Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study
Summary: Background: There has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-07-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X21001765 |
| _version_ | 1819258801464803328 |
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| author | Emily B Wong, MD Stephen Olivier, MA Resign Gunda, PhD Olivier Koole, PhD Ashmika Surujdeen, BSc Dickman Gareta, MSc Day Munatsi, MBA Tshwaraganang H Modise, MSc Jaco Dreyer, NDipIT Siyabonga Nxumalo, BSc Theresa K Smit, PhD Greg Ording-Jespersen, NDipIT Innocentia B Mpofana, MMedSci Khadija Khan, MAppSc Zizile E L Sikhosana, MSc Sashen Moodley, BSc Yen-Ju Shen, PhD Thandeka Khoza, MBChB Ngcebo Mhlongo, MBChB Sanah Bucibo, PgDip Kennedy Nyamande, ProfPhD Kathy J Baisley, MSc Diego Cuadros, PhD Frank Tanser, ProfPhD Alison D Grant, ProfPhD Kobus Herbst, MSc Janet Seeley, ProfPhD Willem A Hanekom, ProfPhD Thumbi Ndung'u, ProfPhD Mark J Siedner, MD Deenan Pillay, ProfPhD Emily B. Wong Stephen Olivier Resign Gunda Olivier Koole Ashmika Surujdeen Dickman Gareta Day Munatsi Tswaraganang H. Modise Jaco Dreyer Siyabonga Nxumalo Theresa K. Smit Greg Ording-Jespersen Innocentia B. Mpofana Khadija Khan Zizile E.L. Sikhosana Sashen Moodley Yen-Ju Shen Thandeka Khoza Ngcebo Mhlongo Sana Bucibo Kennedy Nyamande Kathy J. Baisley Diego Cuadros Frank Tanser Alison D. Grant Kobus Herbst Janet Seeley Willem A. Hanekom Thumbi Ndung'u Mark J. Siedner Deenan Pillay Mosa Suleman Jaikrishna Kalideen Ramesh Jackpersad Kgaugelo Moropane Boitsholo Mfolo Khabonina Malomane Hlolisile Khumalo Nompilo Buthelezi Nozipho Mbonambi Hloniphile Ngubane Thokozani Simelane Khanyisani Buthelezi Sphiwe Ntuli Nombuyiselo Zondi Siboniso Nene Bongumenzi Ndlovu Talente Ntimbane Mbali Mbuyisa Xolani Mkhize Melusi Sibiya Ntombiyenkosi Ntombela Mandisi Dlamini Hlobisile Chonco Hlengiwe Dlamini Doctar Mlambo Nonhlahla Mzimela Zinhle Buthelezi Zinhle Mthembu Thokozani Bhengu Sandile Mtehmbu Phumelele Mthethwa Zamashandu Mbatha Welcome Petros Mthembu Anele Mkhwanazi Mandlakayise Sikhali Phakamani Mkhwanazi Ntombiyenhlahla Mkhwanazi Rose Myeni Fezeka Mfeka Hlobisile Gumede Nonceba Mfeka Ayanda Zungu Hlobisile Gumede Nonhlahla Mfekayi Smangaliso Zulu Mzamo Buthelezi Senzeni Mkhwanazi Mlungisi Dube Philippa Matthews Siphephelo Dlamini Hosea Kambonde Lindani Mthembu Seneme Mchunu Sibahle Gumbi Tumi Madolo Thengokwakhe Nkosi Sibusiso Mkhwanazi Simbusio Nsibande Mpumelelo Steto Sibusiso Mhlongo Velile Vellem Pfarelo Tshivase Jabu Kwinda Bongani Magwaza Siyabonga Nsibande Skhumbuzo Mthombeni Sphiwe Clement Mthembu Antony Rapulana Jade Cousins Thabile Zondi Nagavelli Padayachi Freddy Mabetlela Simphiwe Ntshangase Nomfundo Luthuli Sithembile Ngcobo Kayleen Brien Sizwe Ndlela Nomfundo Ngema Nokukhanya Ntshakala Anupa Singh Rochelle Singh Logan Pillay Kandaseelan Chetty Asthentha Govender Pamela Ramkalawon Nondumiso Mabaso Kimeshree Perumal Senamile Makhari Nondumiso Khuluse Nondumiso Zitha Hlengiwe Khati Mbuti Mofokeng Nomathamsanqa Majozi Nceba Gqaleni Hannah Keal Phumla Ngcobo Costa Criticos Raynold Zondo Dilip Kalyan Clive Mavimbela Anand Ramnanan Sashin Harilall |
