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Sekome K, Gómez-Olivé FX, Sherar LB, Esliger DW, Myezwa H. Sociocultural perceptions of physical activity and dietary habits for hypertension control: voices from adults in a rural sub-district of South Africa. BMC Public Health 2024; 24:2194. [PMID: 39138450 DOI: 10.1186/s12889-024-19320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 07/01/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Over half of adults from rural South Africa are hypertensive. Apart from pharmaceutical treatment, lifestyle changes such as increasing physical activity and reducing dietary salt have been strongly advocated for the control of hypertension. However, the control rates of hypertension for adults in rural South Africa are low. In this paper we explore whether this is due to the recommended lifestyle intervention not aligning with the individual's socio-cultural determinants of behaviour change. AIM To explore the social and cultural beliefs, perceptions and practices regarding physical activity and diet as a hypertension control intervention on hypertensive adults living in a rural sub-district in South Africa. METHODS Nine focus group discussions were conducted with hypertensive adults aged 40 years and above from Bushbuckridge sub-district in Mpumalanga Province of South Africa using a semi-structured interview guide. Each session began with introductions of the discussion theme followed by a short discussion on what the participants know about hypertension and the normal blood pressure readings. Physical activity and dietary habits were then introduced as the main subject of discussion. Probing questions were used to get more insight on a specific topic. A thematic analysis approach was used to generate codes, categories, and themes. A manual approach to data analysis was chosen and data obtained through transcripts were analysed inductively. FINDINGS Participants had a lack of knowledge about blood pressure normal values. Perceived causes of hypertension were alluded to psychosocial factors such as family and emotional-related issues. Physical activity practices were influenced by family and community members' attitudes and gender roles. Factors which influenced dietary practices mainly involved affordability and availability of food. To control their hypertension, participants recommend eating certain foods, emotional control, taking medication, exercising, praying, correct food preparation, and performing house chores. CONCLUSION Lifestyle interventions to control hypertension for adults in a rural South African setting using physical activity promotion and dietary control must consider the beliefs related to hypertension control of this population.
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Affiliation(s)
- Kganetso Sekome
- Department of physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa.
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, South Africa.
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, South Africa
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, South Africa
| | - Hellen Myezwa
- School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gebremeskel GG, Haile TG, Gebrewahd GT, Tadesse DB. High Blood Pressure and Its Associated Factors Among Aksum University Students, Northern Ethiopia, 2019: A Cross-Sectional Study. Int J Public Health 2024; 69:1607275. [PMID: 38832212 PMCID: PMC11144848 DOI: 10.3389/ijph.2024.1607275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
Objectives This study aimed to assess the burden of high blood pressure and its associated factors among students at Aksum University. Methods A total of 240 participants were included; participants were selected through simple random sampling from May 2019 to July 2019. Logistic regression analysis was performed, with statistical significance set at a p-value <0.05 and a 95% confidence level. Results This study found that 17.9% of the participants had high blood pressure, with higher rates observed in males (62.79%) than in females (37.21%). Several factors were identified as associated with high blood pressure, including a family history of high blood pressure [AOR 1.72, 95% CI (1. 75-4.04)], regular physical exercise [AOR 0.64, 95% CI (0.30-0.94)], alcohol consumption [AOR 2.16, 95% CI (1.07-4.62)], tobacco smoking [AOR 5.46, 95% CI (1.98-15.07)], and central obesity [AOR 2.72, 95% CI (1.12-6.58)]. Conclusion This study reveals that one out of six students had high blood pressure. Factors such as a family history of high blood pressure, physical inactivity, tobacco smoking, and central obesity were associated with this condition.
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Affiliation(s)
| | - Teklehaimanot Gereziher Haile
- Department of Maternity and Neonatal Nursing, School of Nursing, College of Health Sciences, Aksum University, Axum, Tigray, Ethiopia
| | - Gebremeskel Tukue Gebrewahd
- Department of Critical Care Nursing, School of Nursing, College of Health Sciences, Aksum University, Axum, Tigray, Ethiopia
| | - Degena Bahrey Tadesse
- Department of Adult Health Nursing, School of Nursing, College of Health Sciences, Aksum University, Axum, Tigray, Ethiopia
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Sekome K, Gómez-Olivé FX, Sherar LB, Esliger DW, Myezwa H. Feasibility and acceptability of a contextualized physical activity and diet intervention for the control of hypertension in adults from a rural subdistrict: a study protocol (HYPHEN). Pilot Feasibility Stud 2024; 10:22. [PMID: 38308346 PMCID: PMC10837970 DOI: 10.1186/s40814-024-01456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/22/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION In rural and remote South Africa, most strokes and ischaemic heart diseases are as a consequence of hypertension, which is a modifiable risk factor. The widely recommended therapeutic approaches to control hypertension are through physical activity and diet modifications. However, there is a lack of culturally sensitive community-based, lifestyle interventions to control hypertension among rural African adult populations. We designed an intervention which recommends adjusting daily routine physical activity and dietary behaviour of adults with hypertension. This study aims to evaluate the feasibility and acceptability of HYPHEN in a rural community setting. METHODS We aim to recruit 30 adult participants with a self-report hypertension diagnosis. A one-arm, prospective design will be used to assess the feasibility and acceptability of recruitment, uptake, engagement, and completion of the 10-week intervention. Recruitment rates will be assessed at week 0. Intervention uptake, engagement, and adherence to the intervention will be assessed weekly via telephone. Blood pressure, body mass index, waist-hip ratio, urinary sodium, accelerometer-measured physical activity, and 24-h diet recall will be assessed at baseline and at 10 weeks. Qualitative semi-structured interviews will be conducted at 10 weeks to explore feasibility and acceptability. DISCUSSION This study offers a person-centred, sociocultural approach to hypertension control through adaptations to physical activity and dietary intake. This study will determine whether HYPHEN is feasible and acceptable and will inform changes to the protocol/focus that could be tested in a full trial. TRIAL REGISTRATION NUMBER PACTR202306662753321.
