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Undiagnosed and untreated disease identified in rural South Africa

A comprehensive health-screening program in rural northern KwaZulu-Natal has found a high burden of undiagnosed or poorly controlled non-communicable diseases Credit: Africa Health Research Institute BIRMINGHAM, Ala. – A comprehensive health-screening…



A comprehensive health-screening program in rural northern KwaZulu-Natal has found a high burden of undiagnosed or poorly controlled non-communicable diseases

Credit: Africa Health Research Institute

BIRMINGHAM, Ala. – A comprehensive health-screening program in rural northern KwaZulu-Natal, South Africa, has found a high burden of undiagnosed or poorly controlled non-communicable diseases, according to a study published in The Lancet Global Health.

Researchers found that four out of five women over the age of 30 were living with a chronic health condition, and that the HIV-negative population and older people — especially those over 50 — bore the higher burden of undiagnosed or poorly controlled non-communicable diseases such as diabetes and hypertension.

The study was co-led by Emily Wong, M.D., a resident faculty member at the Africa Health Research Institute, or AHRI, in Durban, KwaZulu-Natal, South Africa. Wong is also an assistant professor in the Division of Infectious Diseases, University of Alabama at Birmingham Department of Medicine and an associate scientist in the UAB Center for AIDS Research.

“The data will give AHRI researchers and the Department of Health critical indicators for where the most urgent interventions are needed,” Wong said. “The research was done before COVID-19, but it has highlighted the urgency of diagnosing and treating people with non-communicable diseases — given that people with uncontrolled diabetes and hypertension are at higher risk of getting very ill with COVID.”

Durban lies in the worldwide epicenter for HIV-associated tuberculosis infections. Wong works there to understand the impact of HIV infection — the virus that causes AIDS — on tuberculosis pathogenesis, immunity and epidemiology. She collaborates closely with another UAB researcher who also works at AHRI, Andries “Adrie” Steyn, Ph.D., professor in the UAB Department of Microbiology.

“We are working hard to strengthen ties and collaborations between the two institutions and create a UAB-AHRI Tuberculosis Center that further facilitates multi-disciplinary collaborations,” Wong said. Wong joined UAB last year, and she will spend about 80 percent of her time at AHRI and 20 percent at UAB when travel resumes from its COVID-19 hiatus.

As background to the study, 15 years of intense public health efforts that increased access to anti-retroviral therapy in sub-Saharan Africa has beneficially decreased mortality from AIDS and increased life expectancy. As a result, there is an increasing priority to address other causes of disease, including tuberculosis and non-communicable diseases.

In the 18-month Lancet Global Health study, health workers screened 17,118 people age 15 years and older via mobile camps within 1 kilometer of each participant’s home in the uMkhanyakude district. They found high and overlapping burdens of HIV, tuberculosis, diabetes and hypertension among men and women.

While the HIV cases were, for the most part, well diagnosed and treated, some demographic groups, including men in their 20s and 30s, still had high rates of undiagnosed and untreated HIV. The majority of people with tuberculosis, diabetes or hypertension were either undiagnosed or not well controlled. Tuberculosis remains one of the leading causes of death in South Africa, and the high rates of undiagnosed and asymptomatic tuberculosis that health workers found is a concern.

“Our findings suggest that the massive efforts of the past 15 years to test and treat for HIV have done very well for that one disease,” Wong said. “But in that process, we may have neglected some of the other important diseases that are highly prevalent.”

The mobile camps screened for diabetes, high blood pressure, nutritional status (obesity and malnutrition), and tobacco and alcohol use, as well as HIV and tuberculosis. The tuberculosis screening component included high-quality digital chest X-rays and sputum tests for people who reported symptoms or had abnormal X-rays. Clinical information was layered onto 20 years of population data from AHRI’s health and demographic surveillance research. Through a sophisticated data system and the use of artificial intelligence to interpret the chest X-rays, AHRI’s clinical team examined the information in real time and referred people to the public health system as needed.

