MRC/Wits Rural Public Health and Health Transitions Unit (Agincourt)

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Health & Social Systems

Ntirhisano (traditional healers)

Strengthening the primary health care system through partnerships with traditional healers. 

  • PI(s): Carolyn Audet, Ryan Wagner 
  • Project Manager: Wonderful Mabuza 
  • Funder: NIH (USA) 
  • Collaborating Institutions: Vanderbilt University (USA)

Ntirhisano is a transformative initiative dedicated to reshaping healthcare paradigms in rural South and southern Africa, by bridging the gap between traditional healing practices and the biomedical health system. The central aim of Ntirhisano is to enhance health outcomes, both for acute and chronic conditions, by partnering with traditional healers from local communities. 

With approximately 200,000 traditional healers in South Africa, surpassing registered medical professionals, Ntirhisano recognizes their significant role within communities and seeks to explore, through interdisciplinary research, their role in the delivery of primary health care.  

Acknowledging that patients in these settings often engage with both biomedical and traditional health systems, resulting in medical pluralism and further challenges in treatment, the workstream aspires to empower traditional healers through education, ensuring optimal patient care while avoiding potential harm. Furthermore, advocating for seamless collaboration between traditional and biomedical practitioners, streamlining patient referrals and enhancing overall care quality. 

The ultimate goal is to create a transportable model of cooperation between these two systems at the primary healthcare level, establishing a sustainable and scalable approach for similar settings. By fostering mutual respect and shared understanding, Ntirhisano envisions a future where traditional healers contribute effectively to the healthcare landscape, uplifting the well-being of rural communities within South and southern Africa. 


Prospective Household Study of SARS-CoV-2, Influenza, and Respiratory Syncytial Virus Community Burden, Transmission Dynamics and Viral Interaction in South Africa (PHIRST-C Study) 

  • PI: Cheryl Cohen  
  • Co-investigators: Kathleen Kahn, Stephen Tollman, Xavier Gómez-Olivé, Neil Martinson
  • Project Manager: Floidy Wafawanaka 
  • Funders: US Center for Disease Control (USA), National Institute for Communicable Diseases (SA), Wellcome Trust (UK)
  • Collaborating Institutions: NICD, and Perinatal HIV Research Unit (PHRU) (SA)

PHIRST-C aimed to provide information on the natural history of SARS-CoV-2 to inform decisions on optimal strategies for the containment and mitigation of the pandemic locally, regionally, and globally. Objectives were to estimate the community burden of SARS-CoV-2 and to assess the transmission dynamics of SARS-CoV-2 infections in the community. Emphasis was placed on the difference between age groups and HIV-infected and HIV-uninfected individuals. 

The study was a prospective cohort study of households in rural Agincourt and urban Klerksdorp. From July 2020 to August 2021, mid-turbinate nasal swabs were collected twice a week from household members irrespective of symptoms and tested for SARS-CoV-2 using real-time RT-PCR (RT-rtPCR). Information was gathered on symptoms and health-seeking behavior at every visit. Serum was collected every 2 months and tested for anti-SARS-CoV-2 antibodies from the study through 2022. 

The study found high asymptomatic infections (85·3%) and that people living with HIV not virally suppressed were more likely to develop symptomatic illness and to shed SARS-CoV-2 for longer than those HIV-uninfected. Control measures aimed at symptomatic individuals may have limited impact as symptom status of the index case did not affect the proportion of household members subsequently infected.

Verbal Autopsy with Participation Action Research (VAPAR)
  • PI: Lucia D’Ambruoso  
  • Co-Investigators: Stephen Tollman, Kathleen Kahn, Maria van der Merwe, Gerhard Goosen, Jerry Sigudla
  • Funder: South Africa Health Systems Research Initiative from DFID, MRC, Wellcome Trust, ESRC (SA); Scottish Funding Council, Newton Fund, GCRF (UK)
  • Collaborating Institutions: University of Aberdeen, and Queen Margaret University (Scotland); Mpumalanga Department of Health (SA); Umea University (Sweden)

VAPAR addresses exclusion from access to health systems by connecting service users and providers to generate and act on research evidence of practical, local relevance. The programme connects two issues, namely the i) lack of research evidence on the health needs of those excluded from access to health and information systems, and ii) lack of uptake of evidence by the authorities: health service planners, managers, policymakers and providers at different levels. 

