Theme leader: Prof Kathleen Kahn
In rural South Africa, morbidity, mortality, and growth failure associated with undernutrition exist alongside female obesity and emerging cardiovascular disease. By tackling proximal issues of infant growth and nutrition, and social/emotional development, we aim to impact more distal outcomes including cognitive development, educational attainment, HIV infection, adult vascular risk, and economic productivity. ‘The State of Rural South Africa’s Children‘ highlights important research findings on children and adolescents from the MRC/Wits-Agincourt Unit.
YOUth in Care: Identifying barriers to improved healthcare outcomes among young people in rural Mpumalanga Province, South Africa,
Collaboration with the MRC/Wits Developmental Pathways for Health Research Unit and the University of North Carolina at Chapel Hill.
This project aims to identify multi-level factors that influence overall health outcomes among young people ages 12 to 24 in the Agincourt Health and Socio-Demographic Surveillance System site. This will be achieved by conducting interviewer-administered surveys among nearly 700 young people in the area and linking this information to existing facility and community-level data on the specific exposures of interest. In these interviewer-administered surveys participants will be asked about their personal experiences with violence, substance use and abuse, overall emotional well-being, and healthcare accessibility. In addition, individuals will respond to a series of questions about their experiences seeking routine healthcare services in the study site, data which will be further supported by these individuals’ existing clinical care records. A sub-aim of this study is to more accurately characterize routine health service utilization within this highly vulnerable population so crucial intervention points can be identified in the health services seeking process and leveraged to improve service utilization among young people. Ultimately, we intend to utilize the results of this project to intervene on persistent barriers to routine health service utilization among young people, which we hope will yield improved long-term health outcomes in the population over time.
Digital delivery of Behavioural Activation to overcome depression and facilitate social and economic transitions of adolescents in LMICs (DoBAt)
Depression is the leading cause of disability worldwide, and it is particularly problematic among adolescents given the risk for greater depression chronicity across the lifespan. Untreated depression exerts a huge economic toll as it impairs cognitive functioning, interpersonal relationships, interferes with schooling and disrupts work and productivity. These impairments have a greater impact on adolescents in low- and middle-income countries due to the additional adversities they face and the lack of available, effective treatments. This three year project will use smartphones to deliver a digital intervention for adolescents, supported by local lay counsellors, to reduce depression and facilitate successful transitions to adulthood. We will adapt a tailored psychological therapy, Behavioural Activation (BA), among adolescents (15 to 19 years old) living in rural South Africa and Uganda. We will test the effectiveness of delivery of BA for reducing depression (primary outcome), and possible mechanisms, principally executive function and social cognition. As secondary outcomes, we will assess risk-taking behaviours and a range of human capital outcomes. Further, the proposed work will produce relevant measures of executive functions and social cognition through language translation and cultural adaptation and evaluate their reliability and validity in a rural context.
The team comprises a multidisciplinary group of psychologists, psychiatrists, neuroscientists and economists from South Africa (University of the Witwatersrand), Uganda (BRAC), as well as from the UK (University of Oxford, University of Exeter, University College London) and the USA (University of California, Los Angeles, UCLA).
Snacks sold at schools in the Agincourt HDSS study area
Project Ntshembo: Improving the health and nutritional status of adolescents to reduce the intergenerational risk of metabolic disease
Collaboration with the MRC/Wits Developmental Pathways for Health Research Unit and Cambridge University.
Project Ntshembo: This project aims to improve adolescent nutritional status as a critical pathway to improve intrauterine and infant growth, and thereby interrupt the intergenerational transfer of metabolic disease. This will be achieved by implementing a complex community intervention that introduces community-based adolescent-focused health workers to deliver a structured two-year programme to improve rural adolescent nutritional status based on extensive formative work that has been completed in the community. This has focused on physical activity, beliefs and practices regarding childbirth and the postpartum period, and the availability and distribution of food vendors. In addition, a baseline survey was completed on a cross-sectional sample of approximately 500 young women between the ages of 18 and 21 years. in order to understand their lifestyle, eating habits, physical activity level and mental health.
The aim was to examine how these factors can influence their body mass and risk of developing non-communicable diseases. Other questions were asked about their household composition, education and access to health services, and measurements included weight and height to determine body mass index, their body composition and bone health using dual-energy x-ray absorptiometry and ultrasound, and their metabolic disease risk by measuring biological markers such as glucose, insulin and lipids, as well as blood pressure.
This data has also been compared to similar data from an urban Soweto sample of the same age and has resulted in the publication of several international peer-reviewed manuscripts. A pilot and feasibility study of the proposed trial procedures has just been completed in two villages in the Agincourt HDSS study area with the ultimate aim of completing a cluster-randomized trial in the future.
PCV (Pneumococcal Conjugate Vaccines) project
PhD student Sarah Downs taking nasopharyngeal swabs
Africa Streptococcus pneumoniae is a microorganism that generally colonizes the nasopharynx. There are 93 described serotypes, which can be antigenically distinct and have unique potential to cause disorder in the human host. Colonization of the nasopharynx is generally asymptomatic; however, carriage of invasive serotypes may also result in Invasive Pneumococcal disease (IPD). Previous to habitual immunization of kids with pneumococcal conjugate vaccines (PCV), it was anticipated that pneumococcal disorder caused 1 million deaths annually in <5 yr olds.
Cutting-edge vaccines against pneumococcus target the more prevalent, invasive and antibiotic-resistant serotypes. The groups most at risk of developing IPD are infants aged 1 year and younger and HIV-infected women (mothers) due to pneumococcal serotypes usually causing disease in children. Childhood PCV immunization has, however, been associated with reductions in colonization by PCV-serotypes in both HIV-infected and HIV-uninfected mothers.
Considering the affect of childhood PCV immunization on diminishing vaccine-serotype colonization in inoculated and unvaccinated age bunches it may be conceivable to decrease the number of dosages utilized in childhood once there’s as it were constrained circulation and transmission of the immunization serotypes. The transitioning to a decreased dosing plan of PCV, in any case, requires cautious reconnaissance of the chance of introduction to antibody serotypes amid early earliest stages. This could be followed in spite of the fact that serial colonization ponders to best characterize the leftover burden of vaccine-serotype colonization among age bunches focused on for immunization, as well as in other age bunches who might serve as a store for vaccine-serotype colonization which can be transmitted to youthful, powerless children
The current study is being undertaken as a prospective cross-sectional survey in Agincourt (2017) and Soweto (2018). This will provide vital information on the current prevalence of VT and NVT colonization and risk of pneumococcal disease. In addition to surveillance of any changes in NVT prevalence, this data will inform any subsequent interventions and strategies relating to the reduction of morbidity and mortality related to pneumococcal infection.