal screening test results from research studies, and raised informed consent issues. Researchers recognized the importance of mechanisms to increase their accountability to residents throughout the research process, and the complexity of informed consent and fieldwork procedures within research studies.Conclusion: This study elicited the views of residents and researchers in a longitudinal health study area to seek guidance on how to strengthen participation in research governance. Three strategies were identified by participants to widen participation of the experimental public. Firstly, increasing study budgets so that individual screening test results could be personally delivered back to participants. Secondly, more rigorous field staff training in informed consent and study procedures with ongoing monitoring and supervision from researchers. Thirdly, increased earlier involvement of residents in research protocol development through study advisory groups. Additional strategies include deeper involvement of Community Advisory Groups and more focused dissemination of research results to specific audiences. In general, there is a need to identify strategies for increased accountability of researchers and participatory governance through involvement of the experimental public in all aspects of longitudinal public health research as part of the ethics in practice and democratization of science

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

Pension exposure and health:Evidence from a longitudinal study in South Africa

Social protection schemes have been expanding around the world with the objective of protecting older persons during retirement. While theoretically they have been seen as tools to improve individual wellbeing, there are few studies that evaluate whether social pensions can improve health. In this study, we exploit the change in eligibility criteria for the South African Old Age grant to estimate the association between pension exposure eligibility and health of older persons. For this, we use data from the Health and Aging in Africa: A longitudinal Study of an INDEPTH Community in South Africa (HAALSI) and model pension exposure in terms of its cumulative effect. Our results show that pension exposure is associated with better health as measured by a set of health indices. Disentangling these effects, we find that pension exposure is most likely to improve health through the delayed onset of physical disabilities in the elderly population. Our study highlights the relevance of social protection schemes as a mechanism to protect older persons physical health.</p

Moving from medical to health systems classifications of deaths : extending verbal autopsy to collect information on the circumstances of mortality

Acknowledgements The authors would also like to acknowledge the field staff at the MRC, SA/Wits Agincourt Unit, particularly Sizzy Ngobeni. The authors also acknowledge Drs Malin Eriksson and Edward Fottrell at Umeå Centre for Global Health Research *UCGHR) who contributed to the development of the SF-VA indicators, Dr Nawi Ng at UCGHR who advised on the cause of death categories, and Dr Kerstin Edin at UCGHR who provided comments on the manuscript categories, and Dr Kerstin Edin who provided comments on the manuscript. Funding A Health Systems Research Initiative Development Grant from the UK Department for International Development (DFID), Economic and Social Research Council (ESRC), Medical Research Council (MRC (and the Wellcome Trust (MR/N005597/1) funds the research presented in this paper. Support for the Agincourt HDSS including verbal autopsies was provided by The Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z), and the University of the Witwatersrand and Medical Research Council, South Africa.Peer reviewedPublisher PD