Agincourt Health and Socio-Demographic Surveillance System

Abstract Understanding the seasonality of respiratory syncytial virus (RSV) is crucial for cost-effective seasonal RSV prophylaxis administration. The impact of short-term changes in air pollution and meteorological factors on RSV epidemics, particularly their spatial variations, remains unclear. We conducted a time-series analysis to investigate the association between short-term environmental changes and weekly RSV infection in Chile. Weekly data on the number of new laboratory RSV tests and confirmed RSV-positive cases, meteorological factors, and air pollutants were collected from 16 Chilean regions (2015–2018). We fitted a quasi-Poisson regression to evaluate the link between short-term environmental changes and RSV infection in each region. We utilized random effects meta-analyses to pool the region-specific estimates. Subgroup analyses were further conducted to assess variations by socio-economic and geographical context. Nationwide associations were observed between weekly average temperature and RSV activity, with a 1 °C increase being positively associated with an 8.2% (95% confidence interval: 0.87–0.97) decrease in RSV positivity at a lag of 3 weeks. In addition, we found significant positive nationwide associations between air pollutants, i.e., nitrogen dioxide ( $${{\rm{NO}}}_{2}$$ NO 2 ) and particulate matter smaller than 2.5 μm ( $${{\rm{PM}}}_{2.5}$$ PM 2.5 ), and RSV activity. A 5- $${\rm{\mu }}{\rm{g}}/{{\rm{m}}}^{3}$$ μ g / m 3 increase in $${{\rm{PM}}}_{2.5}$$ PM 2.5 and $${{\rm{NO}}}_{2}$$ NO 2 concentrations was positively associated with an increase in RSV positivity of 3.4% (1.00–1.06) and 10.2% (1.05–1.15) at lags of 3 weeks, respectively. We also observed regional variations of environmental impacts on RSV activity across Chile, including $${{\rm{PM}}}_{2.5}$$ PM 2.5 and particulate matter smaller than 10 micrometers ( $${{\rm{PM}}}_{10}$$ PM 10 ). The study suggests that improving air quality could potentially lower the RSV activity, especially in highly polluted areas. Furthermore, temperature and air quality changes may be used for predicting short-term shifts in RSV activity, informing RSV prevention efforts.

South Africa is experiencing a heterogeneous and rapid nutrition transition. Rural-origin Black South Africans frequently migrate to access employment opportunities in urbanized areas, which could place individuals at risk for obesity due to accompanying dietary and lifestyle changes. We utilize longitudinal data-four waves from 2018 to 2022-with detailed internal migration and health information, and negligible participant attrition from the Migrant Health Follow-Up Study, with origin households located in rural northeast South Africa-Agincourt. We employ lagged-dependent variable regressions to test whether (1) the number of waves one is away from their rural home (0-4) and (2) residing in a densely populated urban area (Gauteng province) relative to other locations or remaining in Agincourt over the four waves, are differentially associated with having abdominal obesity, indicated by the preferable measure of the waist circumference-to-height ratio (WHtR), at Wave 4-after adjusting for Wave 1 obesity and other variables, including fast food consumption. WHtR is operationalized as a binary indicator of abdominal obesity as well as a standardized, continuous one. Our analytic sample includes women (N = 895) and men (N = 1010). Our results show that internal migrant women and men face higher chances of having abdominal obesity at Wave 4 than their nonmigrant counterparts. For men, both the number of waves as a migrant and ever migrating to Gauteng are consistently, strongly associated with the chances of having abdominal obesity-considerably more so than women. As obesity rates rise throughout urbanizing low- and middle-income countries, this research emphasizes the importance of understanding the correlates of the risks of obesity that internal migrants will face.