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Affiliation(s)
- Kganetso Sekome
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa.
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Hellen Myezwa
- Faculty of Health Sciences, School of Therapeutic Science, University of the Witwatersrand, Johannesburg, South Africa
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Gizamba JM, Davies J, Africa C, Choo-Kang C, Goedecke JH, Madlala H, Lambert EV, Rae DE, Myer L, Luke A, Dugas LR. Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:861. [PMID: 38062372 PMCID: PMC10704741 DOI: 10.1186/s12879-023-08736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND HIV has become a manageable chronic condition due to the success and scale-up of antiretroviral therapy (ART). Globally, South Africa has the highest number of people living with HIV (PLHIV) and research evidence indicates that countries with the highest burden of PLHIV have a substantial burden of obesity, hypertension (HPT) and type 2 diabetes (T2D). We sought to summarize the burden of these three common NCDs among PLHIV in South Africa. METHODS In this systematic review, multiple databases were searched for articles reporting on the prevalence of obesity, HPT, and T2D among PLHIV in South Africa published since journal inception until March 2022. A meta-analysis was conducted using random-effects models to obtain pooled prevalence estimates of the three NCDs. Heterogeneity was assessed using X2 test on Cochran's Q statistic. RESULTS We included 32 studies, with 19, 22 and 18 studies reporting the prevalence of obesity, HPT, and T2D among PLHIV, respectively. The overall prevalence of obesity, HPT, and T2D was 23.2% [95% CI 17.6; 29.9], 25.5% [95% CI 15.6; 38.7], and 6.1% [95% CI 3.8; 9.7] respectively. The prevalence of obesity was significantly higher among women (P = 0.034) compared to men, however the prevalence of HPT and T2D did not differ by sex. The prevalence of each of the three NCDs did not differ significantly between rural, urban, and peri-urban areas. The prevalence of obesity and T2D was higher in studies conducted between 2013 and 2022 compared to studies conducted between 2000 and 2012, while the prevalence of HPT was higher between 2000 and 2012 compared to between 2013 and 2022. CONCLUSIONS These findings suggest that South Africa is experiencing a syndemic of NCDs among people PLHIV highlighting the need to increase cost-effective interventions and management strategies that involve integrated HIV and NCD care in the South African setting.
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Affiliation(s)
- Jacob M Gizamba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Jess Davies
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Chad Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Candice Choo-Kang
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Julia H Goedecke
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Hlengiwe Madlala
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Estelle V Lambert
- Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dale E Rae
- Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Amy Luke
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Lara R Dugas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
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Bühler JL, Shrikhande S, Kapwata T, Cissé G, Liang Y, Pedder H, Kwiatkowski M, Kunene Z, Mathee A, Peer N, Wright CY. The Association between Apparent Temperature and Hospital Admissions for Cardiovascular Disease in Limpopo Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010116. [PMID: 36612437 PMCID: PMC9820030 DOI: 10.3390/ijerph20010116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 05/27/2023]
Abstract
Cardiovascular diseases (CVDs) have a high disease burden both globally and in South Africa. They have also been found to be temperature-sensitive globally. The association between temperature and CVD morbidity has previously been demonstrated, but little is known about it in South Africa. It is important to understand how changes in temperature in South Africa will affect CVD morbidity, especially in rural regions, to inform public health interventions and adaptation strategies. This study aimed to determine the short-term effect of apparent temperature (Tapp) on CVD hospital admissions in Mopani District, Limpopo province, South Africa. A total of 3124 CVD hospital admissions records were obtained from two hospitals from 1 June 2009 to 31 December 2016. Daily Tapp was calculated using nearby weather station measurements. The association was modelled using a distributed lag non-linear model with a negative binomial regression over a 21-day lag period. The fraction of morbidity attributable to non-optimal Tapp, i.e., cold (6-25 °C) and warm (27-32 °C) Tapp was reported. We found an increase in the proportion of admissions due to CVDs for warm and cold Tapp cumulatively over 21 days. Increasing CVD admissions due to warm Tapp appeared immediately and lasted for two to four days, whereas the lag-structure for the cold effect was inconsistent. A proportion of 8.5% (95% Confidence Interval (CI): 3.1%, 13.7%) and 1.1% (95% CI: -1.4%, 3.5%) of the total CVD admissions was attributable to cold and warm temperatures, respectively. Warm and cold Tapp may increase CVD admissions, suggesting that the healthcare system and community need to be prepared in the context of global temperature changes.
