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Multimorbidity is a global research priority, yet relatively little is known about it in low and middle income countries. South Africa has the largest burden of HIV worldwide but also has a growing burden of non-communicable diseases; potentially leading to uncommon disease combinations. Information about the prevalence of multimorbidity and factors associated with it can assist in healthcare planning and targeting groups of people for interventions. This study aimed to determine the prevalence of multimorbidity by age and sex, as well as factors associated with multimorbidity in people 15 years and older. This study analyses the nationally representative 2016 South African Demographic Health Survey. The sample included 10 336 people who participated in the Adult Health questionnaire and approximately 7 961 people who provided biomarkers. Multivariate logistic regression was used to measure the association of multimorbidity with age, sex, living in an urban or rural area, education level, wealth level, employment status, body mass index, current alcohol or tobacco use. All analyses were conducted using STATA 15. Multimorbidity was present in 20.7% (95% CI: 19.5%– 21.9%) of participants; in 14.8% (95% CI: 13.4% - 16.3%) of males and 26.2% (95% CI: 24.7–27.7%) of females. Multimorbidity increased with age; with the highest odds in the 55–64 years old age group (OR: 24.910, 95% CI: 14.901–41.641, p < 0.001) compared to those aged 15–24 years. The odds of multimorbidity was also higher in young females compared to young males (OR: 2.734, 95% CI: 1.50–4.99, p = 0.001). Possessing tertiary education (OR: 0.722, 95% CI: 0.537–0.97, p = 0.031), being employed (OR: 0.813, 95% CI: 0.675–0.979, p = 0.029) or currently using alcohol (OR: 0.815, 95% CI: 0.686–0.968, p = 0.02) was protective against multimorbidity. Multimorbidity is prevalent within the South African population, with females and older adults being most affected. However, multimorbidity is also observed in younger adults and most likely driven by the high prevalence of HIV and hypertension.

To investigate injury-related mortality in South Africa using a nationally representative sample and compare the results with previous estimates. We conducted a retrospective descriptive study of medico-legal postmortem investigation data from mortuaries using a multistage random sample, stratified by urban and non-urban areas and mortuary size. We calculated age-specific and age-standardized mortality rates for external causes of death. Postmortem reports revealed 52,493 injury-related deaths in 2009 (95% confidence interval, CI: 46,930-58,057). Almost half (25,499) were intentionally inflicted. Age-standardized mortality rates per 100,000 population were as follows: all injuries: 109.0 (95% CI: 97.1-121.0); homicide 38.4 (95% CI: 33.8-43.0; suicide 13.4 (95% CI: 11.6-15.2) and road-traffic injury 36.1 (95% CI: 30.9-41.3). Using postmortem reports, we found more than three times as many deaths from homicide and road-traffic injury than had been recorded by vital registration for this period. The homicide rate was similar to the estimate for South Africa from a global analysis, but road-traffic and suicide rates were almost fourfold higher. This is the first nationally representative sample of injury-related mortality in South Africa. It provides more accurate estimates and cause-specific profiles that are not available from other sources.

Background : Increasing urbanisation and rising unhealthy lifestyle risk factors are contributing to a growing diabetes epidemic in South Africa. In 2000, a study estimated diabetes prevalence to be 5.5% in those aged over 30. Accurate, up-to-date information on the epidemiology and burden of disease due to diabetes and its sequelae is essential in the planning of health services for diabetes management. Objective : To calculate the non-fatal burden of disease in Years Lost due to Disability (YLD) due to diabetes and selected sequelae in South Africa in 2009. YLD measures the equivalent loss of life due to ill-health. Methods : A series of systematic literature reviews identified data on the epidemiology of diabetes and its sequelae in South Africa. The data identified were then applied to Global Burden of Disease (GBD) methodology to calculate the burden attributable to diabetes. Results : Prevalence of type 2 diabetes in South Africa in 2009 is estimated at 9.0% in people aged 30 and older, representing approximately 2 million cases of diabetes. We modelled 8,000 new cases of blindness and 2,000 new amputations annually caused by diabetes. There are 78,900 YLD attributed to diabetes, with 64% coming from diabetes alone, 24% from retinopathy, 6% from amputations, 9% from attributable stroke disability, and 7% from attributable ischemic heart disease disability. Conclusions : We estimate that the prevalence of diabetes is increasing in South Africa. Significant disability associated with diabetes is demonstrated. Some of the attributed burden can be prevented through early detection and treatment. Appendices available online under Reading Tools.

