Profile: Agincourt Health and Socio-demographic Surveillance
System

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Abstract

The Agincourt health and socio-demographic surveillance system (HDSS), located in rural northeast South Africa close to the Mozambique border, was established in 1992 to support district health systems development led by the post- apartheid ministry of health. The HDSS (90 000 people), based on an annual update of resident status and vital events, now supports multiple investigations into the causes and consequences of complex health, population and social transitions. Observational work includes cohorts focusing on different stages along the life course, evaluation of national policy at population, household and individual levels and examination of household responses to shocks and stresses and the resulting pathways influencing health and well-being. Trials target children and adolescents, including promoting psycho-social well-being, preventing HIV transmission and reducing metabolic disease risk. Efforts to enhance the research platform include using automated measurement techniques to estimate cause of death by verbal autopsy, full ‘reconciliation’ of in- and out-migrations, follow-up of migrants departing the study area, recording of extra-household social connections and linkage of individual HDSS records with those from sub-district clinics. Fostering effective collaborations (including INDEPTH multi-centre work in adult health and ageing and migration and urbanization), ensuring cross-site compatibility of common variables and optimizing public access to HDSS data are priorities.

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The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African children

Elizabeth W. Kimani-Murage, Kathleen Kahn, John Pettifor … (2010)

Background Low- to middle-income countries are undergoing a health transition with non-communicable diseases contributing substantially to disease burden, despite persistence of undernutrition and infectious diseases. This study aimed to investigate the prevalence and patterns of stunting and overweight/obesity, and hence risk for metabolic disease, in a group of children and adolescents in rural South Africa. Methods A cross-sectional growth survey was conducted involving 3511 children and adolescents 1-20 years, selected through stratified random sampling from a previously enumerated population living in Agincourt sub-district, Mpumalanga Province, South Africa. Anthropometric measurements including height, weight and waist circumference were taken using standard procedures. Tanner pubertal assessment was conducted among adolescents 9-20 years. Growth z-scores were generated using 2006 WHO standards for children up to five years and 1977 NCHS/WHO reference for older children. Overweight and obesity for those <18 years were determined using International Obesity Task Force BMI cut-offs, while adult cut-offs of BMI ≥ 25 and ≥ 30 kg/m2 for overweight and obesity respectively were used for those ≥ 18 years. Waist circumference cut-offs of ≥ 94 cm for males and ≥ 80 cm for females and waist-to-height ratio of 0.5 for both sexes were used to determine metabolic disease risk in adolescents. Results About one in five children aged 1-4 years was stunted; one in three of those aged one year. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was substantial among adolescent girls, increasing with age and reaching approximately 20-25% in late adolescence. Central obesity was prevalent among adolescent girls, increasing with sexual maturation and reaching a peak of 35% at Tanner Stage 5, indicating increased risk for metabolic disease. Conclusions The study highlights that in transitional societies, early stunting and adolescent obesity may co-exist in the same socio-geographic population. It is likely that this profile relates to changes in nutrition and diet, but variation in factors such as infectious disease burden and physical activity patterns, as well as social influences, need to be investigated. As obesity and adult short stature are risk factors for metabolic syndrome and Type 2 diabetes, this combination of early stunting and adolescent obesity may be an explosive combination.

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Validation and application of verbal autopsies in a rural area of South Africa.

M Garenne, K. Kahn, Stephen Tollman … (2000)