BackgroundSuccessful retention in care of people living with HIV remains a challenge and a cornerstone of ending the epidemic. A better understanding of retention predictors could guide an evidence-based approach to target interventions. We sought to characterise HIV care retention trajectories among individuals receiving antiretroviral therapy (ART) in a rural South Africa setting, and to determine factors associated with those trajectories.MethodsWe conducted a population-based cohort study of individuals receiving ART in ten health care facilities within the Agincourt Health and Socio-Demographic Surveillance System site in Mpumalanga, South Africa, in 2015–18. We used group-based trajectory modelling to identify clusters of individuals with similar retention trajectories and assessed the association between socio-demographic factors and trajectory groups using multinomial logistic regression.ResultsAmong 1689 individuals receiving ART during the study period, five distinct trajectory groups were identified: 30.8% had gradually decreasing retention over time, 10.2% had late increasing retention, 20.7% had early increasing retention, 7.8% had early decreasing retention, and 30.5% had consistently high retention. Individuals in the consistently high retention group were more likely to be female and aged ≥40 years. In contrast, those in the early decreasing retention group were more likely to be male, aged <30 years, and with temporary resident status. Individuals in the early increasing retention group were more likely to be from villages included in a HIV Treatment as Prevention community mobilisation study. Education, marital status, and socioeconomic status were not significantly associated with group membership. Months on ART were weakly associated with group membership.ConclusionsFive distinct retention trajectories were observed and associated with specific sociodemographic factors. Our study offers a data-driven approach to inform the design of targeted interventions to improve HIV care retention. Interventions and policies addressing socioeconomic and system-level factors are essential to achieving better outcomes in high-burden areas.

BackgroundResearch on cognition and pain is limited in Low and Middle-income Countries (LMICs) and understanding how chronic conditions and pain treatment may moderate this association is underexplored. This study aimed to explore the relationship between pain and cognition and the moderating effect of hypertension, diabetes, HIV, pain treatment, and depressive symptoms.MethodsWe analyzed data from 3803 individuals enrolled in the HAALSI study, a longitudinal population study of older adults in Agincourt, South Africa. Pain was measured with the Brief Pain Inventory. Cognition was assessed using a composite of orientation questions, a memory test, and the Trails Making Test B. Chronic conditions were assessed using biological measures, and depressive symptoms were measured using the CES-D scale. Linear regression models were used to investigate the relationship.ResultsBaseline and longitudinal pain were significantly associated with poorer episodic memory (ß = −0.17 [P < .001]; ß = −0.18 [P < .001]). Hypertension amplified the negative effect of pain on episodic memory, while diabetes and HIV did not moderate the relationship between pain and cognition (ß = −0.10 [.006]). Pain treatment was associated with poorer cognitive performance. Depressive symptoms moderated the relationship between pain and both cognition and executive function (EF) (P = .02). The negative effect of pain on episodic memory was observed in individuals with both acute and persisting pain, while it only affected EF in those with acute pain.ConclusionsThese findings highlight the importance of examining factors that may moderate the relationship between pain and cognition and strategies to mitigate the effect pain has on cognition, particularly in LMICs.

Abstract Considerable attention has been given to the socio-economic impacts of the COVID-19 pandemic, primarily focusing on urban settings, while little research has examined the effects on rural communities. This study investigated the impact of the COVID-19 lockdown on livelihoods and food security in the rural area of Bushbuckridge, Mpumalanga Province, South Africa. We utilized a panel data set comprising 454 households from the Sustainability in Communal Socio-Ecological Systems (SUCSES) survey, conducted in 2019 and 2021. To identify the determinants of food security over time, we employed difference-in-differences (DiD) panel regression models for the two time periods, focusing on key indicators of food security, including household food availability, dietary diversity, food access, and overall food security. The analysis revealed significant adverse impacts of the lockdown on local off-farm employment (p &lt; 0.05). In response, households increased their reliance on subsistence agriculture and natural resource use as coping mechanisms. Contrary to expectations, food security metrics improved during the study period. Higher levels of food security were associated with migrant employment, domestic assets, and the use of edible wild fruits and vegetables. In contrast, a high dependency on social grants was correlated with lower food security levels. The study highlights the diverse coping mechanisms rural households employed to adapt to pandemic-related disruptions, underscoring the importance of livelihood diversification. While short-term improvements in food security were observed, the decline in local off-farm employment poses risks to long-term resilience. These findings emphasize the need for targeted policy interventions that support the diversified livelihoods of rural households while strengthening social protection systems to sustain food security beyond crisis periods.

