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Final Report Summary - IPHTRE (Improving Popoulation Health Through Research Exchanges)

Improving Population Health Through Research Exchanges (IPHTRE)

This research exchange programme was undertaken between the University of Umeå, Sweden (coordinator), the University of Warwick, United Kingdom and the University of the Witwatersrand, Johannesburg, South Africa from 2013 to 2016 (48 months). (Although originally University College London had also intended to participate, in fact they were not able to do so).

All of the partners have long-standing research interests in population health, and had engaged in some collaborative activities before the implementation of this exchange programme. However, the additional IRSES resources were instrumental in enhancing and developing collaboration. A substantial number of research papers and three successful PhD theses based on field work in South Africa resulted from the four-year programme.

The University of the Witwatersrand has operated a population health research centre in the Agincourt sub-district of South Africa (in the north-east of the country) since 1992. This well established operation has collected detailed individual health data on a population now exceeding 100,000, through a period of democratic transition and under the HIV/AIDS epidemic that disproportionately affected southern Africa.

The work within this exchange programme is therefore not a self-contained piece of science, but an important enhancement of capacity to the on-going Agincourt population-based programme. The Agincourt site is also a member of the INDEPTH Network, which acts as an umbrella for similar population sites across Africa and Asia. Therefore much of the research here will have wider implications for other settings.

The IPHTRE programme was organised within five work packages, each dealing with a specific area of research. These were (1) Verbal autopsy developments; (2) Assessing adult health and ageing in Africa; (3) The effects of enumeration on a population; (4) Population geography of the HIV/AIDS epidemic and (5) Consequences of epilepsy in a rural African population.

Verbal autopsy (interviewing family members or carers after a death that was not documented) is an important technique for developing reliable cause of death profiles for populations where deaths are not routinely assigned causes. Doing this in a carefully standardised way is very important for making comparisons between different populations. The World Health Organization takes global responsibility for setting standards for verbal autopsy, and the research carried out here contributed substantially to the development of those international standards, as well as developing the InterVA-5 computer model which assigns causes of death under the WHO 2016 standard.

Much population-based health in Africa has concentrated on child and reproductive health, with little attention being given to the health issues experienced by adults as they grow older. As non-communicable diseases become more prevalent in Africa, along with key drivers such as obesity, it is very important to understand better what the impact of ill-health is in the lives of older Africans. This research, including Dr. Xavier Gomez-Olive’s PhD thesis, is therefore of relevance across Africa.

Many of the households in the Agincourt area have been contributing personal information and data to the surveillance system for over twenty years, and so an important research question is to understand how they perceive and understand their own participation. The concept of a specific community contributing health research data over more than a generation is a relatively new one within Africa, and exploring that situation from the community’s perspective is therefore very important.

Sub-Saharan Africa has borne the highest impacts of the HIV/AIDS pandemic that originated around 1990. In South Africa, the impact of the HIV/AIDS epidemic coincided with the country’s transition to democracy, and the combined effects of the epidemic and socio-political change have made the situation hard to understand from a community perspective. Having long-term data on individuals and households in the Agincourt area enabled detailed patterns to be examined, as presented in Dr. Paul Mee’s PhD thesis, which have important consequences for the on-going challenges of containing the epidemic and supporting people living with HIV.

Epilepsy is a worldwide disease, but in much of Africa it continues to be misunderstood, often surrounded by fear and suspicion. Understanding the disease from a community perspective, and working out how to support people living with epilepsy in Africa, is therefore a very neglected area. Work in Agincourt, including Dr. Ryan Wagner’s PhD thesis, has brought new insights to this particular problem.

Further details of this and other on-going work at the Agincourt site can be found at

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