BACKGROUND:Despite rising longevity across Africa, the epidemiology of intrinsic capacity (combination of mental and physical capacities) impairments (ICIs) is understudied. We aimed to determine the prevalence of ICIs and associated sociodemographic and lifestyle factors, pain, functional limitations, and health-related quality of life (HRQoL) across three African countries. METHODS:This population-based cross-sectional study recruited adults aged 40 years and older in five settings: rural (n=1052) and urban (n=1218) Gambia, rural (n=948) and urban (n=968) South Africa, and urban Zimbabwe (n=1110). Researcher-administered questionnaires and physical assessments quantified ICIs. Pain was assessed using the Brief Pain Inventory, functional limitations using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and HRQoL using the 5-level EQ-5D. Setting-specific associations between sociodemographic and lifestyle factors and ICIs were meta-analysed. Differences in pain, function, and HRQoL scores were computed according to ICI number. FINDINGS:The 5296 adults had a mean age of 61·0 (SD 12·9) years; 2823 (53·3%) were female and 2473 (46·7%) were male. Prevalence of two or more ICIs was 62·4% (59·4-65·3) in rural Gambia, 57·6% (54·8-60·4) in urban Gambia, 67·6% (64·5-70·6) in rural South Africa, 72·1% (69·2-74·9) in urban South Africa, and 64·8% (61·9-67·6) in urban Zimbabwe. Having two or more ICIs was more common in those aged 55-69 years (pooled sex-adjusted odds ratio [OR] 1·79 [95% CI 1·51-2·11]) and 70 years and older (7·21 [5·01-10·37]), female individuals (pooled age-adjusted OR 1·73 [95% CI 1·35-2·22]), those who were underweight (pooled age-adjusted and sex-adjusted OR 4·72 [3·41-6·54]), those with lower wealth index (1·38 [1·20-1·58]), those with food insecurity (1·92 [1·17-3·17]), and those who reported current or former tobacco use (1·47 [1·18-1·83]). Overall mean values were 3·95 (SD 10·64) for pain score, 14·17 (18·36) for WOMAC score, and 0·83 (0·11) for HRQoL. Compared with no impairment (n=554 [10·5%]), having two or more ICIs was associated with 2·34-fold (95% CI 1·92-2·84) greater functional limitation, 2·44-fold more pain (1·86-3·20), and lower HRQoL (mean difference -0·06 [-0·07 to -0·05]). INTERPRETATION:In both rural and urban African settings, common ICIs necessitate urgent interventions to maximise functional ability and reduce the effect on quality of life. Individuals most at risk include women, those aged ≥55 years, and people with low socioeconomic status. FUNDING:National Institute for Health Research (NIHR), NIHR-Wellcome Partnership for Global Health Research, and Medical Research Council Musculoskeletal Functional Ability in sub-Saharan Africa. TRANSLATIONS:For the Shona and isiZulu translations of the abstract see Supplementary Materials section.
BACKGROUND:Tuberculosis household contacts are at elevated risk of HIV, and systematic screening for tuberculosis is an opportunity for people to know their status. We aimed to assess the coverage and positivity of HIV testing during household systematic screening for tuberculosis. METHODS:For this systematic review and meta-analysis (PROSPERO: CRD42024471979), we searched MEDLINE, Embase, Global Health, and Africa Wide databases from Jan 1, 2000, to June 24, 2025. The primary analysis population was household contacts of people with tuberculosis without known HIV. Studies were included if HIV testing was offered to household contacts, and in the primary analysis if people known to be living with HIV were excluded from the population eligible for testing. We extracted or derived coverage (proportion of people eligible for testing who received an HIV test) and positivity (proportion of people tested with a positive result) and calculated pooled proportions using random effects meta-analysis. We narratively summarised themes from qualitative reports. Meta-regression examined the association of national HIV prevalence, time period, and participant age, with coverage and positivity of HIV testing. FINDINGS:Searches identified 31 quantitative studies (110 090 people), of which 17 (40 407 people) were included in primary analyses. Seven qualitative studies reported community or provider perspectives. The pooled proportion of eligible household contacts tested for HIV was 72·9% (95% CI 60·3-83·9), ranging from 0% to 100%. Pooled positivity of testing was 5·9% (3·6-8·8) overall. Positivity was 9·7% (5·8-14·5; ten studies) in countries with ≥10% national adult HIV prevalence. Qualitative studies highlighted context-dependent facilitators and barriers of household contacts' capability, opportunity, and motivations to engage with HIV testing. INTERPRETATION:Few studies have evaluated HIV testing for tuberculosis household contacts. Coverage of testing was reasonable but varied substantially across studies. Positivity of testing was high. Further research is needed to understand and optimise acceptability and ensure feasibility of HIV testing within screening of tuberculosis among household contacts, and tuberculosis-HIV programmes in high HIV-incidence settings should consider monitoring implementation of HIV within routine tuberculosis household contact screening. FUNDING:National Institute for Health and Care Research and Wellcome Trust.