Ethiopia faces significant mental health challenges; mental disorders are the leading non-communicable condition, and many adults experience symptoms by age 14-15. We examined structural, institutional, and agentic factors affecting child and adolescent mental well-being in Ethiopia. The aims were to describe the political, economic, social and policy contexts in which mental well-being exists; analysing power, interests, and the influence and resources key stakeholders bring to bear on decision-making processes related to child and adolescent well-being. We used a Political Economy Analysis framework to identify structural and institutional features, networks of influence, and routes for change. Using this lens, a literature review was performed, supplemented with key informant interviews (n = 9). Multiple structural drivers of mental health problems were identified: globalized urbanization and social fragmentation, and political and economic systems characterized by economic ambition but entrenched poverty, aid dependency, conflict and civil war. Despite significant policy recognition and support, there was poor coordination between federal and regional structures and sectors, vastly insufficient resources, and low coverage especially in rural areas. Service delivery was further complicated by widespread and normalised violence against children and young people, low knowledge and awareness among children and families, entrenched stigma and gender inequities, and ethnic tensions, conflict and displacement. Overall, regional resource shortages drastically limited the collective agencies of service users and providers. Meanwhile, development programmes lack context and coordination. The analysis emphasizes an urgent need to enhance implementation support through targeted, contextually relevant mental health policies and programmes, and institutional expansion of spaces and processes for multisectoral working, especially between health and education. Development partners should align with statutory bodies as a mechanism to harmonise and contextualise. The government's tendency to formulate national programs and strategies is positive, but lack of regional funding and support limit effectiveness. Schools and healthcare environments can play powerful roles supporting mental health, however, experience considerable challenges related to resourcing, and lack spaces and processes for multisectoral working. There is a pressing need to resource and support implementation and collaboration capabilities of the school community and healthcare sector to promote mental wellbeing and provide culturally engaged services.

Traditional faith healers (TFHs) are often consulted for serious mental illness (SMIs) in low- and middle-income countries (LMICs). Involvement of TFHs in mental healthcare could provide an opportunity for early identification and intervention to reduce the mental health treatment gap in LMICs. The aim of this study was to identify models of collaboration between TFHs and biomedical professionals, determine the outcomes of these collaborative models and identify any mechanisms (i.e., explanatory processes) or contextual moderators (i.e., barriers and facilitators) of these outcomes. A systematic scoping review of five electronic databases was performed from inception to March 2023 guided by consultation with local experts in Nigeria and Bangladesh. Data were extracted using a predefined data charting form and synthesised narratively. Six independent studies (eight articles) satisfied the inclusion criteria. Study locations included Ghana (n = 1), Nigeria (n = 1), Nigeria and Ghana (n = 1), India (n = 1), Hong Kong (n = 1) and South Africa (n = 1). We identified two main intervention typologies: (1) Western-based educational interventions for TFHs and (2) shared collaborative models between TFHs and biomedical professionals. Converging evidence from both typologies indicated that education for TFHs can help reduce harmful practices. Shared collaborative models led to significant improvements in psychiatric symptoms (in comparison to care as usual) and increases in referrals to biomedical care from TFHs. Proposed mechanisms underpinning outcomes included trust building and empowering TFHs by increasing awareness and knowledge of mental illness and human rights. Barriers to implementation were observed at the individual (e.g., suspicions of TFHs), relationship (e.g., reluctance of biomedical practitioners to equalise their status with TFHs) and service (e.g., lack of formal referral systems) levels. Research on collaborative models for mental healthcare is in its infancy. Preliminary findings are encouraging. To ensure effective collaboration, future programmes should incorporate active participation from community stakeholders (e.g., patients, caregivers, faith healers) and target barriers to implementation on multiple levels.

The prevalence of urinary incontinence (UI) in older women in low- and middle-income countries (LMICs) is not well understood. We conducted a rapid literature review to assess the burden of UI in this population and contextualize findings from a household survey of women aged 40 and older in Nouna, in northwestern Burkina Faso. The rapid review included 21 survey articles. UI prevalence for LMIC women 40 or older varied greatly (6%-80%), with differences by socio-demographics, gynecological factors (menopausal status, birth outcomes), comorbidities (age, education, obesity, diabetes, hypertension, arthritis), behaviors (smoking status) and survey location. The studies used validated tools-the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ UI-SF) was most common (n = 4, 19%)-and bespoke tools that have not yet been validated. In Nouna, 983 (64.5%) of 1,524 women, completed the ICIQ UI-SF. Overall UI prevalence, defined as reporting leakage at least 2-3 times a week, was 2.6% (95% CI 1.73%-3.85%), descriptively increased with age from 0.5% in 40-49 year-olds to 6.6% in those 70 and over. Of those with UI, 88.5% experienced leakage daily, and 50% reported moderate or greater interference with daily life, yet most (88.5%) had not spoken to a healthcare provider. Multivariable analysis revealed that UI was more common among women who were not currently married and decreased with higher education levels. Both the rapid review and survey highlight the burden of UI among older women in LMICs, particularly as they age beyond 60. Given UI's association with physical and mental health, it is crucial to raise awareness of its burden, improve healthcare access, and integrate routine screening into basic healthcare services. Additionally, training healthcare providers and developing culturally appropriate interventions will help address stigma and ensure effective management of UI in this vulnerable population.

