Multimorbidity patterns in South Africa: A latent class analysis

Roomaney, R A; Wyk, Brian van; Cois, Annibale; van-Wyk, V Pillay

doi:10.3389/fpubh.2022.1082587

Cited by 8 publications

(8 citation statements)

References 29 publications

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“…We identified five common co-occurring disease classes: anaemia and hypertension (33.4%), HIV and anaemia (33.2%), HIV and hypertension (19.0%), hypertension and heart disease (7.8%), and diabetes and hypertension (6.6%). Similar latent classes were identified in a study that included all people over the age of 15 years also using the SADHS 2016 (e.g., (1) HIV, hypertension and anaemia (39.4%), (2) anaemia and hypertension (23.7%), (3) cardiovascular-related (19.9%), and (4) diabetes and hypertension (17.0%)) [32], indicating that these diseases could start clustering together at fairly young ages in individuals. However, longitudinal studies may be more useful in determining the age of onset for these diseases.…”

Section: Discussionsupporting

confidence: 53%

Patterns and Predictors of HIV Comorbidity among Adolescents and Young Adults in South Africa

van Wyk,

Roomaney

2024

IJERPH

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Adolescents and young adults (AYA) are identified as a high-risk group for HIV acquisition. However, health services are generally not sensitive to the needs of this priority population. In addition, multimorbidity (having more than one disease in an individual) is not well studied among AYA, as it is typically associated with older individuals. This paper reports on commonly co-occurring disease conditions and disease patterns in AYA, aged 15–24 years, who took part in the 2016 South African Demographic and Health Survey. Chi-squared tests and logistic regression were used to examine the weighted prevalence of disease among those with/without HIV, and the risk factors associated with HIV. Latent class analysis (LCA) was conducted to identify common co-occurring diseases. Of the 1787 individuals included in our analysis, the weighted prevalence of HIV was 8.7%. Hypertension (30.5%), anaemia (35.8%) and diabetes (2.0%) were more prevalent among those with HIV. HIV and anaemia, hypertension and anaemia, and HIV and hypertension comprise the largest disease burden of co-occurring diseases. Co-morbidity was high among those with HIV, emphasizing the need for integrated care of HIV and non-communicable diseases.

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Section: Discussionsupporting

confidence: 53%

Patterns and Predictors of HIV Comorbidity among Adolescents and Young Adults in South Africa

van Wyk,

Roomaney

2024

IJERPH

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“…Results of these studies combined highlight the hey role of hypertension in driving multimorbidity in the SA population and calls for the need for hypertension to be addressed in the country. 56 Collectively, these results illustrate the complex interactions between infectious diseases like HIV and other chronic health conditions. The heterogeneous epidemiological landscapes in SA could be shaped by communities suffering distinct epidemics, possibly driven by the uneven distribution of health and socioeconomic determinants that fueled the infectious and NCDs epidemics at different intensities between regions in the country.…”

Section: Discussionmentioning

confidence: 92%

Geospatial assessment of the convergence of communicable and non-communicable diseases in South Africa

Cuadros,

Moreno,

Tomita

et al. 2023

Journal of Multimorbidity and Comorbidity

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Introduction Several low-and middle-income countries are undergoing rapid epidemiological transition with a rising burden of non-communicable diseases (NCDs). South Africa (SA) is a country with one of the largest HIV epidemics worldwide and a growing burden of NCDs where the collision of these epidemics poses a major public health challenge. Methods Using data from a large nationally representative survey, the South Africa Demographic and Health Survey (SADHS 2016), we conducted a geospatial analysis of several diseases including HIV, tuberculosis (TB), cardiovascular, respiratory, and metabolic diseases to identify areas with a high burden of co-morbidity within the country. We explored the spatial structure of each disease and associations between diseases using different spatial and visual data methodologies. We also assessed the individual level co-occurrence of HIV and the other diseases included in the analysis. Results The spatial distribution for HIV prevalence showed that this epidemic is most intense in the eastern region of the country, mostly within the Gauteng, Mpumalanga, and Kwazulu-Natal provinces. In contrast, chronic diseases had their highest prevalence rates the southern region of the country, particularly in the Eastern and Western Cape provinces. Individual-level analyses were consistent with the spatial correlations and found no statistically significant associations between HIV infection and the presence of any NCDs. Conclusions We found no evidence of geospatial overlap between the HIV epidemic and NCDs in SA. These results evidence the complex epidemiological landscape of the country, characterized by geographically distinct areas exhibiting different health burdens. The detailed description of the heterogenous prevalence of HIV and NCDs in SA reported in this study could be a useful tool to inform and direct policies to enhance targeted health service delivery according to the local health needs of each community.