Chronic kidney disease (CKD) is often complicated by disorders in multiple body systems, associated with higher mortality and morbidity. Young people living with HIV (YPLHIV) have an increased risk of multisystem chronic comorbidities. However, there are few data describing comorbidities associated with CKD among YPLHIV. We conducted a case-control study in seven ART clinics in Kampala, Uganda. Cases were YPLHIV (aged 10–24 years) diagnosed with CKD and controls were those without CKD. We collected data on demographic and clinical factors: HIV viral load, CD4 T cell count, blood pressure, fasting glucose levels, anaemia, electrolytes, parathyroid hormone, and cognitive impairment. We summarized the demographic and clinical factors and used logistic regression to estimate odds ratios (OR) and 95
BACKGROUND:The conceptualisation of tuberculosis has undergone a paradigm shift from binary states to a spectrum, resulting in the International Consensus for Early TB (ICE-TB) framework. This study aimed to use data from a prospective, observational cohort study and multistate modelling to address the lack of contemporary data to quantify movement between ICE-TB states. METHODS:ERASE-TB was a prospective, observational cohort study evaluating novel diagnostic tests for earlier detection of tuberculosis. Household contacts aged at least 10 years in Zimbabwe, Tanzania, and Mozambique were followed up 6-monthly for 12-24 months with comprehensive tuberculosis investigations at each visit. Those not diagnosed with prevalent tuberculosis, with state classification from at least two timepoints were included. ICE-TB states were defined by use of symptomatology, interferon gamma release assays, chest radiographs, and sputum microbiology. A Markov multistate model based on ICE-TB was applied with one initial state (Mycobacterium tuberculosis non-infection), two intermediate states (M tuberculosis infection and non-infectious disease [asymptomatic-symptomatic]), and one absorbing state (infectious disease [asymptomatic-symptomatic]). Transition probabilities were predicted. FINDINGS:1789 (84·8%) of 2109 recruited household contacts were included. At enrolment, most (1000 [55·9%]) did not have M tuberculosis infection; 674 (37·7%) had M tuberculosis infection, and 115 (6·5%) had non-infectious disease. 34 people developed infectious disease (23 asymptomatic, 11 symptomatic). In the multistate model, the transition probabilities of progressing from M tuberculosis non-infection to M tuberculosis infection and M tuberculosis infection to non-infectious disease were 13% and 3% by month 12. For those in non-infectious disease, the probabilities of regression and progression by month 12 were 85% and 13%, respectively. INTERPRETATION:This study applied the ICE-TB framework to describe movement between states by use of contemporary, granular, longitudinal data. Although most people remained static over time, the non-infectious state was more dynamic, with most people regressing over time. FUNDING:European and Developing Countries Clinical Trials Partnership.
Africa's older population is rapidly increasing, necessitating the development of healthy aging interventions. Nutrition is a key component of healthy aging. Evidence synthesis on nutrition outcomes of older adults in Africa is emerging but a synthesis on interventions is lacking. The aim was to synthesize evidence from reviews on older people in Africa to determine the prevalence of nutrition outcomes and associated factors (phase 1) and implemented interventions (phase 2). Literature searches using Medline, EMBASE, Web of Science, African Index Medicus, and African Journals Online were conducted up to May 9, 2024. After screening, 25 reviews (for phase 1) and 22 articles (for phase 2) were selected for inclusion. Most reviews (n = 16; 64%) were systematic, with 8 having a meta-analysis, and published between 2020 and 2023 (n = 20; 80%). The pooled prevalence of malnutrition (being underweight) was 21% (evidence from 5 reviews), 26% for sarcopenia (1 review), 27% for obesity (3 reviews), 32% for constipation (1 review), 39% for food insecurity (2 reviews), 49% for dental caries (1 review), and 64% for vitamin D insufficiency and deficiency (2 reviews). The 22 articles on nutritional interventions represented only 6 countries, mostly South Africa (64%; 14/22), evaluated using randomized trials (n = 10; 45%) and educational interventions (n = 10; 45%). Reported interventions were not typically underpinned by supporting systematic reviews or a contextual evidence base, did not account for the minimally important clinical difference, lacked evidence of community engagement, and were not reported transparently. Nutritional research is needed on older adults outside of South Africa and beyond malnutrition. Future nutritional interventions (ideally, multicomponent) for older people in Africa should consider targeting the multiple nutritional and practical needs (eg, dietary counseling, supplementation) of older adults. Intervention development should be evidence-based, include engagement with older people, and follow complete and transparent reporting.
