A comprehensive health screening program in rural north KwaZulu-Natal has identified high levels of undiagnosed or poorly controlled NCDs

BIRMINGHAM, Ala. – A comprehensive health screening program in rural north KwaZulu-Natal, South Africa, has found high levels 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 live with a chronic condition and that the HIV-negative population and the elderly – especially those over the age of 50 – bear the higher burden of undiagnosed or poorly controlled non-communicable diseases such as Diabetes and high blood pressure.

The study was co-led by Emily Wong, MD, a resident faculty member at the Africa Health Research Institute (AHRI) in Durban, KwaZulu-Natal, South Africa. Wong is also an Assistant Professor in the University of Alabama’s Infectious Diseases Division at the Birmingham Department of Medicine and an Associate Scientist at the UAB Center for AIDS Research.

“The data will provide AHRI researchers and the Department of Health with critical indicators of where the most urgent interventions are needed,” said Wong. “The research was done before COVID-19, but it highlighted the urgency of diagnosing and treating people with non-communicable diseases – as people with uncontrolled diabetes and high blood pressure are at greater risk of developing COVID.”

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

“We are working hard to strengthen the links and collaborations between the two institutions and create a UAB-AHRI tuberculosis center that will further facilitate multidisciplinary collaboration,” said Wong. Wong joined UAB last year and will spend about 80 percent of her time at AHRI and 20 percent at UAB when travel resumes after the COVID-19 hiatus.

As a backdrop to the study, 15 years of intense public health efforts to improve access to antiretroviral therapies in sub-Saharan Africa have increased AIDS mortality and life expectancy. As a result, tackling other causes of disease, including tuberculosis and non-communicable diseases, is becoming an increasing priority.

In the 18 months Lancet Global Health study examined 17,118 people aged 15 and over at mobile camps within 1 km of each participant’s home in the Umkhanyakude district. They found high and overlapping exposures to HIV, tuberculosis, diabetes and high blood pressure in men and women.

Although HIV cases were largely well diagnosed and treated, some demographics, including men between the ages of 20 and 30, still had high rates of undiagnosed and untreated HIV. The majority of people with tuberculosis, diabetes, or high blood pressure have either been undiagnosed or have not been well adjusted. Tuberculosis remains one of the leading causes of death in South Africa and the high rates of undiagnosed and asymptomatic tuberculosis detected by health workers are a cause for concern.

“Our results suggest that the massive efforts of the past 15 years to test and treat HIV have been very successful in this one disease,” said Wong. “But in doing so, we may have neglected some of the other major diseases that are very common.”

The mobile camps examined diabetes, high blood pressure, 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-rays and sputum tests for people who reported symptoms or had abnormal x-rays. Clinical information was layered onto 20 years of population data from AHRI’s health and demographic surveillance research. Using a sophisticated data system and the use of artificial intelligence to interpret the chest x-rays, the AHRI clinical team examined the information in real time and referred people to the public health system when needed.

Researchers found that:

  • Half of people aged 15 and over had at least one active disease and 12 percent had two or more diseases. The incidences of diabetes and high blood pressure were 8.5 percent and 23 percent, respectively.
  • A third of people lived with HIV, but it was mostly well diagnosed and treated. Women were particularly exposed to HIV, high blood pressure and diabetes.
  • With tuberculosis, 1.4 percent of people had an active disease and 22 percent had a lifelong illness. About 80 percent of undiagnosed tuberculosis were asymptomatic, and men had higher rates of active tuberculosis.

The researchers also identified several disease patterns by geographic location – for example, the highest levels of HIV were seen near major roads, while higher rates of tuberculosis and non-communicable diseases were seen in more remote areas.


Wong is the corresponding author of the study “Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-section, population-based multimorbidity study” with 30 co-authors.

Support came from the Wellcome Trust Grant 201433 / Z / 16 / Z, the Bill & Melinda Gates Foundation Grant OPP1175182, the South African Department of Science and Innovation, the South African Medical Research Council, and the South African Population Research Infrastructure Network. Support also came from the National Institutes of Health Grants AI118538 and TW011687, the United Kingdom Medical Research Council, the United Kingdom Department for International Development, the South African Research Chairs Initiative, the Victor Daitz Foundation, and the Sub-Saharan African Network for Tuberculosis and HIV research.

https: //www.uab.edu /News/Research/Items/12115-undiagnosed-and-untreated-disease-identified-in-rural-south-africa


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