Health, population and social transitions in rural Southern Africa: Elucidating pathways and testing interventions.

Rural Southern Africa is in the midst of far-reaching socio-demographic transitions reflected in complex health challenges spanning the life course. The Agincourt health and socio-demographic surveillance system (HDSS), located in a border region of rural South Africa, has tracked and investigated these changes. Findings illuminate a protracted epidemiological transition with worsening mortality from HIV and TB paralleled by increasing vascular disease, particularly stroke, and persistent child malnutrition. Households demonstrate variable capacity to cope, especially with the shock of adult death. This proposal seeks five years further support for the HDSS to secure an exceptional research platform and thereby provide the foundation for a programme to test interventions informed by prior studies, and elucidate causal pathways that affect health outcomes. Enhanced surveillance includes linking project datasets to the HDSS; linking HDSS and clinic records; and an accessible web-bas ed approach to sharing data. Interventions target stunted growth in the youngest; poor mental health and achievement at school; adolescent parenting; phase IIb/III trial site development; secondary prevention of vascular disease with strengthening of chronic care systems; and evaluation of anti-retroviral rollout. Work will vigorously support doctoral/masters and post-doctoral training; and contribute leadership to multi-site collaborations involving the INDEPTH Network of HDSS sites.