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Affiliation(s)
- Jacqueline Lisa Bühler
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
| | - Shreya Shrikhande
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
| | - Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
| | - Guéladio Cissé
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
| | - Yajun Liang
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Hugo Pedder
- Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK
| | - Marek Kwiatkowski
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
| | - Zamantimande Kunene
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa
| | - Angela Mathee
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Durban 4091, South Africa
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Caradee Y. Wright
- Environment and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0001, South Africa
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Rahimi A, Nkombua L. Hypertensive patients’ knowledge and practices on lifestyle modification in Extension 6, Middelburg. S Afr Fam Pract (2004) 2022; 64:e1-e8. [PMID: 36073105 PMCID: PMC9459174 DOI: 10.4102/safp.v64i1.5528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/04/2022] Open
Abstract
Background Hypertension (HTN) is one of the most common chronic diseases affecting the majority of patients worldwide, including in South Africa. The control of HTN and prevention of complications are major challenges for patients and healthcare workers. The proper control of the disease requires a multifactorial approach consisting of medical treatment, as well as lifestyle modification, with the assistance of healthcare workers. Addressing patients’ beliefs, the practice of lifestyle and acceptance of change are some of the ways of aiding control. Methods The researchers used a cross-sectional and descriptive survey to establish the knowledge and practices of lifestyle modifications in patients with hypertension. A validated questionnaire was adopted. A total of 250 participants from the Extension 6 Clinic in Middelburg, Mpumalanga, constituted the study population. Results Most of the participants had borderline high blood pressure (37.2%) or uncontrolled high blood pressure (46%). The participants’ knowledge of HTN and its complications was not adequate. The study established that increased age and long duration of HTN were associated with high numbers of uncontrolled HTN. Most of the participants (88.8%) had difficulty exercising. Also, most of the participants (90.8%) did not have a place or facility for exercises. Fifty per cent of the participants were unable to maintain a balanced healthy diet which included fruits and vegetables. Conclusion The study explored the participants’ knowledge and practice of lifestyle modification. The participants lacked knowledge regarding the definition of HTN and the meaning of controlled HTN. To assist the patients and improve on the identified pitfalls, each consultation session should include some methods of education, and motivation for healthy behaviours and lifestyle modification. This should be extended to all the people visiting the health facilities for them to adopt a healthier diet, greater intake of vegetables and availability of fitness facilities for the community.
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Affiliation(s)
- Amir Rahimi
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Micklesfield LK, Kolkenbeck-Ruh A, Mukoma G, Prioreschi A, Said-Mohamed R, Ware LJ, Motlhatlhedi M, Wrottesley SV, Norris SA. The Healthy Aging Adult South Africa report card: a systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women. Cardiovasc J Afr 2022; 33:200-219. [PMID: 35789240 PMCID: PMC9650148 DOI: 10.5830/cvja-2022-015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/14/2022] [Indexed: 10/03/2023] Open
Abstract
Due to the increasing non-communicable disease burden in Africa, several strategies that target the major lifestyle and physiological risk factors have been implemented to combat such diseases. The Healthy Aging Adult South Africa report card systematically reviews national and regional prevalence data of middle-aged South African adults (45-65 years) published between 2013 and 2020 on diet, physical activity, tobacco use and alcohol consumption, obesity, hypertension, dyslipidaemia and diabetes mellitus. Each indicator was assigned two grades, (1) based on the availability of prevalence data, and (2) based on whether policies have been proposed and implemented for the respective indicators. Alcohol consumption, obesity, hypertension and diabetes received an A grade for the availability of prevalence data. Tobacco use and diet received an A grade for policy and implementation. Gaps have been identified that need to be filled by future research focusing on continued surveillance of all indicators in order to inform and implement effective policies.
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Affiliation(s)
- Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Andrea Kolkenbeck-Ruh
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gudani Mukoma
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Utility of Obesity Indicators for Predicting Hypertension among Older Persons in Limpopo Province, South Africa. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In view of the epidemic proportions of obesity in South Africa and its relationship to cardiometabolic diseases, such as hypertension, a cross sectional study was conducted to investigate the utility of obesity indicators for predicting hypertension among older persons (≥60 years, n = 350) in the Limpopo Province of South Africa. The WHO STEPwise approach was used to collect data on demographic and lifestyle factors. Anthropometrics and blood pressure were measured according to the standard procedures. Receiver operating characteristic curves (ROC) were used to investigate and compare the ability of obesity indicators to predict overall hypertension and either increased systolic (SBP) or increased diastolic (DBP) blood pressure. The area under the ROC curve (AUC) was used to assess a certain indicator’s potential to predict overall hypertension and either increased SBP or increased DBP. Multivariate logistic regression analysis was used to determine the relationship of hypertension with obesity indicators. The mean age of the participants was 69 years (±SD = 7), and hypertension (46%), general obesity (36%) and abdominal obesity (57%) were prevalent among older persons. The obesity indicator body mass index (BMI) (AUC = 0.603 (0.52; 0.69)) was the best predictor of hypertension in older men. Waist circumference (WC) (AUC = 0.640 (0.56; 0.72)) and waist-to-height ratio (WHtR) (AUC = 0.605 (0.52; 0.69)) were better predictors of hypertension than BMI and waist-to-hip ratio (WHR) in older women. After adjustment for risk factors, only WC (AOR = 1.22 (1.16; 1.79)) was significantly associated with hypertension in older women, proposing WC as a screening tool for the prediction of hypertension in South African older women.