| author_facet | Emily B Wong, MD Stephen Olivier, MA Resign Gunda, PhD Olivier Koole, PhD Ashmika Surujdeen, BSc Dickman Gareta, MSc Day Munatsi, MBA Tshwaraganang H Modise, MSc Jaco Dreyer, NDipIT Siyabonga Nxumalo, BSc Theresa K Smit, PhD Greg Ording-Jespersen, NDipIT Innocentia B Mpofana, MMedSci Khadija Khan, MAppSc Zizile E L Sikhosana, MSc Sashen Moodley, BSc Yen-Ju Shen, PhD Thandeka Khoza, MBChB Ngcebo Mhlongo, MBChB Sanah Bucibo, PgDip Kennedy Nyamande, ProfPhD Kathy J Baisley, MSc Diego Cuadros, PhD Frank Tanser, ProfPhD Alison D Grant, ProfPhD Kobus Herbst, MSc Janet Seeley, ProfPhD Willem A Hanekom, ProfPhD Thumbi Ndung'u, ProfPhD Mark J Siedner, MD Deenan Pillay, ProfPhD Emily B. Wong Stephen Olivier Resign Gunda Olivier Koole Ashmika Surujdeen Dickman Gareta Day Munatsi Tswaraganang H. Modise Jaco Dreyer Siyabonga Nxumalo Theresa K. Smit Greg Ording-Jespersen Innocentia B. Mpofana Khadija Khan Zizile E.L. Sikhosana Sashen Moodley Yen-Ju Shen Thandeka Khoza Ngcebo Mhlongo Sana Bucibo Kennedy Nyamande Kathy J. Baisley Diego Cuadros Frank Tanser Alison D. Grant Kobus Herbst Janet Seeley Willem A. Hanekom Thumbi Ndung'u Mark J. Siedner Deenan Pillay Mosa Suleman Jaikrishna Kalideen Ramesh Jackpersad Kgaugelo Moropane Boitsholo Mfolo Khabonina Malomane Hlolisile Khumalo Nompilo Buthelezi Nozipho Mbonambi Hloniphile Ngubane Thokozani Simelane Khanyisani Buthelezi Sphiwe Ntuli Nombuyiselo Zondi Siboniso Nene Bongumenzi Ndlovu Talente Ntimbane Mbali Mbuyisa Xolani Mkhize Melusi Sibiya Ntombiyenkosi Ntombela Mandisi Dlamini Hlobisile Chonco Hlengiwe Dlamini Doctar Mlambo Nonhlahla Mzimela Zinhle Buthelezi Zinhle Mthembu Thokozani Bhengu Sandile Mtehmbu Phumelele Mthethwa Zamashandu Mbatha Welcome Petros Mthembu Anele Mkhwanazi Mandlakayise Sikhali Phakamani Mkhwanazi Ntombiyenhlahla Mkhwanazi Rose Myeni Fezeka Mfeka Hlobisile Gumede Nonceba Mfeka Ayanda Zungu Hlobisile Gumede Nonhlahla Mfekayi Smangaliso Zulu Mzamo Buthelezi Senzeni Mkhwanazi Mlungisi Dube Philippa Matthews Siphephelo Dlamini Hosea Kambonde Lindani Mthembu Seneme Mchunu Sibahle Gumbi Tumi Madolo Thengokwakhe Nkosi Sibusiso Mkhwanazi Simbusio Nsibande Mpumelelo Steto Sibusiso Mhlongo Velile Vellem Pfarelo Tshivase Jabu Kwinda Bongani Magwaza Siyabonga Nsibande Skhumbuzo Mthombeni Sphiwe Clement Mthembu Antony Rapulana Jade Cousins Thabile Zondi Nagavelli Padayachi Freddy Mabetlela Simphiwe Ntshangase Nomfundo Luthuli Sithembile Ngcobo Kayleen Brien Sizwe Ndlela Nomfundo Ngema Nokukhanya Ntshakala Anupa Singh Rochelle Singh Logan Pillay Kandaseelan Chetty Asthentha Govender Pamela Ramkalawon Nondumiso Mabaso Kimeshree Perumal Senamile Makhari Nondumiso Khuluse Nondumiso Zitha Hlengiwe Khati Mbuti Mofokeng Nomathamsanqa Majozi Nceba Gqaleni Hannah Keal Phumla Ngcobo Costa Criticos Raynold Zondo Dilip Kalyan Clive Mavimbela Anand Ramnanan Sashin Harilall |
| author_sort | Emily B Wong, MD |
| collection | DOAJ |