Three national HIV household surveys were conducted in South Africa, in 2002, 2005 and 2008. A novelty of the 2008 survey was the addition of serological testing to ascertain antiretroviral treatment (ART) use. We used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. The estimated \"excess\" HIV prevalence due to ART in 2008 was highest among women 25 years and older and among men 30 years and older. In the period 2002-2005, the HIV incidence rate among men and women aged 15-49 years was estimated to be 2.0 new infections each year per 100 susceptible individuals (/100pyar) (uncertainty range: 1.2-3.0/100pyar). The highest incidence rate was among 15-24 year-old women, at 5.5/100pyar (4.5-6.5). In the period 2005-2008, incidence among men and women aged 15-49 was estimated to be 1.3/100 (0.6-2.5/100pyar), although the change from 2002-2005 was not statistically significant. However, the incidence rate among young women aged 15-24 declined by 60% in the same period, to 2.2/100pyar, and this change was statistically significant. There is evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth. Our analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. We also show the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence.

Background: Multimorbidity is likely to be a significant contributor to ill health and inequality in South Africa and yet has been largely overlooked. Purpose: This paper focuses on the findings of a recent large study that highlighted emerging issues - namely (i) the high levels of multimorbidity among three key groups - older adults, women, and the wealthy; (ii) discordant and concordant disease clusters among the multimorbid. Research Design: Narrative. Study Sample and Data Collection: Not applicable. Results: We discuss the implications of each emerging issue for health systems policy and practice. Conclusion: Although key policies are identified, many of these policies are not implemented and are therefore not part of routine practice, leaving much space for improvement.

With improved access to antiretroviral treatment (ART), adults with HIV live longer to reach older age. The number of older adults living with HIV is increasing steadily, giving rise to a new population of interest in HIV research and for invigorated considerations in health service delivery and policy. We analysed the profile of comorbidities in older people (50 years and older) living with HIV in South Africa. We conducted a secondary analysis of all individuals over 15 years who tested HIV positive in the Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017. We conducted multivariate logistic regression to determine the factors associated with having HIV comorbidity using Stata 15.0 software. We entered 3755 people living with HIV into the analysis, of whom 18.3% (n = 688) were 50 years or older. Older adults had four times greater odds (OR = 4.7 (3.1–7.0)) of having an HIV comorbidity compared to younger adults. Being female (OR = 1.6 (1.1–2.4)) and living in an urban area (OR = 2.6 (1.8–3.7)) increased the odds of HIV comorbidity. Older adults with HIV require comprehensive health care to deal with multimorbidity, to maximise the benefits gained by advances in HIV therapies.

Synthesis of existing prevalence data using rigorous systematic review methods is considered an effective strategy to generate representative and robust prevalence figures to inform health planning and policy. The purpose of this systematic review was to identify, collate, and synthesise all studies reporting the prevalence of total and newly diagnosed type 2 diabetes (T2DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) in South Africa. Four databases, PubMed, Scopus, Web of Science, and African Index Medicus were searched for articles published between January 1997 and June 2020. A total of 1886 articles were identified, of which 11 were included in the meta-analysis. The pooled prevalence in individuals 25 years and older was 15.25% (11.07–19.95%) for T2DM, 9.59% (5.82–14.17%) for IGT, 3.55% (0.38–9.61%) for IFG, and 8.29% (4.97–12.34%) for newly diagnosed T2DM. Although our pooled estimate may be imprecise due to significant heterogeneity across studies with regard to population group, age, gender, setting, diagnostic test, and study design, we provide evidence that the burden of glucose intolerance in South Africa is high. These factors contribute to the paucity of representative T2DM prevalence data. There is a need for well-designed epidemiological studies that use best-practice and standardised methods to assess prevalence.