Researchers found that:

  • Half of the people 15 years or older had at least one active disease, and 12 percent had two or more diseases. The incidences of diabetes and high blood pressure were 8.5 percent and 23 percent, respectively.
  • One-third of the people were living with HIV, but this was mostly well diagnosed and treated. Women bore a particularly high burden of HIV, high blood pressure and diabetes.
  • For tuberculosis, 1.4 percent of the people had active disease, and 22 percent had lifetime disease. About 80 percent of the undiagnosed tuberculosis was asymptomatic, and men had higher rates of active tuberculosis.

Researchers also identified several disease patterns by geographical location — for example, the highest burden of HIV was seen near main roads, while higher rates of tuberculosis and non-communicable diseases were seen in more remote areas.


Wong is corresponding author of the study “Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study,” and there are 30 co-authors.

Support came from Wellcome Trust grant 201433/Z/16/Z, Bill & Melinda Gates Foundation grant OPP1175182, the South African Department of Science and Innovation, the South African Medical Research Council, and the South African Population Research Infrastructure Network. Support also came from National Institutes of Health grants AI118538 and TW011687, the United Kingdom Medical Research Council, the United Kingdom Department for International Development, the South African Research Chairs Initiative, the Victor Daitz Foundation, and the Sub-Saharan African Network for Tuberculosis and HIV Research.

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Demographic shifts over the balance of this decade

In this week’s video insight, I want to discuss two intriguing findings from Deutsche Bank’s report on global demographic shifts. Firstly, we’ll…



In this week’s video insight, I want to discuss two intriguing findings from Deutsche Bank’s report on global demographic shifts. Firstly, we’ll explore the substantial population growth in less developed regions and its potential implications. Secondly, we’ll delve into the aging population in developed markets, their dependence on government pensions, and the resulting consequences. Many commodities, both construction-related and agricultural, as well as healthcare should benefit from the aggressive shift in demographics.


Hi, I’m David Buckland and welcome to this week’s video insight.

Deutsche Bank Research have released a report on global demographics over the balance of this decade; and I believe two of the more pertinent conclusions follow:

Number 1, In the 71-year period between 1950 and 2021, the population growth of the more developed regions of the world was around 480 million people. For context, the world population in 1950 was 2.5 billion people. However, over the 8-year period 2022-2030, the population growth of the less developed regions of the world is forecast to increase by 575 million people. For context, the world population in 2030 is forecast to be 8.5 billion people.

Growth in less developed regions will catalyse unprecedented demand for raw materials

Growth in less developed regions will catalyse unprecedented demand for raw materials

The strong Emerging Market population growth will drive huge urbanisation, construction, energy and electricity demand, infrastructure, and of course education. Australia should benefit as a significant exporter of commodities, including Coal, Iron-ore, Wheat, Beef, Copper, and Aluminium – where we rank first, second, third or fourth in the world of exports. And;

Number 2, people in developed markets are aging and generally lack pension savings. However growing lifespans from “better health” means people are generally working longer, through either choice or necessity. Amongst the OECD (Organization for Economic Co-operation and Development) countries, the retirement age has gently been trending up to the current 63.5 years of age. 

That said, reliance on governments to provide for retirees is a risk to bigger budget deficits, and potentially bond yields. People want governments to fund pensions, and the concentration of voting power in older generations will keep the pressure up on those governments.

Pension spending in advanced economies is trending up to an estimated 9.25 per cent of GDP (gross domestic product) by 2030, it was sub 5 per cent in 1970, and this is often financed by people in work. The working age population as a percentage of the total population is trending down for many developed economies and that forecast ratio of around 55 per cent by 2030 stands out, particularly places like France, Germany, Italy, and the UK.

Labour force projections for this decade are grim for many major economies

Labour force projections for this decade are grim

Of the 36 OECD economies, total healthcare expenditure is expected to grow by 1.8 per cent of GDP between 2015 and 2030 to around 10 per cent of GDP. In the US, for example, this figure is growing by 3.4 per cent to 20 per cent of GDP over the 15 years to 2030.

In summary, many commodities, both construction-related and agricultural, as well as healthcare should benefit from the aggressive shift in demographics particularly in developing economies over the balance of this decade.

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EUR/USD extends losses, Fed meeting looms

Fed widely expected to hold rates The euro is in negative territory on Wednesday after posting a losing session a day earlier. In the North American session,…



  • Fed widely expected to hold rates

The euro is in negative territory on Wednesday after posting a losing session a day earlier. In the North American session, EUR/USD is trading at 1.0532, down 0.40%.