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Obesity as a Risk Factor for Hypertension and Diabetes among Truck Drivers in a Logistics Company, South Africa. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite the occupational nature of truckers predisposing them to cardiovascular diseases and risk factors, data is scarce on their prevalence of obesity and its association with developing hypertension (HBP) and diabetes in South Africa. Extracted from the original cross-sectional study of a sample of 312 employees in a logistics company, a census of 96 male truckers was used to determine the prevalence of obesity and its association with HBP and diabetes. WHO STEPwise approach was used to collect data, including systolic (SBP) and diastolic (DBP) blood pressure and anthropometry measurements. HBP is defined as SBP/DBP ≥ 140/90 mmHg, overweight/obesity as BMI ≥ 25 kg/m2, abdominal obesity by waist circumference as WC ≥ 90cm, waist-to-hip-ratio as WHR ≥ 0.90, and waist-to-height ratio as WHtR ≥ 0.5. Data were analysed using SPSS 22. The mean age of truckers was 46 years, 29% were smokers, and 57% alcohol users, while 26% were physically inactive. The prevalence of overweight (44%) and obesity (30%) were observed, while abdominal obesity was high; WC (59%), WHR (65%), and WHtR (80%). HBP (57%) was prevalent and diabetes was 14%. The odds of developing HBP were high for obese truckers by WC [AOR = 4.68; CI = 1.92–11.34)] and by WHtR [AOR = 5.49 CI = 1.74–17.27), while diabetes was associated with WHR (AOR = 1.19; CI = 1.19–31.21). This study showed an associative link between obesity, HBP, and diabetes among the truckers, which is informative for a relevant prevention programme tailored to their needs.
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Houle B, Gaziano TA, Angotti N, Mojola SA, Kabudula CW, Tollman SM, Gómez-Olivé FX. Hypertension incidence among middle-aged and older adults: findings from a 5-year prospective study in rural South Africa, 2010-2015. BMJ Open 2021; 11:e049621. [PMID: 34876423 PMCID: PMC8655592 DOI: 10.1136/bmjopen-2021-049621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES There is a scarcity of longitudinal cohort studies in sub-Saharan Africa to understand the epidemiology of cardiovascular disease as a basis for intervention. We estimated incident hypertension and associated sociodemographic, health and behavioural risk factors in a population aged 40 years and older over a 5-year period. DESIGN We assessed the association between incident hypertension and sociodemographic, health and behavioural factors using Poisson regression. We adjusted for non-response in 2015 using inverse probability sampling weights from a logistic regression including sex and age at baseline. SETTING Rural South Africa. PARTICIPANTS We used a population-based cohort of normotensive adults in 2010 who were aged 40 years and older at retest in 2015. RESULTS Of 676 individuals completing baseline and 5-year follow-up, there were 193 incident cases of hypertension. The overall hypertension incidence rate was 8.374/100 person-years. In multivariable analyses, those who became hypertensive were more likely to be older, have a high waist circumference (incidence rate ratio (IRR): 1.557, 95% CI: 1.074 to 2.259) and be employed (IRR: 1.579, 95% CI: 1.071 to 2.329) at baseline. Being HIV positive and not on antiretroviral therapy at baseline was associated with lower risk of incident hypertension. CONCLUSIONS Over a 5-year period, 29% of respondents developed hypertension. Given the high burden of hypertension in South Africa, continued longitudinal follow-up is needed to understand the complex interplay of non-communicable and infectious diseases and their underlying and modifiable risk factors to inform public health prevention strategies and programmes.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas A Gaziano
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Nicole Angotti
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, American University, Washington, District of Columbia, USA
| | - Sanyu A Mojola
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, School of Public and International Affairs, and Office of Population Research, Princeton University, Princeton, New Jersey, USA
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umea University, Umea, Sweden
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
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11
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Ringane MC, Choma SSR. The optimal WC cut-off points for the prediction of subclinical CVD as measured by carotid intima-media thickness among African adults: a cross-sectional study. BMC Cardiovasc Disord 2021; 21:575. [PMID: 34852773 PMCID: PMC8638118 DOI: 10.1186/s12872-021-02389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased waist circumference (WC) is one of the cardiovascular disease (CVD) risk factors used to predict cardiovascular events. Waist circumference cut-off values for predicting metabolic syndrome and other cardiovascular risks have been previously studied. Carotid intima-media thickness (CIMT) is one of the cardiovascular risk factor recently described and reported to be suitable as it is a direct measurement of vascular quality. Hence the aim of the present study was to determine the optimal WC cut-off point for the prediction of subclinical CVD. METHODS The study was a cross-sectional study using quantitative methods, conducted among 1318 adults aged between 40 and 60 years old, residing in a rural Black population in Limpopo province. Carotid Intima-Media Thickness measurements were performed using a LOGIQ ultrasound system (GE Healthcare, CT, USA). Waist Circumference (WC) (cm) was measured to the nearest 0.1 cm. Bivariate correlation, logistic regression and receiver operating characteristic were analysed using the statistical package for social sciences version 26.0 software. RESULTS Among the total population, 69% were women and 31% men with a mean age of 53 ± 7 years. Among women, WC at a cut-off value of 95 cm gave the highest sensitivity of 57%, the specificity of 55% and an area under the curve (AUC) of 0.588. In men, an optimum WC cut-off point of 82 cm yielded the highest sensitivity and specificity at 72% and 70% respectively, with an AUC of 0.767 p < 0.001. CONCLUSION The traditional waist circumference cut-off points (94 cm for women and 80 cm for men) that are currently used for the diagnosis of metabolic syndrome might not be suitable in the prediction of an increased CIMT.