VAPAR creates a space through research that we employ to connect people and services in a mutually supportive learning-and-action engagement. The process combines longitudinal data with narratives and visual images, generating analysis and interpretations of practical relevance in communities and health systems. The work is intended to have impacts on services through an inclusive and adaptive knowledge partnerships process strengthening health systems to achieve health equity gains. Our objectives are as follows: 

  • Develop inclusive knowledge partnerships to strengthen health systems: conduct a series of collective reflection and action cycles to generate information on disease burdens, their social and health systems determinants, and on norms, practices and priorities for action from the perspectives of disadvantaged groups; analyse in a multi-level process of health systems engagement, develop recommendations, plan and document implementation, and reevaluate;  
  • Evaluate change in health, health equity and empowerment: Over three reflection and action cycles, analyse health outcomes, behaviours and service provision. Identify mechanisms through which changes do (or do not) occur in implementation. Understand impacts and whether and how these address health equity and empowerment, whether and how these relate to the use of evidence, and the influence of social and political contexts; 
  • Build sustainability and transferability: Promote and support the use of VAPAR in routine health systems functions to translate co-produced evidence into action. Contribute to communities of practice for collaborative research through teaching and training. Disseminate to the public, health systems stakeholders, governmental, technical and research groups. The research will engage communities and health systems actors at different levels to develop and act on co-produced evidence for health systems change. 
Know your numbers
  • PI(s): Xavier Gómez-Olivé, Charles Parry 
  • Project Manager: Jane Simmonds 
  • Funder: South African Medical Research Council
  • Collaborating Institutions: SAMRC

South Africa has a high prevalence of hypertension in persons over 60 years. Over 4 million South Africans over 60 receive an Older Person Grant (OPGs) and many recipients queue to collect these grants.  These queues – at post offices, retail stores and mobile South African Social Security Agency (SASSA) cash payment points – present a unique opportunity to deliver an intervention for blood pressure (BP) reduction to people who are not normally able to access public health services at clinics. Know Your Numbers (KYN) was a 12-month study to determine if regular measurement and feedback of BP in grant queues, together with promotion of hypertension knowledge and referral to care, reduced BP among participants. Monthly BP measurements were taken in 6 queues in the Bushbuckridge sub-district, Mpumalanga. During this study, we measured BP, promoted hypertension knowledge, introduced a BP Report Card, and referred into care where blood pressure was high. During the intervention, we performed over 7000 measurements, the majority (73%) in women. Overall, study results demonstrated that measuring BP in grant queues together with hypertension knowledge and awareness was effective in reducing BP in older rural populations.

Multimorbidity self-management in rural South Africa

Self-management approaches among individuals with multiple chronic health conditions in rural South Africa 

  • PI: Chodziwadziwa Kabudula
  • Co-PI: Edward Fottrell 
  • Project Manager: Audry Dube 
  • Funder: UKRI (UK), Wits University (SA)
  • Collaborating Institutions: Wits School of Public Health (SA), Centre for Global Non-communicable Diseases, University College London (UK)

The overall aim of the project is to assess the extent to which individuals with multiple chronic health conditions living in rural South Africa self-monitor their health, what methods they use, and the effect of different self-monitoring approaches on behaviours and health outcomes – as a basis for improving and supporting personal self-management and its effectiveness. 

The project spanned a year, comprising two phases. Phase one focused on gathering qualitative data, exploring local knowledge systems regarding core concepts linked to chronic diseases, co-morbidities, self-monitoring, and acceptance within the community. This phase involved six focus group discussions and seven in-depth interviews with community members, chronic patients, and healthcare providers. Additionally, a quantitative cross-sectional survey was conducted among over two thousand chronic patients visiting healthcare centres. 

Phase two entailed an intervention, providing 98 participants with chronic conditions monitoring devices, including glucose monitors, blood pressure monitors, weight scales, activity trackers, and an application-equipped phone for recording results. Toward the study's conclusion, participants received a sleep monitoring device for seven days.