Fed expected to pause rates

The Federal Reserve makes its interest rate announcement later today and the markets have fully priced in rate pause, which would keep the benchmark rate at 5.25%-5.50%. Although the decision is practically a given, investors will be looking for signals as to what the Fed plans to do next. Fed Chair Powell has been hawkish about inflation and I wouldn’t be surprised if he reiterated the same message at today’s meeting.

On the employment front, JOLTS Job Openings rose to 9.55 million in September, up from a revised 9.49 million in August and above the market consensus of 9.25 million. This was the highest level in four months, another sign that the labour market remains strong. The US releases nonfarm payrolls on Friday, with the banner gain of 336,000 last month still fresh in investors’ minds. The market consensus for September stands at 180,000.

German manufacturing expected to remain soft

Germany’s economy has sputtered, and the once proud locomotive of European growth is looking more like the sick man of Europe. The manufacturing sector has been exceptionally weak and has posted three successive readings below the 40 level. A reading below 50 points to contraction, while above 50 signals expansion. Germany will release the Manufacturing PMI on Thursday. The market consensus for October stands at 40.7, which would be a slight improvement from the September gain of 39.6.


EUR/USD Technical

  • There is resistance at 1.0595 and 1.0664
  • 1.0495 and 1.0426 are providing support

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Estee Slaughter: Beauty Giant Implodes To 6 Year Low As Consumers Hit Brick Wall

Estee Slaughter: Beauty Giant Implodes To 6 Year Low As Consumers Hit Brick Wall

When we looked at the performance of consumer stocks last…



Estee Slaughter: Beauty Giant Implodes To 6 Year Low As Consumers Hit Brick Wall

When we looked at the performance of consumer stocks last quarter, we found a not unexpected divergence between companies catering to lower income consumers, which have been hammered for much of 2023, and those targeting rich buyers, which - especially in the case of a handful of European luxury giants such as LVMH, Kering and Hermes  - had done tremendously well for much of the past year, making Bernard Arnault the richest man in the world, if not for long.

Fast forwarding to today, while we have yet to hit rock bottom when it comes to lower income cohorts, it is becoming increasingly clear that the answer to our question from May, namely "did the luxury bubble just burst" is now a resounding yes as the following boom-to-bust chart of European luxury giants LVMH, Hermes and Kering shows.

Today, the bursting of the luxury bubble took its latest casualty, Estée Lauder, whose already-battered shares plummeted even more, tumbling as much as 21%, their biggest one-day drop in history, after the beauty giant slashed its full-year outlook on troubles in China and the Middle East. The stock has lost almost half of its value in 2023 alone.

As BBG notes, the owner of the MAC and Tom Ford brands has been "floundering in its crucial travel retail business in Asia due to weaker-than-expected demand." The continued weakness in that channel, as well as an added drag from the Israel-Hamas war, show the beauty company has failed once again to get its footing, meaning it is likely to keep ceding market share to archrival L’Oréal.

For the current fiscal year, Estée Lauder expects net sales in a range of negative 2% to positive 1% versus the prior year, while earnings are seen at $2.08 to $2.35 a share. In August, it had forecast net sales to increase between 5% to 7% and saw earnings of $3.43 to $3.70 a share.

Estée Lauder said net sales in the most recent quarter fell 10%, in line with the downbeat outlook the company forecast in August (the only positive was that the company did a +6% in the Americas vs a Consensus -2%, although that too is about to reverse now that Americans are finally paying down their student loans, credit cards are maxed out and any "excess savings" are long gone).

For the current quarter, the company now expects net sales to decrease between 9% to 11% versus a year ago and sees diluted net earnings between 47 cents and 57 cents a share. The potential risks from disruption in Israel and the Middle East are expected to have a dilutive impact of 8 cents. The company doesn’t break out what portion of revenue it generates in the region.

“The big question, like last quarter, and the one before it, will be: ‘Is this the final cut?’” Bernstein analysts led by Callum Elliott wrote in a research note.