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Affiliation(s)
- M C Ringane
- Department of Pathology and Medical Sciences, University of Limpopo, Private Bag X1106, Sovenga, South Africa.
| | - S S R Choma
- Department of Pathology and Medical Sciences, University of Limpopo, Private Bag X1106, Sovenga, South Africa
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Douglas M, Kgatla N, Sodi T, Musinguzi G, Mothiba T, Skaal L, Makgahlela M, Bastiaens H. Facilitators and barriers in prevention of cardiovascular disease in Limpopo, South Africa: a qualitative study conducted with primary health care managers. BMC Cardiovasc Disord 2021; 21:492. [PMID: 34641818 PMCID: PMC8507214 DOI: 10.1186/s12872-021-02290-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background In the Southern African countries, cardiovascular disease burden is increasing and the second most prevalent cause of death after infectious diseases. The sustainable primary prevention of cardiovascular disease is associated with the engagement of facilitators that support it and hindered by barriers that undermine the support of a healthy lifestyle at the community level. The purpose of the study was to investigate facilitators and barriers at the level of primary health care facilities, on prevention of cardiovascular disease in Limpopo Province of South Africa. Methods This study is an exploratory and descriptive qualitative design, where open-ended key informant interviews were conducted among 20 primary health care managers conveniently sampled in their respective health care facilities. Coding and analysis were done using the thematic analysis method with the assistance of Atlas ti qualitative software. Results Various facilitators for the prevention of CVD were identified in this study. One of such facilitators is the availability and adherence to CVD treatment guidelines in the district. Other facilitators included top-down health education programme; collaboration with schools, traditional and religious leaders; the use of modern technology; and a structured healthcare system. Barriers were also identified as poor infrastructural development; shortage of medical supplies and equipment; lack of health promotion activities; shortage of nurses and other health care personnel; and poor accessibility to primary health care services. Conclusion This study has identified barriers and facilitators that may be harnessed to improve cardiovascular disease prevention, care, and management in a rural setting in South Africa. The facilitators should be strengthened, and barriers identified redressed. Trial registration number: REC-0310111-031. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02290-1.
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Affiliation(s)
- Mbuyiselo Douglas
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa.
| | - Nancy Kgatla
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Tholene Sodi
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Geofrey Musinguzi
- Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Tebogo Mothiba
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Linda Skaal
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Mpsanyana Makgahlela
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Hilde Bastiaens
- Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
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Bokaba M, Modjadji P, Mokwena KE. Undiagnosed Hypertension in a Workplace: The Case of a Logistics Company in Gauteng, South Africa. Healthcare (Basel) 2021; 9:healthcare9080964. [PMID: 34442101 PMCID: PMC8394589 DOI: 10.3390/healthcare9080964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
A large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular diseases in South Africa. A workplace may either mitigate or accentuate the risk factors for hypertension. A cross sectional study was conducted to determine the prevalence of undiagnosed hypertension and associated factors among 312 employees in a Logistics Company, South Africa. A modified, validated, self-administered WHO STEPwise questionnaire was used to collect data on demography, lifestyle factors, anthropometry and blood pressure (BP). Hypertension was defined at BP ≥ 140/90 mmHg. Data was analysed using STATA 14. Mean age of employees was 40 ± 10 years, with a 50% prevalence of undiagnosed hypertension. No significant association was observed between occupation and undiagnosed hypertension, except for high prevalence of undiagnosed hypertension among truck drivers and van assistants (43%), and general workers (27%), having higher odds of increased waist-to-height ratio. Hypertension was associated with age (OR = 2.3, 95%CI; 1.21–4.27), alcohol use (AOR = 1.8, 95%CI; 1.05–2.93), waist circumference (AOR = 2.3, 95%CI; 1.29–4.07) and waist-to-height-ratio (AOR = 3.7, 95%CI; 1.85–7.30). Improved and effective workplace health programs and policies are necessary for management of undiagnosed hypertension among employees. Longitudinal studies on mediation of occupation in association of demographic and lifestyle factors with hypertension in workplaces are needed.
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14
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Mphekgwana PM, Mabila LN, Maimela E. Indirect and direct effects of factors associated with diabetes amongst the rural black population in the Dikgale Health and Demographic Surveillance System, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e6. [PMID: 34342480 PMCID: PMC8335786 DOI: 10.4102/phcfm.v13i1.2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/17/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Diabetes is an enormous, growing clinical and public health problem, which together with hypertension contributes significantly to the high risk of cardiovascular diseases (CVDs) globally. Aim To examine the indirect and direct effects of risk factors simultaneously as a network of multiple pathways leading to diabetes in the rurally based adult population (aged 15+) using a household survey. Methods This investigation was based on a predictive model using a cross-sectional community-based study to identify the direct and indirect effects of diabetes risk factors in the Dikgale Health and Demographic Surveillance System (HDSS) consisting of 15 villages, with 7200 households and a total population of approximately 36 000. Fasting blood glucose and total cholesterol were measured using ILAB 300 with the following cut-off values: high fasting blood glucose 7 mmol/L and triglycerides 1.70 mmol/L. Results A total of 1407 individuals were interviewed, of whom 1281 had their blood pressure (BP) measured. The conceptual model was validated by the goodness-of-fit indexes (comparative fit index [CFI] = 1.00, Tucker Lewis index [TLI] = 1.041, root mean square error of approximation [RMSEA] = 0.001). Hypertension had the strongest direct effect of 0.0918 on diabetes, followed by age (0.0039) and high waist circumference (−0.0023). Hypertension also mediates the effects that high waist circumference (0.0005) and triglycerides (0.0060) have on diabetes status. Conclusion The results in this study confirm the conceptual model considered in the risk factors for diabetes and suggest that hypertension, age and high waist circumference are the key variables directly affecting the diabetes status in the South African rural black population. The direct effect of triglycerides on diabetes suggests mediation by some measured factor(s).
