Rural Public Health & Health Transition Research Unit

Highlights

The Unit’s goal is ‘to better understand the dynamics of health, population and social transitions in rural South (and southern) Africa in order to mount a more effective public health, public sector and social response’. Work over more than a decade has demonstrated the mortality impact of emerging non-communicable disease despite overwhelming chronic infectious disease (HIV and TB), and highlighted the implications of this for the provision of effective primary health care. A Lancet research article was published as part of a 30th anniversary commemorative issue on Primary Health Care (Tollman SM, Kahn K et al. Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study.The Lancet 2008; 372: 893-901); this has a linked commentary and was discussed in the editorial. In August 2009, The Lancet produced a South Africa series (The Lancet, Health in South Africa, August 2009); Tollman contributed to the paper on non-communicable diseases that includes data from the Agincourt HDSS.

The Unit is uniquely positioned to study coverage of, and equity in access to, treatment programs including VCT and ART, as well as other chronic care services. This will be achieved through linking health facility records with the Agincourt population-based database. Work evaluating the most effective methods for the linking is near completion.

The Unit’s efforts to develop effective chronic care systems, responding to both infectious and non-communicable disease, are strengthened through partnership with the Mpumalanga Department of Health. This involves provision of population-based health and household data for provincial and district priority setting, and Research & Development efforts to develop effective health programmes for children and adults.
 
Medium-term sustainability of the Agincourt health and socio-demographic surveillance system over the period 2008-2013 is assured through the awarding of a five-year Wellcome Trust programme grant (GB£2.9 million).

Comparative rural-urban research on child and adolescent growth, development and risk for adult chronic disease is jointly led with the urban Birth-to-Twenty Project (Soweto), and benefits from two major longitudinal studies.
 
Research portfolio
Studies to-date and a strengthened research platform combine to produce the portfolio presented below. Every project is linked to the HDSS, relies on its data management system during field and analytic phases, and will ultimately contribute new datasets to the research platform thus extending and enriching it. To avoid overburdening study participants, HDSS management is careful to monitor selection of samples to limit participation in multiple studies. Project-specific funding is sourced separately.

Figure 2 describes an organizational framework for the research programme indicating major research themes and links between them.

Fig 2. Population and Social Transitions in Agincourt

Theme 1: Levels, trends and transitions
Theme leader: Sam Clark, with Mark Collinson

• Seeks to understand dynamics of demographic/epidemiological change in rural populations contending with rapid transitions, and identify the forces driving that change.

Theme 2: Child health and development
Theme leader: Kathleen Kahn, with John Pettifor

• Project PROMISE: Primary prevention to promote adolescent and infant health and wellbeing and to reduce intergenerational risk of metabolic disease in transitioning societies
• Kulani Child Health and Resilience Project
• Pneumococcal conjugate vaccine (PCV) introduction
• HIV & Education in Young South African Women

           
Theme 3: Adult health and wellbeing
Theme leader: Steve Tollman, with Myles Connor

• Studies on the epidemiology of epilepsy in demographic surveillance sites (SEEDS)
• Health and wellbeing of ageing populations in Africa and Asia  

Theme 4: HIV/AIDS and Chronic care
Theme leader: Steve Tollman

• Home-based VCT in support of HAART roll-out    
• Trials site development                
• Chronic care

Theme 5: Household response to shocks and stresses
Theme leader: Mark Collinson, with Wayne Twine

• Natural resources and household vulnerability/resilience                   
• The social role of elders     
• Migration, health and wellbeing   

Data
For an indepth explanation regarding access to the Agincourt data base, please go to the Agincourt data website http://www.agincourt.co.za/DataSection/

Funders
The Wellcome Trust, UK; William and Flora Hewlett Foundation, USA; University of the Witwatersrand, SA; South African Medical Research Council; South African National Research Foundation; National Institutes of Health (NIH), USA; INDEPTH  Network; Rockefeller Brothers Foundation, USA; CSIR, SA; Fogarty International Centre, USA.

Collaborators
At Wits University: School of Public Health, Centre for Health Policy; Departments of Child Health, Sociology, Economics; Birth to Twenty, Forced Migration Studies Programme (FMSP), Wits Institute for Social and Economic Research (WISER), Centre for African Ecology, Reproductive Health Research Unit. In South Africa: Africa Centre Demographic Information System (ACDIS) University of KwaZulu-Natal; Dikgale DSS, University of Limpopo; Medical Research Council; Statistics South Africa; University of Cape Town. International: INDEPTH; UK: London School of Hygiene and Tropical Medicine, Warwick, Oxford, Cambridge and Edinburgh Universities; Europe: Pasteur Institut, France; Umeå University, Sweden; World Health Organisation, Geneva. USA: Colorado, Brown, Princeton and Harvard Universities.