To validate the causes of death determined with a single verbal autopsy instrument covering all age groups in the Agincourt subdistrict of rural South Africa. Verbal autopsies (VAs) were conducted on all deaths recorded during annual demographic and health surveillance over a 3-year period (1992-95) in a population of about 63 000 people. Trained fieldworkers elicited signs and symptoms of the terminal illness from a close caregiver, using a comprehensive questionnaire written in the local language. Questionnaires were assessed blind by three clinicians who assigned a probable cause of death using a stepwise consensus process. Validation involved comparison of VA diagnoses with hospital reference diagnoses obtained for those who died in a district hospital; and calculation of sensitivity, specificity and positive predictive value (PPV) for children under 5 years, and adults 15 years and older. A total of 127 hospital diagnoses satisfied the criteria for inclusion as reference diagnoses. For communicable diseases, sensitivity of VA diagnoses among children was 69%, specificity 96%, and PPV 90%; among adults the values were 89, 93 and 76%. Lower values were found for non-communicable diseases: 75, 91 and 86% among children; and 64, 50 and 80% among adults. Most misclassification occurred within the category itself. For deaths due to accidents or violence, sensitivity was 100%, specificity 97%, and PPV 80% among children; and 75, 98 and 60% among adults. Since causes of death were largely age-specific, few differences in sensitivity, specificity and PPV were found for adults and children. The frequency distribution of causes of death based on VAs closely approximated that of the hospital records used for validation. VA findings need to be validated before they can be applied to district health planning. In Agincourt, a single verbal autopsy instrument provided a reasonable estimate of the frequency of causes of death among adults and children. Findings can be reliably used to inform local health planning and evaluation.

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Refining a probabilistic model for interpreting verbal autopsy data.

Peter Byass, Edward Fottrell, Lan Huong Dao … (2006)

To build on the previously reported development of a Bayesian probabilistic model for interpreting verbal autopsy (VA) data, attempting to improve the model's performance in determining cause of death and to reassess it. An expert group of clinicians, coming from a wide range geographically and in terms of specialization, was convened. Over a four-day period the content of the previous probabilistic model was reviewed in detail and adjusted as necessary to reflect the group consensus. The revised model was tested with the same 189 VA cases from Vietnam, assessed by two local clinicians, that were used to test the preliminary model. The revised model contained a total of 104 indicators that could be derived from VA data and 34 possible causes of death. When applied to the 189 Vietnamese cases, 142 (75.1%) achieved concordance between the model's output and the previous clinical consensus. The remaining 47 cases (24.9%) were presented to a further independent clinician for reassessment. As a result, consensus between clinical reassessment and the model's output was achieved in 28 cases (14.8%); clinical reassessment and the original clinical opinion agreed in 8 cases (4.2%), and in the remaining 11 cases (5.8%) clinical reassessment, the model, and the original clinical opinion all differed. Thus overall the model was considered to have performed well in 170 cases (89.9%). This approach to interpreting VA data continues to show promise. The next steps will be to evaluate it against other sources of VA data. The expert group approach to determining the required probability base seems to have been a productive one in improving the performance of the model.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Epidemiol

Journal ID (iso-abbrev): Int J Epidemiol

Journal ID (publisher-id): ije

Journal ID (hwp): intjepid

Title: International Journal of Epidemiology

Publisher: Oxford University Press

ISSN (Print): 0300-5771

ISSN (Electronic): 1464-3685

Publication date (Print): August 2012

Publication date (Electronic): 28 August 2012

Publication date PMC-release: 28 August 2012

Volume: 41

Issue: 4

Pages: 988-1001

Affiliations

¹Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, ²Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, ³International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana, ⁴Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, UK, ⁵Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France, ⁶Institut de Recherche pour le Développement (IRD), Unite Mixte Internationale (UMI) Résiliences, Paris, France, ⁷Department of Sociology, University of Washington, Seattle, WA, USA and ⁸Institute of Behavioral Science, University of Colorado, Boulder, CO, USA

Author notes

*Corresponding author. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. E-mail: Kathleen.Kahn@ 123456wits.ac.za

Article

Publisher ID: dys115

DOI: 10.1093/ije/dys115

PMC ID: 3429877

PubMed ID: 22933647

SO-VID: abec22b5-77fd-4293-a8e2-461f846e0d1d

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date accepted : 19 June 2012

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Pages: 14

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Most cited references 39

The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African children

Validation and application of verbal autopsies in a rural area of South Africa.

Refining a probabilistic model for interpreting verbal autopsy data.

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