| description | Summary: Background: There has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and non-communicable diseases in such a population in rural South Africa. Methods: We did a cross-sectional study of eligible adolescents and adults from the Africa Health Research Institute demographic surveillance area in the uMkhanyakude district of KwaZulu-Natal, South Africa. The participants, who were 15 years or older, were invited to participate at a mobile health camp. Medical history for HIV, tuberculosis, hypertension, and diabetes was established through a questionnaire. Blood pressure measurements, chest x-rays, and tests of blood and sputum were taken to estimate the population prevalence and geospatial distribution of HIV, active and lifetime tuberculosis, elevated blood glucose, elevated blood pressure, and combinations of these. Findings: 17 118 adolescents and adults were recruited from May 25, 2018, to Nov 28, 2019, and assessed. Overall, 52·1% (95% CI 51·3–52·9) had at least one active disease. 34·2% (33·5–34·9) had HIV, 1·4% (1·2–1·6) had active tuberculosis, 21·8% (21·2–22·4) had lifetime tuberculosis, 8·5% (8·1–8·9) had elevated blood glucose, and 23·0% (22·4–23·6) had elevated blood pressure. Appropriate treatment and optimal disease control was highest for HIV (78·1%), and lower for elevated blood pressure (42·5%), active tuberculosis (29·6%), and elevated blood glucose (7·1%). Disease prevalence differed notably by sex, across age groups, and geospatially: men had a higher prevalence of active and lifetime tuberculosis, whereas women had a substantially high prevalence of HIV at 30–49 years and an increasing prevalence of multiple and poorly controlled non-communicable diseases when older than 50 years. Interpretation: We found a convergence of infectious and non-communicable disease epidemics in a rural South African population, with HIV well treated relative to all other diseases, but tuberculosis, elevated blood glucose, and elevated blood pressure poorly diagnosed and treated. A public health response that expands the successes of the HIV testing and treatment programme to provide multidisease care targeted to specific populations is required to optimise health in such settings in sub-Saharan Africa. Funding: Wellcome Trust, Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network. Translation: For the isiZulu translation of the abstract see Supplementary Materials section. |
| first_indexed | 2024-12-23T18:59:53Z |
| format | Article |
| id | doaj.art-de48ef277f9c43eeaca37218bf9e6edc |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-23T18:59:53Z |
| publishDate | 2021-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-de48ef277f9c43eeaca37218bf9e6edc2022-12-21T17:34:45ZengElsevierThe Lancet Global Health2214-109X2021-07-0197e967e976Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity studyEmily B Wong, MD0Stephen Olivier, MA1Resign Gunda, PhD2Olivier Koole, PhD3Ashmika Surujdeen, BSc4Dickman Gareta, MSc5Day Munatsi, MBA6Tshwaraganang H Modise, MSc7Jaco Dreyer, NDipIT8Siyabonga Nxumalo, BSc9Theresa K Smit, PhD10Greg Ording-Jespersen, NDipIT11Innocentia B Mpofana, MMedSci12Khadija Khan, MAppSc13Zizile E L Sikhosana, MSc14Sashen Moodley, BSc15Yen-Ju Shen, PhD16Thandeka Khoza, MBChB17Ngcebo Mhlongo, MBChB18Sanah Bucibo, PgDip19Kennedy Nyamande, ProfPhD20Kathy J Baisley, MSc21Diego Cuadros, PhD22Frank Tanser, ProfPhD23Alison