{
  "abstract": "Background\n\nAttrition in longitudinal studies, defined as the loss of participants over time, may threaten the validity of study results. This study examined patterns, magnitude, and risk factors for attrition in the AWI-Gen cohort.Methods\n\nThe study included 12,032 participants from six African sites, with a median baseline age of 51 years (IQR: 45-57 years). Exploratory data analysis was conducted to examine attrition patterns and magnitude, and fixed-effects logistic regression models were used to identify significant factors associated with different causes of attrition (all-cause, non-death vs death, preventable vs non-preventable) while accounting for site-specific variation. Sensitivity analyses, including Bonferroni adjustments, imputation, and site-specific analyses, were used to assess model robustness. Model goodness-of-fit was evaluated, and adjusted odds ratios with 95% confidence intervals were reported, with a significance threshold of p < 0.05.Results\n\nAfter five years, AWI-Gen experienced 40% attrition. Causes included being unreachable by cell phone (42.6%), refusal (26.0%), death (13.9%), relocation (10.5%), and being recorded as too ill to participate (3.9%), with variations across sites. Male sex and lower socioeconomic status were consistently associated with increased odds across attrition outcomes, while older age, tobacco use, hypertension, chronic kidney disease, and cardiovascular disease were additionally associated with death-related and non-preventable attrition.Conclusion\n\nThis study underscores the importance of reporting attrition causes for consistency in longitudinal research. Male participants, individuals of lower socioeconomic status, older adults, tobacco users, and those living with chronic conditions such as hypertension, chronic kidney disease, and cardiovascular disease were at increased risk of attrition. Tailored retention strategies, including enhanced participant tracing and communication, targeted engagement of men and socioeconomically disadvantaged groups, regular contact with older participants, and integration of follow-up activities with chronic disease management services, may improve participant retention and help preserve the validity of longitudinal research.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.",
    "Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.",
    "MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.",
    "SAMRC/Wits Ageing African Adult Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.",
    "School of Human Development and Health, Southampton, UK.",
    "Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.",
    "Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.",
    "Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical Sciences, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana.",
    "Department of Epidemiology, School of Public Health, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana.",
    "African Population and Health Research Center (APHRC), Nairobi, Kenya.",
    "DIMAMO Population Research Centre, University of Limpopo, Polokwane, South Africa.",
    "Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santè, CNRST, Nanoro, Burkina Faso.",
    "MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia.",
    "Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. michele.ramsay@wits.ac.za."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 22,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Okechinyere Achilonu"
    },
    {
      "affs": [
        1
      ],
      "name": "Theophilus Mathema"
    },
    {
      "affs": [
        1
      ],
      "name": "Furahini Tluway"
    },
    {
      "affs": [
        2
      ],
      "name": "F Xavier Gómez-Olivé"
    },
    {
      "affs": [
        3
      ],
      "name": "Lisa K Micklesfield"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Shane A Norris"
    },
    {
      "affs": [
        5
      ],
      "name": "Nigel J Crowther"
    },
    {
      "affs": [
        2
      ],
      "name": "Chodziwadziwa Whiteson Kabudula"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Godfred Agongo"
    },
    {
      "affs": [
        6,
        8
      ],
      "name": "Engelbert A Nonterah"
    },
    {
      "affs": [
        1
      ],
      "name": "Kayode Adetunji"
    },
    {
      "affs": [
        1
      ],
      "name": "Siyanda Madala"
    },
    {
      "affs": [
        7,
        8
      ],
      "name": "Patrick O Ansah"
    },
    {
      "affs": [
        9
      ],
      "name": "Isaac Kisiangani"
    },
    {
      "affs": [
        9
      ],
      "name": "Shukri F Mohamed"
    },
    {
      "affs": [
        1
      ],
      "name": "Ananyo Choudhury"
    },
    {
      "affs": [
        10
      ],
      "name": "Cairo Bruce Ntimana"
    },
    {
      "affs": [
        10
      ],
      "name": "Reneilwe Given Mashaba"
    },
    {
      "affs": [
        11
      ],
      "name": "Hermann Sorgho"
    },
    {
      "affs": [
        1,
        11,
        12
      ],
      "name": "Palwende Romuald Boua"
    },
    {
      "affs": [
        13
      ],
      "name": "Michele Ramsay"
    },
    {
      "name": "as members of AWI-Gen and the H3Africa Consortium"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ep63wd1k87hmh.bib",
  "cited_by": 0,
  "doi": "10.1186/s12889-026-28794-z",
  "fulltext_url": "https://europepmc.org/articles/PMC13753191",
  "id": "ep63wd1k87hmh",
  "issns": [
    "1471-2458"
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  "landing_url": "https://europepmc.org/article/MED/43009899",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "3312|Survey Methodology and Nonresponse"
    ]
  ],
  "openalex": "W7172262660",
  "pdf_url": "https://europepmc.org/articles/PMC13753191?pdf=render",
  "pmcid": "PMC13753191",
  "pmid": "43009899",
  "published": "2026-08-03",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/ep63wd1k87hmh.ris",
  "sources": [
    {
      "first_seen": "2026-11-12T15:22:43Z",
      "native_id": "MED:43009899",
      "source": "europepmc",
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    {
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      "native_id": "PMC13753191",
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      "url": "https://doi.org/10.1186/s12889-026-28794-z"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1471-2458",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Participant attrition in a multi-regional population-based study in Africa: insights from the AWI-Gen study.",
  "title_text": "Participant attrition in a multi-regional population-based study in Africa: insights from the AWI-Gen study.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-15T12:22:23Z",
  "url": "https://research.draconitic.com/paper/ep63wd1k87hmh",
  "venue": "BMC public health",
  "versions": []
}