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Affiliation(s)
- Peter M Mphekgwana
- Department of Research Administration and Development, University of Limpopo, Polokwane.
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15
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Chiwandire N, Zungu N, Mabaso M, Chasela C. Trends, prevalence and factors associated with hypertension and diabetes among South African adults living with HIV, 2005-2017. BMC Public Health 2021; 21:462. [PMID: 33676478 PMCID: PMC7937211 DOI: 10.1186/s12889-021-10502-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many people are now living longer with HIV due to access to antiretroviral treatment. In turn, there has been an increase in the burden of hypertension and diabetes. The paucity of data on the burden of hypertension and diabetes in adults living with HIV in South Africa is a public health concern. The paper aimed to describe the prevalence and factors associated with hypertension and diabetes among adults living with HIV (ALHIV). METHODS This was a secondary data analysis of the population based on the South African National HIV Prevalence, Incidence, Behaviour and Communication surveys for 2005, 2008 and 2017. Descriptive statistics were used to summarise the characteristics of the study sample. Bivariate and multivariate logistic regression analyses were used to determine factors associated with hypertension and diabetes. RESULTS The total study population of ALHIV aged 25 years and older was 978, 1023 and 2483 for 2005, 2008 and 2017. The prevalence of hypertension showed an increasing trend at 11.8% in 2005, 9.5% in 2008 and 14.3% in 2017. The prevalence of diabetes was 3.3% in 2005, 2.8% in 2008 and 3.2% in 2017. Increased odds of hypertension among adults living with HIV were consistently associated with being female and the age group 45 years older across all the survey years, including pensioners and the sick, living in urban areas, high risk of hazardous alcohol consumption, diabetes and heart disease. Increased odds of diabetes were consistently associated with hypertension across all the survey years, including age group 45 years and older, and poor health. While having a secondary level of education and above was protective against diabetes. CONCLUSION The study showed that the prevalence of hypertension is high and has increased over time among adults living with HIV while the prevalence of diabetes has remained constant. Findings identified factors consistently associated with the prevalence of both diseases overtime, including contemporary risk factors that should be targeted in the integrated management of chronic disease and HIV care model.
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Affiliation(s)
- Nicola Chiwandire
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Nompumelelo Zungu
- Human Sciences Research Council, Pretoria, South Africa
- Department of Psychology, University of Pretoria, Pretoria, South Africa
| | | | - Charles Chasela
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Implementation Science Unit Programme, Right to Care, Johannesburg, South Africa
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Nurses' Experiences in Managing Cardiovascular Disease in Selected Rural and Peri-Urban Clinics in Limpopo Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052570. [PMID: 33806589 PMCID: PMC7967373 DOI: 10.3390/ijerph18052570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/17/2022]
Abstract
Deaths caused by cardiovascular diseases (CVDs) account for 60% of all deaths that occur in rural and remote areas. Disease management programs are increasingly used to improve the effectiveness of chronic care. Nurses are a key component of the health workforce and have an important role to play in CVD prevention, treatment, and the care of sick people in remote areas. Due to the nature of their work, nurses are prone to working hard, and to experience burnout, sleep, or eating disorders. This is often exacerbated by a shortage of staff and equipment. The objectives of the study were to explore and describe the experiences of professional nurses in managing CVDs in South African rural and peri-urban clinics. A qualitative, explorative-descriptive design and a contextual research approach were adopted for the present study. Purposive sampling was employed to recruit nurses who were managing patients with CVD from 11 primary health care facilities. Data were collected through semi-structured individual interviews and analyzed using Tesch's open coding method. Interview transcripts were coded and analyzed for common themes. The following two major themes emerged from the data: perceived institutional challenges affecting the management of CVDs and nurses' perceptions of patient challenges that impede the effective management of CVD. The study concludes by highlighting that apart from a resource challenge, the shortage of nurses in rural clinics is the biggest reason behind overcrowding, waiting long hours for consultations, and an increase in the workload, resulting in medical errors and poor quality care. It is, therefore, recommended that, for improved care and management of CVD in rural populations, local governments need to employ more skilled nurses whilst availing the necessary material resources.
