SOUTH AFRICA – A comprehensive health-screening program in rural South Africa has found a high burden of undiagnosed or poorly controlled non-communicable diseases, according to a study by the Africa Health Research Institute (AHRI).

Researchers have found that four out of five women over the age of 30 are living with a chronic health condition, and that the HIV-negative population and older people bare the higher burden of undiagnosed or poorly controlled non-communicable diseases such as diabetes and hypertension.

The study which was co-led by Emily Wong, M.D., a resident faculty member at the Africa Health Research Institute (AHRI), in Durban, KwaZulu-Natal, South Africa will give AHRI researchers and the Department of Health critical indicators for where the most urgent interventions are needed

The research which was done before COVID-19 has highlighted the urgency of diagnosing and treating people with non-communicable diseases, given that people with uncontrolled diabetes and hypertension are at higher risk of getting very ill with COVID.

As background to the study, 15 years of intense public health efforts that increased access to anti-retroviral therapy in sub-Saharan Africa has beneficially decreased mortality from AIDS and increased life expectancy.

As a result, there is an increasing priority to address other causes of disease, including tuberculosis and non-communicable diseases.

In the 18-month Lancet Global Health study, health workers screened 17,118 people age 15 years and older via mobile camps within 1 kilometer of each participant’s home in the uMkhanyakude district.

They found high and overlapping burdens of HIV, tuberculosis, diabetes and hypertension among men and women.

While the HIV cases were, for the most part, well diagnosed and treated, some demographic groups, including men in their 20s and 30s, still had high rates of undiagnosed and untreated HIV.

The majority of people with tuberculosis, diabetes or hypertension were either undiagnosed or not well controlled.

Tuberculosis remains one of the leading causes of death in South Africa, and the high rates of undiagnosed and asymptomatic tuberculosis that health workers found is a concern.

“Our findings suggest that the massive efforts of the past 15 years to test and treat for HIV have done very well for that one disease,” Wong said.

The mobile camps screened for diabetes, high blood pressure, nutritional status (obesity and malnutrition), and tobacco and alcohol use, as well as HIV and tuberculosis.

Through a sophisticated data system and the use of artificial intelligence to interpret the chest X-rays, AHRI’s clinical team examined the information in real time and referred people to the public health system as needed.

Researchers found that half of the people 15 years or older 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.

Also, one-third of the people were living with HIV, but this was mostly well diagnosed and treated. Women bore a particularly high burden of HIV, high blood pressure and diabetes.

As for tuberculosis, 1.4 percent of the people had active disease, and 22 percent had lifetime disease. About 80 percent of the undiagnosed tuberculosis was asymptomatic, and men had higher rates of active tuberculosis.

Researchers also identified several disease patterns by geographical location — for example, the highest burden of HIV was seen near main roads, while higher rates of tuberculosis and non-communicable diseases were seen in more remote areas.