ORCID Profile
0000-0002-2610-2625
Current Organisation
Princeton University
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Publisher: Wiley
Date: 11-07-2022
DOI: 10.1111/PADR.12494
Abstract: This article examines the meaning of health among middle‐aged and older adults in a rural South African setting, where 72 percent of adults aged 40 and over are living with a major chronic condition, and 81 percent report good or very good health. We draw on a unique mixed‐methods dataset that includes a population‐based survey with disease biomarkers (hypertension, diabetes, HIV), self‐assessments of health including self‐rated health, functional ability and medication use, as well as nested qualitative life history interviews with survey participants including questions about lived experiences of health. We conduct survey trend analysis and ordinal logistic regression, as well as inductive and deductive coding of qualitative interviews, and triangulate findings across data sources. Overall, we find that self‐rated health and functional ability are not associated with biometric disease indicators however, we find that gendered familial expectations, life course stage, and the socioepidemiological context work together to regulate the salience of illness as people age. The study highlights the utility of research with multiple measures of health in illuminating the challenges of aging amidst the complex epidemiological transitions that increasingly characterize low‐ and middle‐income countries.
Publisher: SAGE Publications
Date: 10-01-2018
Abstract: Objective: The African HIV epidemic is aging, yet HIV testing behavior studies either exclude older persons or include too few to say much about age differences. Method: Strategically combining focus group interviews (participants in 40s/50s/60s-plus age groups) and survey data from rural South Africa (where HIV prevalence peaks in the late 30s, but continues to be over 10% into the late 60s), we examine gender and life course variation, motivations, and barriers in HIV testing. Results: We find significant gender differences—Women test at higher rates at younger ages, men at older ages. Our qualitative data not only highlight recognition of testing importance but also suggest gendered motivations and perceptions of testing. Men and women report similar barriers, however, including fear of finding out their (positive) HIV status, limited confidentiality, and partner nondisclosure. Discussion: We conclude with recommendations to increase HIV testing uptake among older adults including home testing, couples testing, and HIV testing concurrently with noncommunicable diseases.
Publisher: SAGE Publications
Date: 25-07-2022
DOI: 10.1177/08912432221114877
Abstract: When men and women cannot attain idealized gendered forms of economic provision and dependence, how do they make sense of this perceived failure? In this article, we posit that poor health narratives serve as a gendered tool to make sense of inadequate livelihoods, even when that inadequacy is attributable to structural conditions. We draw on survey and life-history interview data from middle-aged and older rural South Africans. The survey data show that even after adjusting for biometrically measured health differences, working-age (40–59 years) men report poorer health when they are unemployed, and women (age 40+) and pension-age men (age 60+) report poorer health when they live without household earners. Life-history interviews show parallel patterns: When their economic circumstance is not troubled, in iduals regularly minimize health concerns conversely, when they have a troubled livelihood, in iduals draw on poor health to explain it. When women and men cannot perform idealized gendered practices in the family, poor health becomes a tool to reduce the resulting cognitive dissonance. Poor health narratives recast perceived gender failures to an in idualized, biological explanation. Our study illustrates how the epidemiological context can be a resource that forestalls a redefinition of gender norms when the gender order is in crisis.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2022
DOI: 10.1186/S12889-022-12791-Z
Abstract: Sub-Saharan African settings are experiencing dual epidemics of HIV and hypertension. We investigate effects of each condition on mortality and examine whether HIV and hypertension interact in determining mortality. Data come from the 2010 Ha Nakekela population-based survey of in iduals ages 40 and older (1,802 women 1,107 men) nested in the Agincourt Health and socio-Demographic Surveillance System in rural South Africa, which provides mortality follow-up from population surveillance until mid-2019. Using discrete-time event history models stratified by sex, we assessed differential mortality risks according to baseline measures of HIV infection, HIV-1 RNA viral load, and systolic blood pressure. During the 8-year follow-up period, mortality was high (477 deaths). Survey weighted estimates are that 37% of men (mortality rate 987.53/100,000, 95% CI: 986.26 to 988.79) and 25% of women (mortality rate 937.28/100,000, 95% CI: 899.7 to 974.88) died. Over a quarter of participants were living with HIV (PLWH) at baseline, over 50% of whom had unsuppressed viral loads. The share of the population with a systolic blood pressure of 140mm Hg or higher increased from 24% at ages 40-59 to 50% at ages 75-plus and was generally higher for those not living with HIV compared to PLWH. Men and women with unsuppressed viral load had elevated mortality risks (men: adjusted odds ratio (aOR) 3.23, 95% CI: 2.21 to 4.71, women: aOR 2.05, 95% CI: 1.27 to 3.30). There was a weak, non-linear relationship between systolic blood pressure and higher mortality risk. We found no significant interaction between systolic blood pressure and HIV status for either men or women ( p .05). Our results indicate that HIV and elevated blood pressure are acting as separate, non-interacting epidemics affecting high proportions of the older adult population. PLWH with unsuppressed viral load were at higher mortality risk compared to those uninfected. Systolic blood pressure was a mortality risk factor independent of HIV status. As antiretroviral therapy becomes more widespread, further longitudinal follow-up is needed to understand how the dynamics of increased longevity and multimorbidity among people living with both HIV and high blood pressure, as well as the emergence of COVID-19, may alter these patterns.
Publisher: Springer Science and Business Media LLC
Date: 30-03-2020
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-049621
Abstract: There is a scarcity of longitudinal cohort studies in sub-Saharan Africa to understand the epidemiology of cardiovascular disease as a basis for intervention. We estimated incident hypertension and associated sociodemographic, health and behavioural risk factors in a population aged 40 years and older over a 5-year period. We assessed the association between incident hypertension and sociodemographic, health and behavioural factors using Poisson regression. We adjusted for non-response in 2015 using inverse probability s ling weights from a logistic regression including sex and age at baseline. Rural South Africa. We used a population-based cohort of normotensive adults in 2010 who were aged 40 years and older at retest in 2015. Of 676 in iduals completing baseline and 5-year follow-up, there were 193 incident cases of hypertension. The overall hypertension incidence rate was 8.374/100 person-years. In multivariable analyses, those who became hypertensive were more likely to be older, have a high waist circumference (incidence rate ratio (IRR): 1.557, 95% CI: 1.074 to 2.259) and be employed (IRR: 1.579, 95% CI: 1.071 to 2.329) at baseline. Being HIV positive and not on antiretroviral therapy at baseline was associated with lower risk of incident hypertension. Over a 5-year period, 29% of respondents developed hypertension. Given the high burden of hypertension in South Africa, continued longitudinal follow-up is needed to understand the complex interplay of non-communicable and infectious diseases and their underlying and modifiable risk factors to inform public health prevention strategies and programmes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-06-2020
No related grants have been discovered for SANYU MOJOLA.