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A mixed-methods, population-based study of a syndemic in Soweto, South Africa

Nature Human Behaviour volume 6, pages 64–73 (2022)Cite this article

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Abstract

A syndemic has been theorized as a cluster of epidemics driven by harmful social and structural conditions wherein the interactions between the constitutive epidemics drive excess morbidity and mortality. We conducted a mixed-methods study to investigate a syndemic in Soweto, South Africa, consisting of a population-based quantitative survey (N = 783) and in-depth, qualitative interviews (N = 88). We used ethnographic methods to design a locally relevant measure of stress. Here we show that multimorbidity and stress interacted with each other to reduce quality of life. The paired qualitative analysis further explored how the quality-of-life impacts of multimorbidity were conditioned by study participants’ illness experiences. Together, these findings underscore the importance of recognizing the social and structural drivers of stress and how they affect the experience of chronic illness and well-being.

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Data availability

The data that support the findings of this study cannot be shared publicly due to the risk of patient identification where small numbers of patients per neighbourhood cluster are included (that is, clusters 2 and 3). Researchers interested in inquiring about access to confidential data should contact the corresponding author.

Code availability

The code that supports the findings of this study is available from the corresponding author upon request.

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Acknowledgements

We are greatly indebted to the participants, their families and our research assistants, as this study would not have existed without them. We thank X. Potelwa, S. Kunene, J. Mabasa, S. Mavi, G. Morsi, Z. Mpanza and S. Sihlangu for their collaborative work on the study. We also thank the front-line and community health workers who are working endlessly to keep Soweto and the rest of South Africa healthy and safe during this challenging time. The project benefited substantially from the support of M. Beery. The research was funded by US National Institutes of Health (NIH) grant nos R21TW010789 (E.M., S.A.N. and A.C.T.) and D43TW010543 (A.W.K.), the South African Medical Research Council (S.A.N.) and the Department of Science and Innovation–National Research Foundation Centre of Excellence in Human Development (S.A.N.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA

    Emily Mendenhall & Anthony Panasci

  2. SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Emily Mendenhall, Andrew Wooyoung Kim, Lindile Cele, Feziwe Mpondo, Edna N. Bosire & Shane A. Norris

  3. Center for Global Health, Massachusetts General Hospital, Boston, MA, USA

    Andrew Wooyoung Kim & Alexander C. Tsai

  4. DSI-NRF Centre for Excellence in Human Development, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Feziwe Mpondo

  5. Center for Innovation in Global Health, Georgetown University, Washington, DC, USA

    Edna N. Bosire

  6. Kamuzu University of Health Sciences, Mahatma Gandhi, Blantyre, Malawi

    Edna N. Bosire

  7. Global Health Research Institute, School of Health and Human Development, University of Southampton, Southampton, UK

    Shane A. Norris

  8. Mongan Institute, Massachusetts General Hospital, Boston, MA, USA

    Alexander C. Tsai

  9. Harvard Medical School, Boston, MA, USA

    Alexander C. Tsai

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  1. Emily Mendenhall
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Contributions

E.M. conceived, designed and supervised the project; led and oversaw the analysis; and wrote the paper. A.W.K. organized the data collection and analysis and commented on the manuscript. A.P. analysed the survey data and commented on the manuscript. L.C. collected the data, analysed the qualitative data, prepared some of the tables and commented on the manuscript. F.M. validated the Soweto Syndemics Scale and commented on the manuscript. E.N.B. analysed the qualitative data, helped prepare the tables and commented on the manuscript. S.A.N. conceived and designed the project and commented on the manuscript. A.C.T. conceived and designed the project, led the conceptualization and execution of the quantitative data analysis, and substantially edited the manuscript.

Corresponding author

Correspondence to Emily Mendenhall.

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Competing interests

E.M. reports receiving a financial stipend from Elsevier for her work as co-editor-in-chief of SSM-Mental Health. A.C.T. reports receiving a financial stipend from Public Library of Science for his work as specialty consulting editor of PLoS Medicine and from Elsevier for his work as co-editor-in-chief of SSM-Mental Health.

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Peer review information Nature Human Behaviour thanks Cassandra Workman for their contribution to the peer review of this work.

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Mendenhall, E., Kim, A.W., Panasci, A. et al. A mixed-methods, population-based study of a syndemic in Soweto, South Africa. Nat Hum Behav 6, 64–73 (2022). https://doi.org/10.1038/s41562-021-01242-1

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