D Grant, ProfPhD24Kobus Herbst, MSc25Janet Seeley, ProfPhD26Willem A Hanekom, ProfPhD27Thumbi Ndung'u, ProfPhD28Mark J Siedner, MD29Deenan Pillay, ProfPhD30Emily B. WongStephen OlivierResign GundaOlivier KooleAshmika SurujdeenDickman GaretaDay MunatsiTswaraganang H. ModiseJaco DreyerSiyabonga NxumaloTheresa K. SmitGreg Ording-JespersenInnocentia B. MpofanaKhadija KhanZizile E.L. SikhosanaSashen MoodleyYen-Ju ShenThandeka KhozaNgcebo MhlongoSana BuciboKennedy NyamandeKathy J. BaisleyDiego CuadrosFrank TanserAlison D. GrantKobus HerbstJanet SeeleyWillem A. HanekomThumbi Ndung'uMark J. SiednerDeenan PillayMosa SulemanJaikrishna KalideenRamesh JackpersadKgaugelo MoropaneBoitsholo MfoloKhabonina MalomaneHlolisile KhumaloNompilo ButheleziNozipho MbonambiHloniphile NgubaneThokozani SimelaneKhanyisani ButheleziSphiwe NtuliNombuyiselo ZondiSiboniso NeneBongumenzi NdlovuTalente NtimbaneMbali MbuyisaXolani MkhizeMelusi SibiyaNtombiyenkosi NtombelaMandisi DlaminiHlobisile ChoncoHlengiwe DlaminiDoctar MlamboNonhlahla MzimelaZinhle ButheleziZinhle MthembuThokozani BhenguSandile MtehmbuPhumelele MthethwaZamashandu MbathaWelcome Petros MthembuAnele MkhwanaziMandlakayise SikhaliPhakamani MkhwanaziNtombiyenhlahla MkhwanaziRose MyeniFezeka MfekaHlobisile GumedeNonceba MfekaAyanda ZunguHlobisile GumedeNonhlahla MfekayiSmangaliso ZuluMzamo ButheleziSenzeni MkhwanaziMlungisi DubePhilippa MatthewsSiphephelo DlaminiHosea KambondeLindani MthembuSeneme MchunuSibahle GumbiTumi MadoloThengokwakhe NkosiSibusiso MkhwanaziSimbusio NsibandeMpumelelo StetoSibusiso MhlongoVelile VellemPfarelo TshivaseJabu KwindaBongani MagwazaSiyabonga NsibandeSkhumbuzo MthombeniSphiwe Clement MthembuAntony RapulanaJade CousinsThabile ZondiNagavelli PadayachiFreddy MabetlelaSimphiwe NtshangaseNomfundo LuthuliSithembile NgcoboKayleen BrienSizwe NdlelaNomfundo NgemaNokukhanya NtshakalaAnupa SinghRochelle SinghLogan PillayKandaseelan ChettyAsthentha GovenderPamela RamkalawonNondumiso MabasoKimeshree PerumalSenamile MakhariNondumiso KhuluseNondumiso ZithaHlengiwe KhatiMbuti MofokengNomathamsanqa MajoziNceba GqaleniHannah KealPhumla NgcoboCosta CriticosRaynold ZondoDilip KalyanClive MavimbelaAnand RamnananSashin HarilallAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA; Division of Infection and Immunity, University College London, London, UK; Correspondence to: Dr Emily B Wong, Africa Health Research Institute, KwaZulu-Natal 4013, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UKAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South AfricaDepartment of Pulmonology and Critical Care, Inkosi Albert Luthuli Hospital, Durban, South Africa; Department of Respiratory Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UKDepartment of Geography, University of Cincinnati, USAAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Lincoln International Institute for Rural Health, University of Lincoln, UK; Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; Department of Science and Innovation, Medical Research Council, South African Population Research Infrastructure, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UKAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UKAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard