Spatial Clustering of All-Cause and HIV-Related Mortality in a Rural South African Population (2000–2006)
Identifieur interne : 002298 ( Main/Exploration ); précédent : 002297; suivant : 002299Spatial Clustering of All-Cause and HIV-Related Mortality in a Rural South African Population (2000–2006)
Auteurs : Elias Namosha [Afrique du Sud] ; Benn Sartorius [Afrique du Sud] ; Frank Tanser [Afrique du Sud]Source :
- PLoS ONE [ 1932-6203 ] ; 2013.
Abstract
Sub-Saharan Africa bears a disproportionate burden of HIV infection. Knowledge of the spatial distribution of HIV outcomes is vital so that appropriate public health interventions can be directed at locations most in need. In this regard, spatial clustering analysis of HIV-related mortality events has not been performed in a rural sub-Saharan African setting.
Kulldorff’s spatial scan statistic was used to identify HIV-related and all-cause mortality clusters (
HIV-related and all-cause mortality exhibit strong spatial clustering tendencies in this population. Highest HIV-related mortality and all-cause mortality occurred in the peri-urban communities along the National Road and was lowest in the urban township and remote rural communities. The geography of HIV-related mortality corresponded closely to the geography of HIV prevalence, with the notable exception of the urban township where high HIV-related mortality would have been expected on the basis of the high HIV prevalence. Our results suggest that HIV treatment and care programmes should be strengthened in easy-to-reach high density, peri-urban populations near National Roads where both HIV-related and all-cause mortality are highest.
Url:
DOI: 10.1371/journal.pone.0069279
PubMed: 23935972
PubMed Central: 3720283
Affiliations:
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Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation><affiliation><nlm:aff id="aff2"><addr-line>Papua New Guinea Institute of Medical Research, Papua, New Guinea</addr-line></nlm:aff><wicri:noCountry code="subfield">New Guinea</wicri:noCountry></affiliation></author><author><name sortKey="Sartorius, Benn" sort="Sartorius, Benn" uniqKey="Sartorius B" first="Benn" last="Sartorius">Benn Sartorius</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author><author><name sortKey="Tanser, Frank" sort="Tanser, Frank" uniqKey="Tanser F" first="Frank" last="Tanser">Frank Tanser</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>The Africa Centre for Health and Population Studies, Mtubatuba, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>The Africa Centre for Health and Population Studies, Mtubatuba</wicri:regionArea><wicri:noRegion>Mtubatuba</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Sub-Saharan Africa bears a disproportionate burden of HIV infection. Knowledge of the spatial distribution of HIV outcomes is vital so that appropriate public health interventions can be directed at locations most in need. In this regard, spatial clustering analysis of HIV-related mortality events has not been performed in a rural sub-Saharan African setting.</p></sec><sec><title>Methodology and Results</title><p>Kulldorff’s spatial scan statistic was used to identify HIV-related and all-cause mortality clusters (<italic>p</italic><0.05) in a population-based demographic surveillance survey in rural KwaZulu Natal, South Africa (2000–2006). The analysis was split pre (2000–2003) and post (2004–2006) rollout of antiretroviral therapy, respectively. Between 2000–2006 a total of 86,175 resident individuals ≥15 years of age were under surveillance and 5,875 deaths were recorded (of which 2,938 were HIV-related) over 343,060 person-years of observation (crude all-cause mortality rate 17.1/1000). During both time periods a cluster of high HIV-related (RR = 1.46/1.51, p = 0.001) and high all-cause mortality (RR = 1.35/1.38, <italic>p</italic> = 0.001) was identified in peri-urban communities near the National Road. A consistent low-risk cluster was detected in the urban township in both time periods (RR = 0.60/0.39, <italic>p</italic> = 0.003/0.005) and in the first time period (2000–2003) a large cluster of low HIV-related and all-cause mortality in a remote rural area was identified.</p></sec><sec><title>Conclusions</title><p>HIV-related and all-cause mortality exhibit strong spatial clustering tendencies in this population. Highest HIV-related mortality and all-cause mortality occurred in the peri-urban communities along the National Road and was lowest in the urban township and remote rural communities. The geography of HIV-related mortality corresponded closely to the geography of HIV prevalence, with the notable exception of the urban township where high HIV-related mortality would have been expected on the basis of the high HIV prevalence. Our results suggest that HIV treatment and care programmes should be strengthened in easy-to-reach high density, peri-urban populations near National Roads where both HIV-related and all-cause mortality are highest.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Sankoh, Oa" uniqKey="Sankoh O">OA Sankoh</name></author><author><name sortKey="Yazoume, Y" uniqKey="Yazoume Y">Y Yazoume</name></author><author><name sortKey="Saueborn, R" uniqKey="Saueborn R">R Saueborn</name></author><author><name sortKey="Muller, O" uniqKey="Muller O">O Muller</name></author><author><name sortKey="Becher, H" uniqKey="Becher H">H Becher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fukuda, Y" uniqKey="Fukuda Y">Y Fukuda</name></author><author><name sortKey="Umezaki, M" uniqKey="Umezaki M">M Umezaki</name></author><author><name sortKey="Nakamura, K" uniqKey="Nakamura K">K Nakamura</name></author><author><name 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Newell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tanser, F" uniqKey="Tanser F">F Tanser</name></author><author><name sortKey="Lesueur, D" uniqKey="Lesueur D">D LeSueur</name></author><author><name sortKey="Solarsh, G" uniqKey="Solarsh G">G Solarsh</name></author><author><name sortKey="Wilkinson, D" uniqKey="Wilkinson D">D Wilkinson</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="B Rnighausen, T" uniqKey="B Rnighausen T">T Bärnighausen</name></author><author><name sortKey="Hosegood, V" uniqKey="Hosegood V">V Hosegood</name></author><author><name sortKey="Timaeus, Im" uniqKey="Timaeus I">IM Timaeus</name></author><author><name sortKey="Newell, Ml" uniqKey="Newell M">ML Newell</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kulldorff, M" uniqKey="Kulldorff M">M Kulldorff</name></author><author><name sortKey="Athas, Wf" 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