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“…South Africa is currently experiencing a convergence of NCDs and CDs [ 22 , 23 , 24 , 25 , 26 ], causing the burden of multimorbidity to range from 3% to 87% in various group populations. The common multimorbidity patterns in South Africa are combined TB and HIV, hypertension and diabetes, and hypertension and HIV [ 27 ], and to a lesser extent, the coexistence of HIV, anaemia hypertension, and/or diabetes has been reported [ 28 ]. Although South Africa has put in place a primary health care approach for a better health care since the inception of the democratic government in 1994 [ 29 , 30 ], the country remains burdened with NCDs and CDs coexisting [ 13 , 23 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although South Africa has put in place a primary health care approach for a better health care since the inception of the democratic government in 1994 [ 29 , 30 ], the country remains burdened with NCDs and CDs coexisting [ 13 , 23 , 25 ]. Despite the increasing co-occurrence of multiple chronic conditions and poor clinical outcomes among chronic patients [ 13 ], minimal research has been conducted on multimorbidity in South Africa [ 27 , 28 ]. While multimorbidity requires a complexity of care [ 13 , 31 , 32 ], most local studies have reported medication adherence from a single index point of view for hypertension, diabetes, and HIV treatments.…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity, Treatment, and Determinants among Chronic Patients Attending Primary Health Facilities in Tshwane, South Africa

Mkhwanazi,

Modjadji,

Mokgalaboni

et al. 2023

Diseases

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The growing burden of non-communicable diseases amidst the largest burden of HIV in South Africa leads to disease combinations of multimorbidity with the complexity of care. We conducted a cross-sectional study to assess multimorbidity, medication adherence, and associated factors among out-patients with chronic diseases in primary health care (PHC) facilities in Tshwane, South Africa. A structured questionnaire was used to collect data on comorbidities and medication adherence, along with socio-demographic and lifestyle factors. Logistic regression models were used to analyse the determinants of multimorbidity and medication adherence. In all 400 patients with chronic diseases (mean age: 47 ± 12 years) living in poor environments, common chronic conditions were hypertension (62%), diabetes (45%), HIV (44%), TB (33%), hypercholesterolemia (18%), and gout (13%). The proportion of concordant comorbidity (i.e., diseases with similar risk profiles and management) was 72%, more than 28% of discordant comorbidity (i.e., diseases not related in pathogenesis or management). Most patients had two coexisting chronic conditions (75%), while few had more than two chronic conditions (23%) and single-occurring conditions (2%). Prevalence rates for common multimorbidity patterns were 25% (HIV and TB), 17% (hypertension and diabetes), 9% (hypertension, diabetes, and hypercholesterolemia), and 2% (hypertension diabetes and HIV), while medication adherence was estimated at 74%. In multivariate analysis, multimorbidity was associated with an older age and lower socio-economic status, while medication non-adherence was associated with a younger age and socio-economic factors. The study highlights the presence of multimorbidity among primary care patients attributed to hypertension, diabetes, HIV, and TB in South Africa with non-adherence to medication in one-third of patients. Policies are needed for education on multimorbidity with a need to optimize lifestyle modifications, perhaps proactive outreach or nursing contact with high-risk patients with public-health-sensitive conditions, such as HIV and/or TB, as well as patients with a history of non-adherence to medications. Considerations should be given to the development of a medication adherence scale for multiple chronic conditions beyond assessing adherence to a single index medication.

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Multimorbidity patterns in South Africa: A latent class analysis

Cited by 8 publications

References 29 publications

Patterns and Predictors of HIV Comorbidity among Adolescents and Young Adults in South Africa

Patterns and Predictors of HIV Comorbidity among Adolescents and Young Adults in South Africa

Geospatial assessment of the convergence of communicable and non-communicable diseases in South Africa

Multimorbidity, Treatment, and Determinants among Chronic Patients Attending Primary Health Facilities in Tshwane, South Africa

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