Undiagnosed and untreated disease identified in rural South Africa


Emily Wong, MD Credit: Africa Health Research Institute

A comprehensive health screening program in northern KwaZulu-Natal, South Africa, has found a high burden of undiagnosed or poorly controlled non-communicable diseases, according to a study published in The Lancet Global Health.

The researchers found that four out of five women over the age of 30 lived with a chronic illness and that the HIV-negative population and the elderly, especially those over the age of 50, had the highest burden of undiagnosed non-communicable diseases. or poorly controlled. such as diabetes and hypertension.

The study was co-led by Emily Wong, MD, a faculty member at the Africa Health Research Institute, or AHRI, in Durban, KwaZulu-Natal, South Africa. Wong is also an assistant professor in the Infectious Diseases Division at the University of Alabama at the Department of Medicine in Birmingham and an associate scientist at the UAB AIDS Research Center.

“The data will provide AHRI researchers and the Department of Health with critical indicators for where the most urgent interventions are needed,” Wong said. “The research was done before COVID-19, but has highlighted the urgency of diagnosing and treating people with noncommunicable diseases, as people with uncontrolled diabetes and hypertension have a higher risk of becoming very ill with COVID.” .

Durban is at the global epicenter of HIV-associated tuberculosis infections. Wong is working to understand the impact of HIV infection — the virus that causes AIDS — on the pathogenesis of tuberculosis, immunity, and epidemiology. He works closely with another UAB researcher who also works at AHRI, Andries “Adrie” Steyn, Ph.D., a professor in the UAB Department of Microbiology.

“We are working hard to strengthen ties and collaborations between the two institutions and create a UAB-AHRI Tuberculosis Center that will further facilitate multidisciplinary collaborations,” Wong said. Wong joined the UAB last year and will spend approximately 80 percent of his time at AHRI and 20 percent at the UAB when the journey of his COVID-19 hiatus resumes.

As a background to the study, 15 years of intense public health efforts that increased access to antiretroviral therapy in sub-Saharan Africa have beneficially reduced AIDS mortality and increased life expectancy. life. As a result, there is a growing priority to address other causes of , including tuberculosis and noncommunicable diseases.

In 18 months Lancet Global Health in the study, health workers examined 17,118 people aged 15 and over using mobile camps less than 1 mile from each participant’s home in the uMkhanyakude district. They found high and overlapping loads of HIV, tuberculosis, diabetes, and hypertension between men and women.

Although HIV cases were, for the most part, well diagnosed and treated, some demographic groups, including men in their twenties and thirties, still had high rates of undiagnosed and untreated HIV. Most people with tuberculosis, diabetes, or hypertension were undiagnosed or poorly controlled. Tuberculosis remains one of the leading causes of death in South Africa, and of the undiagnosed and asymptomatic tuberculosis found by health professionals is a concern.

“Our findings suggest that the massive efforts of the last 15 years to test and treat HIV have been very good for this disease,” Wong said. “But in the process, we may have neglected some of the other major diseases that are very prevalent.”

Mobile camps were examined for diabetes, , nutritional status (obesity and malnutrition), tobacco and alcohol consumption, as well as HIV and tuberculosis. The tuberculosis screening component included high-quality digital chest X-ray testing and spectrum testing for people who had symptoms or had abnormal x-rays. Clinical information was included in 20 years of population data from AHRI health and demographic surveillance research. Using a sophisticated data system and the use of artificial intelligence to interpret chest X-rays, the AHRI clinical team examined the information in real time and referred people to the public health system according to the needs.

The researchers found that:

  • Half of people aged 15 and over had at least one active illness and 12% had two or more illnesses. The incidences of diabetes and hypertension were 8.5% and 23%, respectively.
  • One-third of people lived with HIV, but most were diagnosed and treated well. Women had a particularly high burden of HIV, high blood pressure, and diabetes.
  • For tuberculosis, 1.4% of people had active diseases and 22% had lifelong diseases. About 80 percent of undiagnosed tuberculosis was asymptomatic and men had higher rates of active tuberculosis.

The researchers also identified several disease patterns by geographic location, for example, the highest HIV burden was seen near major roads, while the highest rates of i they were seen in more remote areas.

The application of artificial intelligence could help diagnose HIV more accurately

Citation: Undiagnosed and untreated disease identified in rural South Africa (2021, June 18) recovered on June 18, 2021 at https://medicalxpress.com/news/2021-06-undiagnosed-untreated-disease-rural- south.html

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