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Prevalence and health effects of communicable and non‐communicable disease comorbidity in rural KwaZulu‐Natal, South Africa
Author(s) -
Sharman Monica,
Bachmann Max
Publication year - 2019
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13297
Subject(s) - medicine , comorbidity , non communicable disease , tuberculosis , diabetes mellitus , population , communicable disease , cohort , multimorbidity , demography , rural area , cohort study , public health , environmental health , pediatrics , disease , nursing , pathology , sociology , endocrinology
Objectives To describe changes in prevalence of hypertension, diabetes, HIV and tuberculosis, and prevalence of comorbidity, and to investigate associations between each condition, and combinations of conditions, with self‐reported general health and hospital admission. Methods This study used data from a longitudinal population‐based HIV and health surveillance cohort, conducted by the Africa Health Research Institute in Umkhanyakude district of rural KwaZulu‐Natal, South Africa. Results Prevalence of hypertension, HIV and diabetes increased from 2009 to 2015, and prevalence of tuberculosis decreased. 81% of the 47 334 participants were female; hypertension and diabetes were the commonest conditions in people over age 50, whereas HIV was most common in those younger than 50 years. Comorbidity of communicable and non‐communicable conditions was commonest in 40‐ to 60‐year‐olds. The adjusted odd ratios (OR) for better self‐reported general health with multimorbidity were 0.53 (95% CI 0.51–0.56), 0.29 (95% CI 0.27–0.29), 0.25 (95% CI 0.21–0.37) and 0.21 (95% CI 0.12–0.37) for one, two, three and four conditions, respectively, vs. no conditions. Tuberculosis was most strongly and inversely associated with better general health (OR 0.34 (0.31–0.37) and most strongly associated with hospital admission (OR 3.26 (2.32–2.99)). Conclusion The high prevalence of communicable and non‐communicable conditions in this rural South African population is giving rise to a burden of multimorbidity, as increased access to antiretroviral treatment has reduced mortality in people with HIV. Healthcare systems must adapt by working towards integrated primary care for HIV/AIDS and non‐communicable diseases.