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Mphekgwana PM, Malema N, Monyeki KD, Mothiba TM, Makgahlela M, Kgatla N, Makgato I, Sodi T. Hypertension Prevalence and Determinants among Black South African Adults in Semi-Urban and Rural Areas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7463. [PMID: 33066410 PMCID: PMC7602258 DOI: 10.3390/ijerph17207463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 11/03/2022]
Abstract
The burden of hypertension is reported to be on the rise in developing countries, such as South Africa, despite increased efforts to address it. Using a cross-sectional study design, we assessed and compared the prevalence of and risk factors associated with hypertension amongst adults aged ≥18 years in semi-urban and rural communities (1187 semi-urban and 1106 rural). Trained community health workers administered the INTERHEART Risk Score tool and performed blood pressure assessments using the MEDIC Pharmacists Choice Blood Pressure Monitor. Hypertension was defined to be a systolic blood pressure (BP) ≥ 140 mmHg and diastolic BP ≥ 90 mmHg. A multivariate logistic regression model was used to identify factors and determine their relationship with hypertension. The prevalence of hypertension amongst semi-urban and rural communities was 21% with no gender difference. In the semi-urban area, physical activity, family history, fruit intake, salty food, and eating meat were significantly associated with the odds of hypertension among women, whereas only the waist-to-hip ratio (WHR), diabetic status, and salty food were the predictors for rural women. Factors such as fried food and low fruit intake were significantly associated with the odds of hypertension among men in the semi-urban area, whereas only the WHR was significant among men in the rural area. Hypertension was found to be prevalent among semi-urban and rural adults in Limpopo Province, South Africa.
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Affiliation(s)
- Peter M. Mphekgwana
- Research Administration and Development, University of Limpopo, Polokwane 0700, South Africa
| | - Nancy Malema
- Department of Psychology, University of Limpopo, Polokwane 0700, South Africa; (N.M.); (M.M.); (I.M.); (T.S.)
| | - Kotsedi D. Monyeki
- Department of Physiology and Environmental Health, University of Limpopo, Polokwane 0700, South Africa;
| | - Tebogo M. Mothiba
- Faculty of Health Science, University of Limpopo, Polokwane 0700, South Africa;
| | - Mpsanyana Makgahlela
- Department of Psychology, University of Limpopo, Polokwane 0700, South Africa; (N.M.); (M.M.); (I.M.); (T.S.)
| | - Nancy Kgatla
- Department of Nursing Science, University of Limpopo, Polokwane 0700, South Africa;
| | - Irene Makgato
- Department of Psychology, University of Limpopo, Polokwane 0700, South Africa; (N.M.); (M.M.); (I.M.); (T.S.)
| | - Tholene Sodi
- Department of Psychology, University of Limpopo, Polokwane 0700, South Africa; (N.M.); (M.M.); (I.M.); (T.S.)
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Dereje N, Earsido A, Temam L, Abebe A. Uncovering the high burden of hypertension and its predictors among adult population in Hosanna town, southern Ethiopia: a community-based cross-sectional study. BMJ Open 2020; 10:e035823. [PMID: 33051227 PMCID: PMC7554456 DOI: 10.1136/bmjopen-2019-035823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Hypertension is a global public health problem, with its burden increasing particularly in developing countries. However, it has not yet received due attention in Ethiopia. The aim of this study was to determine the prevalence and associated factors of hypertension among adult population in Hosanna town, southern Ethiopia. DESIGN Community-based cross-sectional study. SETTING Hosanna town, southern Ethiopia. PARTICIPANTS Adult population aged ≥18 years (n=634) were recruited by a multistage stratified sampling technique. OUTCOME MEASURES A face-to-face interview using structured questionnaire was carried out by trained nurses. Anthropometry and blood pressure were measured following standard procedures. Hypertension status was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg in two separate measurements or reported use of prescribed antihypertensive drugs for raised blood pressure. Factors associated with hypertension were identified by multivariable binary logistic regression analysis. RESULTS The overall prevalence of hypertension was found to be 17.2% (19.3% and 14.2% among men and women, respectively). About 40% were unaware that they were hypertensive prior to the study. Older age ≥35 years (adjusted OR=3.9, 95% CI: 1.4 to 10.8), alcohol use (adjusted OR=3.4, 95% CI: 1.4 to 8.3), consumption of saturated oil (adjusted OR=6.5, 95% CI: 1.5 to 17.5) and unspecified different types of oil (adjusted OR=8.2, 95% CI: 1.9 to 25.1) and overweight/obesity (adjusted OR=2.9, 95% CI: 1.9 to 4.6) were found to be independently associated with hypertension. CONCLUSIONS The prevalence of both diagnosed and undiagnosed hypertension is alarmingly high in the town. These findings underscore the need to design health information provision systems on the risk factors of hypertension and promote good health practices. Blood pressure screening programmes at community levels to identify and treat undiagnosed hypertension should be considered.
