Mandate of MRC/Wits-Agincourt

In partnership with host communities and local institutions, the MRC/Wits Agincourt Research Unit aims to better understand and respond to the dynamics of health, population and social transitions in rural South and southern Africa, to mount a more effective public health, public sector and social response and, thereby, inform national, regional, and global policy.

Agincourt addresses four fundamental questions:

The unpredictability and pace of evolving health, population, and social transitions.

The interacting social and biological determinants and consequences – highlighting vulnerability and resilience – at key stages along the life course.

When, where and how to intervene most effectively.

The implications for health and social sector responses to achieve a more equitable, socially, and economically productive society.

Work is underpinned by the Health and socio-Demographic Surveillance System (HDSS) platform, covering a whole population cohort of ~120,000 persons in 31 adjacent villages, and involving ongoing monitoring of all births, deaths and in- and out-migrations. This population data is linked to clinic and hospital records. Together, this provides an exceptional longitudinal platform for observational and intervention research along the life course, with special focus on children (respiratory infections), adolescents (HIV/AIDS, depression, NCD risk) and older adults (multi-morbidity, cognitive change). Focus on socio-environmental exposures (education, labour migration, socioeconomic status, natural resources, food security) interacts with emphasis on behaviour and physiological risk. 

The figure outlines a framework highlighting key research areas:

Framework highlighting key research areas at Agincourt.

Map of the Agincourt Health and Demographic Surveillance Systems field site and its geographic location within Mpumalanga, South Africa.

The Unit’s primary base is in a rural setting 500km northeast of Johannesburg. Providing a counterpoint to South Africa’s urban bias, the Unit endeavours to bring the best science to bear in a context where populations carry much of the national burden of disease. It contributes vital evidence, provides leadership to sub-Saharan research networks, and partners with leading African, UK and US institutions. Making well-characterised data available to research and policy communities is a priority. Altogether, the Unit contributes unique, population-oriented insight to support health and development in rural South and southern Africa, while providing advanced research training and career development opportunities.

Agincourt’s Research

Agincourt’s research falls under six themes, namely the Longitudinal Research Platform, Adolescent Health and Development, Adult Health and Healthy Ageing, Social and Environmental Determinants, Health and Social Systems, and Mental and Neurological Health and Wellbeing.

The Longitudinal Research Platform theme centers on the Agincourt Health and socio-Demographic Surveillance System (HDSS), which has tracked a rural population's health, demographic, and socio-economic data for over 30 years. All deaths have been followed in these years using the WHO standardized tool of Verbal Autopsy to establish causes of death and burden of disease in the community. This platform supports diverse research projects, including linking healthcare data from clinics and hospitals to monitor disease burden, analyzing excess mortality during the COVID-19 pandemic, and addressing multimorbidity using advanced data science techniques. Additionally, the integration of minimally invasive tissue sampling enhances cause-of-death determination, contributing to better understanding and policy-making in health systems.

The Adolescent Health and Development theme addresses critical health challenges among adolescents in Agincourt. Research focuses on combating depression through digital interventions, improving nutrition and healthy behaviors to tackle malnutrition, and enhancing HIV prevention services for at-risk youth. These projects aim to improve mental, physical, and sexual health, facilitating healthier transitions into adulthood.

The Adult Health and Healthy Ageing theme focuses on understanding and addressing health challenges in aging populations in Agincourt. Key research areas include the impacts of chronic diseases like dementia and kidney disease, the complexities of informal caregiving in resource-limited settings, and the socioeconomic factors influencing health inequities. By harmonizing local data with global studies, these projects aim to improve health outcomes for older adults through early detection, better disease management, and support for caregivers.

The Social and Environmental Determinants theme explores the complex interplay between migration, urbanization, natural resource use, and household dynamics in rural South Africa. It examines how these factors influence health, well-being, and ecological sustainability. Research projects under this theme investigate the health impacts of internal migration, the reliance of rural households on natural resources for livelihoods, and the effects of rural electrification on household dynamics and labor market participation. These studies, embedded within the Agincourt Health and socio-Demographic Surveillance System, provide valuable insights for shaping policies related to health, social welfare, and sustainable development.

The Health and Social Systems theme focuses on improving healthcare delivery and management, particularly in rural and underserved communities. Projects under this theme emphasize the integration of traditional and biomedical healthcare practices, understanding the impact of chronic conditions, and addressing health inequities through innovative research and community engagement. These studies aim to develop sustainable models for healthcare that can be replicated in similar settings, enhancing the overall health and well-being of populations in South Africa and beyond. Through interdisciplinary collaborations, these projects seek to inform health policies and practices, contributing to more effective and equitable health systems. The Mental and Neurological Health and Wellbeing (MNHW) theme at the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) seeks to bring together research related to the human brain and mind across the life course. The ultimate goal is to strengthen research and innovation and generate solutions to the large unaddressed burden of mental, neurological and substance-use (MNS) conditions in rural and low-resource contexts within South Africa and on the African continent. The theme’s working group aims to exploit similarities in methodological approaches, and leverage the interdisciplinary skillsets of researchers that make up the teams of investigators on individual projects within the theme, and build capacity for MNHW research in Southern Africa.

Community Engagement

The SAMRC/Wits-Agincourt Unit has been working closely with its host communities for over 30 years. The Unit’s Public Engagement Office (PEO) plays a crucial role in developing constructive relationships with the community and general public, service providers, researchers, fieldworkers, data analysts, administration, and research office. The PEO is responsible for ensuring that the Unit’s longitudinal community-based surveillance work rests on stable long-term relationships that need to be nurtured and fostered.

Agincourt's Capacity Building and Leadership

The SAMRC/Wits-Agincourt Unit builds the capacity of local staff through its data internship programme, supervises doctoral students, and mentors postdoctoral fellows and early to mid-career researchers. The unit also provides leadership to sub-Saharan African research networks, and partners with leading African, UK, and US institutions.

Contact AGINCOURT 

Agincourt (agincourt.co.za)

Get in touch via ngoni.ngwarai@wits.ac.za