Traditional faith healers (TFHs) are often consulted for serious mental illness (SMIs) in low- and middle-income countries (LMICs). Involvement of TFHs in mental healthcare could provide an opportunity for early identification and intervention to reduce the mental health treatment gap in LMICs. The aim of this study was to identify models of collaboration between TFHs and biomedical professionals, determine the outcomes of these collaborative models and identify any mechanisms (i.e., explanatory processes) or contextual moderators (i.e., barriers and facilitators) of these outcomes. A systematic scoping review of five electronic databases was performed from inception to March 2023 guided by consultation with local experts in Nigeria and Bangladesh. Data were extracted using a predefined data charting form and synthesised narratively. Six independent studies (eight articles) satisfied the inclusion criteria. Study locations included Ghana (n=1), Nigeria (n=1), Nigeria and Ghana (n=1), India (n=1), Hong Kong (n=1) and South Africa (n=1). We identified two main intervention typologies: (1) Western-based educational interventions for TFHs and (2) shared collaborative models between TFHs and biomedical professionals. Converging evidence from both typologies indicated that education for TFHs can help reduce harmful practices. Shared collaborative models led to significant improvements in psychiatric symptoms (in comparison to care as usual) and increases in referrals to biomedical care from TFHs. Proposed mechanisms underpinning outcomes included trust building and empowering TFHs by increasing awareness and knowledge of mental illness and human rights. Barriers to implementation were observed at the individual (e.g., suspicions of TFHs), relationship (e.g., reluctance of biomedical practitioners to equalise their status with TFHs) and service (e.g., lack of formal referral systems) levels. Research on collaborative models for mental healthcare is in its infancy. Preliminary findings are encouraging. To ensure effective collaboration, future programmes should incorporate active participation from community stakeholders (e.g., patients, caregivers, faith healers) and target barriers to implementation on multiple levels.

Traditional faith healers (TFHs) are often consulted for serious mental illness (SMIs) in low- and middle-income countries (LMICs). Involvement of TFHs in mental healthcare could provide an opportunity for early identification and intervention to reduce the mental health treatment gap in LMICs. The aim of this study was to identify models of collaboration between TFHs and biomedical professionals, determine the outcomes of these collaborative models and identify any mechanisms (i.e., explanatory processes) or contextual moderators (i.e., barriers and facilitators) of these outcomes. A systematic scoping review of five electronic databases was performed from inception to March 2023 guided by consultation with local experts in Nigeria and Bangladesh. Data were extracted using a predefined data charting form and synthesised narratively. Six independent studies (eight articles) satisfied the inclusion criteria. Study locations included Ghana (n = 1), Nigeria (n = 1), Nigeria and Ghana (n = 1), India (n = 1), Hong Kong (n = 1) and South Africa (n = 1). We identified two main intervention typologies: (1) Western-based educational interventions for TFHs and (2) shared collaborative models between TFHs and biomedical professionals. Converging evidence from both typologies indicated that education for TFHs can help reduce harmful practices. Shared collaborative models led to significant improvements in psychiatric symptoms (in comparison to care as usual) and increases in referrals to biomedical care from TFHs. Proposed mechanisms underpinning outcomes included trust building and empowering TFHs by increasing awareness and knowledge of mental illness and human rights. Barriers to implementation were observed at the individual (e.g., suspicions of TFHs), relationship (e.g., reluctance of biomedical practitioners to equalise their status with TFHs) and service (e.g., lack of formal referral systems) levels. Research on collaborative models for mental healthcare is in its infancy. Preliminary findings are encouraging. To ensure effective collaboration, future programmes should incorporate active participation from community stakeholders (e.g., patients, caregivers, faith healers) and target barriers to implementation on multiple levels.