Community-based health screening and all-cause mortality in rural South Africa: a longitudinal cohort study.
Description
Gareta ohne Rolle, 08.6.2026
Publisher DOI
PubMed ID
42231928
Abstract
Introduction
South Africa is experiencing a significant shift in its disease burden from high HIV and tuberculosis (TB) mortality to increased burden of non-communicable diseases (NCDs). Despite this, screening, treatment and control for NCDs remain limited. Community health fairs are often used to identify and refer individuals with chronic diseases in underserved areas, but their impact on morbidity and mortality is unclear.Methods
From 2018 to 2020, individuals aged 15+ in the Africa Health Research Institute's demographic surveillance area in rural KwaZulu-Natal were invited to Vukuzazi, a community health fair programme offering screening and referrals for HIV, TB, hypertension and diabetes. All residents were followed through regular household surveillance to identify deaths. We used inverse probability of treatment weighting survival analysis to estimate the effect of attendance on all-cause mortality and logistic regression to assess whether any difference in mortality may be explained by increased access to care.Results
Of those eligible, 18 041 (50.0%) participated in Vukuzazi. Individuals were observed after the health fairs for a median of 4.0 years (IQR 3.7-4.2 years) comprising a total of 127 625 person years. Vukuzazi health fair attendance was associated with a 25% relative reduction in the hazard of all-cause mortality (HR=0.75, 95% CI 0.67 to 0.84), corresponding to a 1.5% absolute reduction in mortality over 5 years. In the 3 months post health fair, attenders had 13% increased odds of clinic attendance (OR=1.13, 95% CI 1.10 to 1.17), but no change in clinic attendance among non-attenders (OR=1.02, 95% CI 0.98 to 1.06).Conclusion
Participation in a community-based health fair was associated with a reduction in 5-year all-cause mortality in rural South Africa. The reduced mortality in those attending corresponded to an increase in primary healthcare engagement following the health fairs. The integration of health fairs with a paired referral system may be an effective strategy to improve health outcomes in the region.
South Africa is experiencing a significant shift in its disease burden from high HIV and tuberculosis (TB) mortality to increased burden of non-communicable diseases (NCDs). Despite this, screening, treatment and control for NCDs remain limited. Community health fairs are often used to identify and refer individuals with chronic diseases in underserved areas, but their impact on morbidity and mortality is unclear.Methods
From 2018 to 2020, individuals aged 15+ in the Africa Health Research Institute's demographic surveillance area in rural KwaZulu-Natal were invited to Vukuzazi, a community health fair programme offering screening and referrals for HIV, TB, hypertension and diabetes. All residents were followed through regular household surveillance to identify deaths. We used inverse probability of treatment weighting survival analysis to estimate the effect of attendance on all-cause mortality and logistic regression to assess whether any difference in mortality may be explained by increased access to care.Results
Of those eligible, 18 041 (50.0%) participated in Vukuzazi. Individuals were observed after the health fairs for a median of 4.0 years (IQR 3.7-4.2 years) comprising a total of 127 625 person years. Vukuzazi health fair attendance was associated with a 25% relative reduction in the hazard of all-cause mortality (HR=0.75, 95% CI 0.67 to 0.84), corresponding to a 1.5% absolute reduction in mortality over 5 years. In the 3 months post health fair, attenders had 13% increased odds of clinic attendance (OR=1.13, 95% CI 1.10 to 1.17), but no change in clinic attendance among non-attenders (OR=1.02, 95% CI 0.98 to 1.06).Conclusion
Participation in a community-based health fair was associated with a reduction in 5-year all-cause mortality in rural South Africa. The reduced mortality in those attending corresponded to an increase in primary healthcare engagement following the health fairs. The integration of health fairs with a paired referral system may be an effective strategy to improve health outcomes in the region.
Date Issued
2026
Publication Type
Article
Subject(s)
Subjects
Causality
•
Community Participation
•
Incidence
•
Program Evaluation
Language(s)
en
Author(s)
Magut, Faith |
Olivier, Stephen |
Sessego, Ariane |
Mazibuko, Lusanda |
Busang, Jacob |
Hanekom, Willem |
Gareta, Dickman |
Herbst, Kobus |
Baisley, Kathy |
Siedner, Mark |
Additional Credits
Journal
BMJ Public Health
Publisher
BMJ Publishing Group
ISSN
2753-4294
2753-4294
Access(Rights)
open.access