Key Research Findings and Research Translation

Research & Evaluation Platform – Trends & Transitions
For the type of demographic data available, access this excel spreadsheet “Core Agincourt demographic data 2016

Rural South Africa is in the midst of multiple interrelated transitions that have led to marked changes in population structure over two decades.

Fuelled by fast-declining fertility and by the HIV/AIDS epidemic causing an increase in child mortality, the mid-1990s to mid-2000s saw rapid narrowing of  the pyramid base. By 2011, this pattern was reversing, partly reflecting the population effects of prevention-of-mother-to-child transmission programmes and stabilizing of fertility trends. Spatial patterns of mortality reflect inequalities between former Mozambican refugees and South African host communities. Despite a recent slight upswing, fertility remains at near replacement level.

“The poorest people in the population continue to bear a high burden of HIV/AIDS and tuberculosis mortality, despite free antiretroviral therapy being made available from public health facilities. Associations between socioeconomic status and increasing burden of mortality from non-communicable diseases is likely to become prominent. Integrated strategies are needed to improve access to and uptake of HIV testing, care, and treatment, and management of non-communicable diseases in the poorest populations.

SES vs prob of dying Cho paperAnnual probability of dying, by cause and quintile of household wealth for 2001–13 (A) HIV/AIDS and tuberculosis. (B) Other communicable diseases (excluding HIV/AIDS and tuberculosis) and maternal, perinatal, and nutritional causes. (C) Non-communicable diseases. (D) Injuries. Data are predicted summed annual probabilities of death per 1000 person-years, by cause of death and household wealth quintiles that were estimated by multinomial logistic regression. All measures are adjusted for age, sex, and time period. SES=socioeconomic status.”(from the abstract and page 12 of “Kabadula C, Houle B, Collinson MA, Kahn K, Gómez-Olivé FX, Tollman S, Clark SJ . Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis. The Lancet Global Health. Vol 5 September 2017)

Adult Health & Wellbeing
There is evidence of increased cardiometabolic disease risk across the life course . In children, we find early stunting (one-third of 1–year-olds) and adolescent overweight and obesity (20–25% in older girls) in the   same socio-geographic population. Central obesity increased from 15% of girls during puberty to 35% at the end of puberty, indicating elevated risk for metabolic disease that is associated with higher socio-economic  status. In adults, evidence for a cardiovascular disease transition is clear despite the massive increase in deaths from AIDS and tuberculosis.  High blood pressure and obesity in middle aged women are at unprecedented levels, fostered by changes in lifestyle, diet and occupation.

Infant and child survival are profoundly affected by a mother’s death, as is child mobility, and fostering by women pensioners is clearly advantageous.Food security among poorer households remains precarious, with harvesting of natural resources acting as an important buffer against ‘shocks’ such as death of a breadwinner.

Among the poorest households, reliance on natural resources is high, no matter what the specific cause of adult death.

Some recent research translation 

Population level
PRICELESS-SA (Priority cost effective lessons for systems strengthening) engages closely with the Department of Health and Treasury in a number of areas. An example is research to support the sugary drinks tax with contributions to the Davis Tax Committee, March 2016, and at a Treasury Consultation, Nov 2016; as well as advocacy and engagement across various media platforms – ongoing at the moment.|

SAPRIN (South African Population Research Infrastructure Network) will harmonise data and operations of the 3 existing HDSSs, and will then introduce 4 new ones (3 urban and another rural). This will generate up-to-date, longitudinal data representative of South Africa’s rapidly changing poorer communities for analysis, evaluation and calibration of national datasets; and inform policy-making, targeting of interventions and cost evaluations, thereby improving pro-poor interventions.  See below for a video on SAPRIN:

Health care system: national level
Ministerial Committee, DOH – Kahn served on the Health Data Advisory Coordinating Committee (HDACC) (2010-2015) established to advise the Minister of Health on high-level indicators to monitor outcomes of the Negotiated Service Delivery Agreement (NSDA) for Output 2: A long and healthy life for all South Africans.

Health care system: local and provincial levels
Partnership with MCWY&N is particularly strong and includes a formal ‘collaboration agreement’, with DOH staff co-applicants on a successful UKMRC grant proposal and co-authors on journal publications31 for the VAPAR (Verbal Autopsy with Participatory Action Research) study.  A key finding that stimulated this partnership is that around 50% of children under 5 STILL die at home.

In 2016, the Public Engagement Office produced an attractive 8-page document titled ‘State of South Africa’s Rural Children: a case study of 31 villages” that synthesises findings on child health and wellbeing from diverse projects over several year.

Triangulation of national census and HDSS data
Unit members have played a leadership role in establishing the Inter-Ministerial Committee on Migration and Urbanisation co-hosted by Statistics-SA and Department of Social Development.

Individual / participant level
 Point of care results: With a growing number of studies requiring biomarker measurement, we provide ‘point of care’ results to study participants where appropriate (eg blood pressure, glucose, HIV rapid results after counseling) with referral to sub-district clinics where indicated.

Global / regional level
World Health Organization (WHO) Collaborating Centre for Verbal Autopsy (VA)
VA data from the MRC/Wits-Agincourt Unit were used to refine and validate the InterVA-4 and InterVA-5 software for automated assessment of VA, now used by the WHO.

Research Brief
The Public Engagement office produced a research brief in 2011.  The 2011 Agincourt Research Briefing was titled “Changing Lives in Rural South Africa – Annual research Brief of the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) Nov 2011”.  Briefs on other research studies are also available, for example this on highlighting sugar sweetened beverages.