A new health research hub brings hope of improving health services in the Rustenburg Valley in the North West Province. Spotlight finds out more about how the Bafokeng Health and Demographic Surveillance System Node will work and what it has to offer.
Vivian Moremi envisions a shift in how the people of the "dew" confront tuberculosis (TB) - the top infectious disease killer on the planet.
"Most of the community members are not aware of the different types of TB existing," the community leader of the estimated 150 000 people living in some 29 villages of the Royal Bafokeng Nation located in the Rustenburg Valley in the North West province tells Spotlight.
Moremi is hopeful though that a new health surveillance system poised to educate and empower will ignite a change in better understanding TB and challenging misconceptions that she says hinder progress.
Along with TB, the new BAMMISHO research node aims to address other critical health challenges like HIV and chronic diseases. This node, also known as the Bafokeng Health and Demographic Surveillance System (HDSS) was launched in November last year. It makes up the newest and seventh South African Population Research Infrastructure Network (SAPRIN) research node. By gathering accurate, long-term data on health trends, migration and social issues, the hope is that the new node will enhance healthcare planning and policy development for the area.
The Bafokeng people control 1 400km of land situated on the largest platinum reserve in the world.
"The Royal Bafokeng Nation is located in the mining areas, thus increasing the burden of TB in the villages," Moremi notes. "When a person dies of TB related complications, most of the people in our communities think that it is caused by 'sejeso' [food poisoning] and delay to consult with relevant health practitioners," she reckons.
At the peak of the TB epidemic in the early 2000s, incidence rates in the mining industry were about seven times the rates in the general population. The South African mining industry has however been keeping it well below the national level since 2017, claims the Minerals Council South Africa.
Moremi says she believes that awareness campaigns run by BAMMISHO will mean "our people will start to take TB seriously".
Overall, she says the research node will enhance community health outcomes by helping communities understand the purpose of research, leading to more participation, and reducing stigma.
'Direct benefits'
The Bafokeng people will receive direct benefits from BAMMISHO's population-based research approach, such as better access to healthcare, increased attention to preventing or managing problems affecting the community, shaping the research through participation in a community advisory board, and at community report-back meetings, says the research node's director Professor Geoff Setswe.
The BAMMISHO research hub will deal with the quadruple epidemic of disease such as HIV, TB, chronic diseases of lifestyle, violence and trauma, Setswe tells Spotlight.
"We will track this cohort longitudinally for their health and demographic changes over time, obtain robust longitudinal demographic data on births, deaths, migration and other health-related events to address critical gaps in the information and translate research evidence into public health policy and programmes that will improve the health of the community," he says.
With a focus on the health and socio-economic impact of mining and migration, BAMMISHO research, Setswe says, will quantify changes in patterns of disease, identify underlying causal pathways, and test interventions to improve health outcomes.
"We will describe trends in infant, maternal and adult mortality and chronic disease with aging," he says. "We anticipate contributing to ongoing longitudinal SAPRIN node analysis using demographic and verbal autopsy data. This household surveillance approach will help in tracking missing cases of HIV, TB and chronic diseases," says Setswe. "In particular, our research will provide a nuanced understanding of the multiple drivers of migration and the impact of migration from rural areas to urban areas on patients missing treatments for HIV/AIDS, TB and chronic illnesses as they migrate," he adds.
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The BAMMISHO research hub, Setswe says, will initially employ about 27 people, with additional hires as the project progresses.
The team consists of three categories of research staff during the setup phase: 1) Five specialists in public health, epidemiology, demography, behavioral sciences, and geographic information system and mapping; 2) Seven research managers, including operations, data, laboratory, and community engagement managers, plus three fieldwork supervisors; 3) Around 15 local fieldworkers, selected in consultation with the Royal Bafokeng administration and advisory board, who will collect data electronically using tablets and survey software.
As a partnership including Aurum Institute, Wits University, Sefako Makgatho University of Health Sciences, and Johns Hopkins University, BAMMISHO will have three units: An implementation research and data management division will provide essential information on population dynamics, burden of disease measures, and host implementation research studies aimed at population or community-level interventions; a clinical and laboratory research division will host clinical intervention and cohort studies; and the health systems and public health division will manage health systems and health policy research and broader public health research, including managing interaction with the health service delivery system, healthcare providers, and patients.
How BAMMISHO fits in SAPRIN
Of the seven SAPRIN nodes, four are rural. They are Agincourt (Mpumalanga), DIMAMO (Limpopo), AHRI (KwaZulu-Natal) and BAMMISHO (North West). There are three urban nodes; GRT-INSPIRED (Gauteng), C-SHARP (Western Cape), and USINGA (KwaZulu-Natal).
The seven HDSS nodes, says SAPRIN Director Dr Kobus Herbst, collect longitudinal health and demographic data in their respective nodes using a common and standard research protocol. This enables SAPRIN to pool comprehensive data from the seven nodes to monitor the health and demographic changes within a population over time and facilitates the transferability of findings to similar contexts and the calibration of national data sets, such as those of Statistics South Africa (Stats SA).
"This capability significantly enhances the understanding of health and demographic trends in South Africa, helping to inform decision-making and policy formulation," says Herbst.
He says BAMMISHO will collect the same data as the other six research nodes, but from a different community and context. It is thought that the Royal Bafokeng Nation - a rural area with agriculture-based villages and large-scale mining - will offer a unique perspective on the health and well-being of poor communities in South Africa.
"In addition to implementing the common SAPRIN surveillance protocol, all nodes including BAMMISHO are also encouraged to implement their own unique research agenda," says Herbst.
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@saprin_mrc welcomed its seventh Health and Demographic Surveillance System research node, the Bafokeng Health and Demographic Surveillance Node (BAMMISHO), yesterday, during an official launch event at the Kanana Multi-cultural Centre in Rustenburg. https://t.co/wjeMdJomZ5 pic.twitter.com/HS1wZMhhXU -- SAMRC (@MRCza) November 28, 2024
SAPRIN is funded by the Department of Science, Technology and Innovation, in line with the South African Research Infrastructure Roadmap. The roadmap outlines the country's vision for developing and maintaining research infrastructure, aiming to support high-quality research, foster innovation, and address national priorities.
The South African Medical Research Council (SAMRC) is the hosting institution and provides support to SAPRIN by assisting with managing the distribution of funds and negotiating sub-contracts.
'Trust and respect'
Setswe did not disclose the cost of the research node, saying it is still in the planning stage and consultations with the community advisory board are ongoing. He says that sharing this sensitive information before finalising discussions with the tribal authority would breach the trust between the parties involved.
Dr Kealogetswe Mongale, a clinical psychologist working with the Royal Bafokeng Nation, believes the BAMMISHO node will help to foster trust and respect between researchers and the people they serve.
"The node places emphasis on community engagement, ensuring that research findings translate into actionable policies and interventions. This will help in building trust and respect between researchers and the community," she says.
The Royal Bafokeng Nation, also called 'the people of the dew", sometimes address their King and each other as "Mokwena" meaning "he of the crocodile" as a sign of respect. Whether those involved in the BAMMISHO node will also earn this token of respect, remains to be seen.