Chief Executive Officer Fabrizio Freda said in a statement that the New York-based company lowered its fiscal 2024 outlook due to slower growth in prestige beauty in Asia travel retail and mainland China, as well as the risk of disruption to its business in Israel and elsewhere in the Middle East.

Remarkably, even though Estée Lauder had already lowered expectations in the previous quarter - after already cutting its outlook several times in the past year leading to another near record price drop back in April - the market was still caught off-guard, sending the stock down the most on record. That’s raised concerns among investors that executives don’t have a good grip on what’s happening in their business.

“We thought that this quarter could be the trough and did not expect another guidance cut,” RBC Capital Markets analyst Nik Modi wrote in a research note. “All the read thrus suggested China was weak, but we thought EL’s guidance last quarter accounted for the weakness. Clearly we were wrong.”

On a call with analysts, CEO Freda said: “We expect calendar year 2023 to be the final and, frankly, painful post-Covid reset period for the company.”

Good luck with that.

Curiously, the cosmetic industry may be the one place where lower-income consumers are holding out better then their higher-income peers. Estée Lauder’s quarterly results are in contrast to competitor L’Oréal, which said late last month that sales were up 4.5% in the three months that ended on Sept. 30. While the French beauty giant - which sells more mass-market items under brands such as Maybelline New York and L’Oréal Paris - has also been hit by the slowdown in duty-free sales in China and South Korea, the business represents a much smaller portion of its revenue versus Estée Lauder.

L'Oreal's cheaper products have sold more briskly than items from its more expensive brands as inflation-weary consumers have become pickier. Estée Lauder, meanwhile, sells more higher-end products and on Wednesday cited the “slower-than-expected recovery of overall prestige beauty.”

Which brings us to a key question: has the consumer finally hit a brick wall? While we are confident that recent results indeed confirm that consumers are virtually tapped out, a slightly more cheerful take comes from Goldman consumer trader Scott Feiler who tries to present today's dismal results in a slightly better light.

Here is his take on today's earnings onslaught:

  • Bottom-Line Intact for 3Q: The magnitude of top-line upside has begun to slow, but companies have pretty continued to beat across the board on the EPS/EBITDA line for 3Q. Even the names with the biggest downward reactions this morning so far in the pre (Wayfair, EL, CCEP, GOOS) largely all beat EPS for this quarter.
  • Top-Line Upside is slowing though: While bottom-line remains intact (for 3Q at least), the top-line upside does appear to be harder to come by. See YUM, EAT, EL, GOOS etc for prints that largely saw in-line sales, even as EPS handily beat.
  • Restaurants remain a relatively bright spot in the US: YUM (+1.5% comp beat), FWRG (40 bps comp beat) and EAT (20 bps comp beat at Chili’s) are all “fine” still with still constructive commentary, even as traffic has slowed some.
  • China Unsurprisingly called out as weak: 2 of the biggest stock disappointments this morning are EL (called out incremental headwinds from a slower-than-expected recovery of overall prestige beauty in mainland China) and YUMC (said they observed softening consumer demand emerged in late September through October).
  • The 2 biggest single names in focus in our IB chats - EL and Wayfair.  
    • For EL, the guidance cut only 1 quarter in is well below any of the worst estimates we had heard. The only “positive” is the bulk of it was blamed on China (somewhat known) and the Middle East.  They did a +6% in the Americas vs a Consensus -2%, and so we think a focus on the 930AM call will be whether there were shipment benefits that helped that figure. Despite the better Americas and Jason’s note titled ““bottom perhaps finally found,” the overwhelming feedback continued to be negative this morning on lack of conviction in an EPS bottom.
    • For Wayfair, the stock dropped hard as soon as the release hit. A ton of inbounds from most asking why. Yes, revenues missed for 3Q but it was only a 1% miss vs consensus and the bogey, while margins beat by about 150 bps. The big concern here seems to be less about margins (most understand a beat was likely) and more about top-line, especially fears around 4Q. On the call, they spoke to QTD gross revenues running around flat. We think expectations were well below the consensus +5% for the full 4Q, so agree that the -10% move lower in the pre is a bit surprising. This is a shoot first, ask questions later type tape though.

Needless to say, that is hardly the kind of tape one sees at the start of bull markets.

Tyler Durden Wed, 11/01/2023 - 12:45

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