Medical School, Cambridge, MA, USA; Max Planck Institute for Infection Biology, Berlin, GermanyAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UKSummary: Background: There has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and non-communicable diseases in such a population in rural South Africa. Methods: We did a cross-sectional study of eligible adolescents and adults from the Africa Health Research Institute demographic surveillance area in the uMkhanyakude district of KwaZulu-Natal, South Africa. The participants, who were 15 years or older, were invited to participate at a mobile health camp. Medical history for HIV, tuberculosis, hypertension, and diabetes was established through a questionnaire. Blood pressure measurements, chest x-rays, and tests of blood and sputum were taken to estimate the population prevalence and geospatial distribution of HIV, active and lifetime tuberculosis, elevated blood glucose, elevated blood pressure, and combinations of these. Findings: 17 118 adolescents and adults were recruited from May 25, 2018, to Nov 28, 2019, and assessed. Overall, 52·1% (95% CI 51·3–52·9) had at least one active disease. 34·2% (33·5–34·9) had HIV, 1·4% (1·2–1·6) had active tuberculosis, 21·8% (21·2–22·4) had lifetime tuberculosis, 8·5% (8·1–8·9) had elevated blood glucose, and 23·0% (22·4–23·6) had elevated blood pressure. Appropriate treatment and optimal disease control was highest for HIV (78·1%), and lower for elevated blood pressure (42·5%), active tuberculosis (29·6%), and elevated blood glucose (7·1%). Disease prevalence differed notably by sex, across age groups, and geospatially: men had a higher prevalence of active and lifetime tuberculosis, whereas women had a substantially high prevalence of HIV at 30–49 years and an increasing prevalence of multiple and poorly controlled non-communicable diseases when older than 50 years. Interpretation: We found a convergence of infectious and non-communicable disease epidemics in a rural South African population, with HIV well treated relative to all other diseases, but tuberculosis, elevated blood glucose, and elevated blood pressure poorly diagnosed and treated. A public health response that expands the successes of the HIV testing and treatment programme to provide multidisease care targeted to specific populations is required to optimise health in such settings in sub-Saharan Africa. Funding: Wellcome Trust, Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network. Translation: For the isiZulu translation of the abstract see Supplementary Materials section.http://www.sciencedirect.com/science/article/pii/S2214109X21001765 |