Using a systematic review method, the prevalence of anaemia, iron deficiency (ID), and iron deficiency anaemia (IDA) in women of reproductive age (WRA) and children under 5 years of age was obtained to inform priorities in health planning and policy in South Africa. We searched electronic databases for articles published between 1997 and 2021. A total of 713 articles were identified, of which 14 articles comprising 9649 WRA and 4085 children were included. Since most of the included studies were of low quality, we did not pool data in a meta-analysis due to heterogeneity (I2 > 75%). In WRA, anaemia prevalence ranged from 22.0% to 44.0%; ID from 7.7% and 19.0%; and IDA from 10.5% to 9.7%. The prevalence of anaemia in pregnancy was 29.0% to 42.7%; and 60.6% to 71.3% in HIV-infected pregnant women. Three national surveys reported anaemia in children at 28.9%, 10.7%, and 61.3%, respectively. Overall, among the children under 5 years old, anaemia was more prevalent in 1-year-olds (52.0%) compared to the other age groups. Between 2005 and 2012, ID increased by 3.8% and IDA decreased by 83.2% in children. Anaemia in WRA and children under 5 years in South Africa was a moderate public health concern. Therefore, interventions addressing anaemia should be intensified, and policies on iron supplementation and food fortification need to be revised and aligned to the WHO multiple micronutrient supplementation recommendations.

Objective Due to gaps in the literature, we developed a systematic method to assess multimorbidity using national surveys. The objectives of this study were thus to identify methods used to define and measure multimorbidity, to create a pre-defined list of disease conditions, to identify potential national surveys to include, to select disease conditions for each survey, and to analyse and compare the survey findings. Results We used the count method to define multimorbidity. We created a pre-defined list of disease conditions by examining international literature and using local data on the burden of disease. We assessed national surveys, reporting on more than one disease condition in people 15 years and older, for inclusion. For each survey, the prevalence of multimorbidity was calculated, the disease patterns among the multimorbid population were assessed using a latent class analysis and logistic regression was used to identify sociodemographic and behavioural factors associated with multimorbidity. The prevalence of multimorbidity varied for each survey from 2.7 to 20.7%. We used a systematic and transparent method to interrogate multimorbidity in national surveys. While the prevalence in each survey differs, they collectively indicate that multimorbidity increases in older age groups and tends to be higher among women.

Alcohol use has widespread effects on health and contributes to over 200 detrimental conditions. Although the pattern of heavy episodic drinking independently increases the risk for injuries and transmission of some infectious diseases, long-term average consumption is the fundamental predictor of risk for most conditions. Population surveys, which are the main source of data on alcohol exposure, suffer from bias and uncertainty. This article proposes a novel triangulation method to reduce bias by rescaling consumption estimates by sex and age to match country-level consumption from administrative data. We used data from 17 population surveys to estimate age- and sex-specific trends in alcohol consumption in the adult population of South Africa between 1998 and 2016. Independently for each survey, we calculated sex- and age-specific estimates of the prevalence of drinkers and the distribution of individuals across consumption categories. We used these aggregated results, together with data on alcohol production, sales and import/export, as inputs of a Bayesian model and generated yearly estimates of the prevalence of drinkers in the population and the parameters that characterise the distribution of the average consumption among drinkers. Among males, the prevalence of drinkers decreased between 1998 and 2009, from 56.2% (95% CI 53.7%; 58.7%) to 50.6% (49.3%; 52.0%), and increased afterwards to 53.9% (51.5%; 56.2%) in 2016. The average consumption from 52.1 g/day (49.1; 55.6) in 1998 to 42.8 g/day (40.0; 45.7) in 2016. Among females the prevalence of current drinkers rose from 19.0% (17.2%; 20.8%) in 1998 to 20.0% (18.3%; 21.7%) in 2016 while average consumption decreased from 32.7 g/day (30.2; 35.0) to 26.4 g/day (23.8; 28.9). The methodology provides a viable alternative to current approaches to reconcile survey estimates of individual alcohol consumption patterns with aggregate administrative data. It provides sex- and age-specific estimates of prevalence of drinkers and distribution of average daily consumption among drinkers in populations. Reliance on locally sourced data instead of global and regional trend estimates better reflects local nuances and is adaptable to the inclusion of additional data. This provides a powerful tool to monitor consumption, develop burden of disease estimates and inform and evaluate public health interventions.