| spellingShingle | Emily B Wong, MD Stephen Olivier, MA Resign Gunda, PhD Olivier Koole, PhD Ashmika Surujdeen, BSc Dickman Gareta, MSc Day Munatsi, MBA Tshwaraganang H Modise, MSc Jaco Dreyer, NDipIT Siyabonga Nxumalo, BSc Theresa K Smit, PhD Greg Ording-Jespersen, NDipIT Innocentia B Mpofana, MMedSci Khadija Khan, MAppSc Zizile E L Sikhosana, MSc Sashen Moodley, BSc Yen-Ju Shen, PhD Thandeka Khoza, MBChB Ngcebo Mhlongo, MBChB Sanah Bucibo, PgDip Kennedy Nyamande, ProfPhD Kathy J Baisley, MSc Diego Cuadros, PhD Frank Tanser, ProfPhD Alison D Grant, ProfPhD Kobus Herbst, MSc Janet Seeley, ProfPhD Willem A Hanekom, ProfPhD Thumbi Ndung'u, ProfPhD Mark J Siedner, MD Deenan Pillay, ProfPhD Emily B. Wong Stephen Olivier Resign Gunda Olivier Koole Ashmika Surujdeen Dickman Gareta Day Munatsi Tswaraganang H. Modise Jaco Dreyer Siyabonga Nxumalo Theresa K. Smit Greg Ording-Jespersen Innocentia B. Mpofana Khadija Khan Zizile E.L. Sikhosana Sashen Moodley Yen-Ju Shen Thandeka Khoza Ngcebo Mhlongo Sana Bucibo Kennedy Nyamande Kathy J. Baisley Diego Cuadros Frank Tanser Alison D. Grant Kobus Herbst Janet Seeley Willem A. Hanekom Thumbi Ndung'u Mark J. Siedner Deenan Pillay Mosa Suleman Jaikrishna Kalideen Ramesh Jackpersad Kgaugelo Moropane Boitsholo Mfolo Khabonina Malomane Hlolisile Khumalo Nompilo Buthelezi Nozipho Mbonambi Hloniphile Ngubane Thokozani Simelane Khanyisani Buthelezi Sphiwe Ntuli Nombuyiselo Zondi Siboniso Nene Bongumenzi Ndlovu Talente Ntimbane Mbali Mbuyisa Xolani Mkhize Melusi Sibiya Ntombiyenkosi Ntombela Mandisi Dlamini Hlobisile Chonco Hlengiwe Dlamini Doctar Mlambo Nonhlahla Mzimela Zinhle Buthelezi Zinhle Mthembu Thokozani Bhengu Sandile Mtehmbu Phumelele Mthethwa Zamashandu Mbatha Welcome Petros Mthembu Anele Mkhwanazi Mandlakayise Sikhali Phakamani Mkhwanazi Ntombiyenhlahla Mkhwanazi Rose Myeni Fezeka Mfeka Hlobisile Gumede Nonceba Mfeka Ayanda Zungu Hlobisile Gumede Nonhlahla Mfekayi Smangaliso Zulu Mzamo Buthelezi Senzeni Mkhwanazi Mlungisi Dube Philippa Matthews Siphephelo Dlamini Hosea Kambonde Lindani Mthembu Seneme Mchunu Sibahle Gumbi Tumi Madolo Thengokwakhe Nkosi Sibusiso Mkhwanazi Simbusio Nsibande Mpumelelo Steto Sibusiso Mhlongo Velile Vellem Pfarelo Tshivase Jabu Kwinda Bongani Magwaza Siyabonga Nsibande Skhumbuzo Mthombeni Sphiwe Clement Mthembu Antony Rapulana Jade Cousins Thabile Zondi Nagavelli Padayachi Freddy Mabetlela Simphiwe Ntshangase Nomfundo Luthuli Sithembile Ngcobo Kayleen Brien Sizwe Ndlela Nomfundo Ngema Nokukhanya Ntshakala Anupa Singh Rochelle Singh Logan Pillay Kandaseelan Chetty Asthentha Govender Pamela Ramkalawon Nondumiso Mabaso Kimeshree Perumal Senamile Makhari Nondumiso Khuluse Nondumiso Zitha Hlengiwe Khati Mbuti Mofokeng Nomathamsanqa Majozi Nceba Gqaleni Hannah Keal Phumla Ngcobo Costa Criticos Raynold Zondo Dilip Kalyan Clive Mavimbela Anand Ramnanan Sashin Harilall Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study The Lancet Global Health |
| title | Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study |
| title_full | Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study |
| title_fullStr | Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study |
| title_full_unstemmed | Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study |
| title_short | Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study |
| title_sort | convergence of infectious and non communicable disease epidemics in rural south africa a cross sectional population based multimorbidity study |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X21001765 |
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