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Affiliation(s)
- Nebiyu Dereje
- Department of Public Health, Wachemo University, Hosanna, Ethiopia
| | - Alemu Earsido
- Department of Public Health, Wachemo University, Hosanna, Ethiopia
| | - Layla Temam
- Department of Medicine, Wachemo University, Hosanna, Ethiopia
| | - Ashenafi Abebe
- Department of Statistics, Wachemo University, Hosanna, Ethiopia
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Simo LP, Agbor VN, Noubiap JJN, Nana OP, Nkosu PSM, Anouboweh AFA, Ndi JN, Mbock JN, Bakari NF, Tambou HGG, Mbanya D. Hypertension prevalence, associated factors, treatment and control in rural Cameroon: a cross-sectional study. BMJ Open 2020; 10:e040981. [PMID: 32907908 PMCID: PMC7482484 DOI: 10.1136/bmjopen-2020-040981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Sub-Saharan Africa is experiencing a surge in the burden of hypertension, and rural communities are increasingly affected by the epidemic. OBJECTIVES We aimed to determine the prevalence of and factors associated with hypertension in rural communities of the Baham Health District (BHD), Cameroon. In addition, we sought to assess awareness, treatment and control rates of hypertension among community members. DESIGN A community-based cross-sectional study. SETTING Participants from five health areas in the BHD were recruited from August to October 2018. PARTICIPANTS Consenting participants aged 18 years and above were included. RESULTS We included 526 participants in this study. The median age of the participants was 53.0 (IQR=35-65) years and 67.1% were female. The crude prevalence of hypertension was 40.9% (95% CI=36.7-45.1) with no gender disparity. The age-standardised prevalence of hypertension was 23.9% (95% CI=20.3-27.5). Five-year increase in age (adjusted OR (AOR)=1.34; 95% CI=1.23-1.44), family history of hypertension (AOR=2.22; 95% CI=1.37-3.60) and obesity (AOR=2.57; 95% CI=1.40-4.69) were associated with higher odds of hypertension after controlling for confounding. The rates of awareness, treatment and control of hypertension were 37.2% (95% CI=31.0-43.9), 20.9% (95% CI=16.0-26.9) and 22.2% (95% CI=12.2- 37.0), respectively. CONCLUSION The high prevalence of hypertension in these rural communities is associated with contrastingly low awareness, treatment and control rates. Age, family history of hypertension and obesity are the major drivers of hypertension in this community. Veracious policies are needed to improve awareness, prevention, diagnosis, treatment and control of hypertension in these rural communities.
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Affiliation(s)
- Larissa Pone Simo
- Department of Clinical Medicine, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
- Dzeng Sub-divisional Hospital, Dzeng, Centre Region, Cameroon
| | - Valirie Ndip Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Jean Jacques N Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Orlin Pagnol Nana
- Department of Clinical Medicine, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Pride Swiri-Muya Nkosu
- Department of Clinical Medicine, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | | | - Jude Nfor Ndi
- Department of Clinical Medicine, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Jacques Nguend Mbock
- Department of Clinical Medicine, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Noel Fils Bakari
- Department of Clinical Medicine, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | | | - Dora Mbanya
- Department of Clinical Medicine, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
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Xhakaza L, Abrahams-October Z, Mohammednur MM, Pearce B, Adeniyi OV, Johnson R, Benjeddou M. Socio-demographic and modifiable risk factors of diabetes and hypertension among resource constrained patients from rural areas in Mdantsane Township in South Africa. Afr Health Sci 2020; 20:1344-1354. [PMID: 33402984 PMCID: PMC7751544 DOI: 10.4314/ahs.v20i3.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Recently, developing countries have shown a dramatic increase in non-communicable diseases (NCDs). The burden of NCDs in South Africa has increased over the past years resulting in an estimated 37% of all- cause mortality and 16% of disability-adjusted life years. Currently, diabetes mellitus (DM) and hypertension (HTN) are the two most prevalent NCDs associated with the rapid increase in mortality. Objective To demonstrate the socio-demographic and modifiable risk factors of diabetes mellitus (DM) and hypertension (HTN) among South African adults. Methods A cross-sectional analytical study was conducted in the Cecilia Makiwane Hospital serving the residents of Mdantsane. Relevant socio-demographic data, anthropometric measurements, triplicate blood pressure, fasting blood glucose and lipogram analysis were obtained from 265 outpatients. Results Multivariate anlysis shows that; salt intake, smoking, elevated triglycerides and decreased high-density lipoprotein levels were significantly associated with DM with adjusted odds ratio of 0.18 (p=0.002), 0.26 (p=0.048), 2.19 (p=0.006) and 0.38 (p=0.001), respectively. Overweight and obesity were significantly associated with hypertension with odds ratio of 0.03 (p=0.01) and 0.06 (p=0.006), respectively. Conclusion The burden of DM and HTN on society can be drastically reduced with simple lifestyle changes, development of preventative strategies, large-scale screening and better disease management in South Africa.
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Affiliation(s)
- Lettilia Xhakaza
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Zainonesa Abrahams-October
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Mohammedmekin Mohammedseid Mohammednur
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Brendon Pearce
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | | | - Rabia Johnson
- South African Medical Research Council, Parow, Cape Town, South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - Mongi Benjeddou
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
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Prevalence of Hypertension and Associated Factors among the Outpatient Department in Akaki Kality Subcity Health Centers, Addis Ababa, Ethiopia. Int J Hypertens 2020; 2020:7960578. [PMID: 32908691 PMCID: PMC7450304 DOI: 10.1155/2020/7960578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/23/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
Background Fatalities from hypertension in East Africa are increasing, even though they decreased in western industrial regions. Older age, being female, illiterate, smoking, physical inactivity, and high waist circumferences are major risk factors for the development of hypertension. The prevalence of hypertension among Federal Ministry Civil servants in Addis Ababa, Ethiopia, has found to be high; which is an indication for institution-based hypertension-screening programs. Objective Prevalence of hypertension and associated factors among the outpatient department in Akaki Kality Subcity Health Centers, Addis Ababa, Ethiopia. Methodology. Facility-based cross-sectional study was carried out on systematically sampled 401 out-department patients whose age was greater than or equal to 18 years in four government health centers in Addis Ababa. Data collection took place from March 10, 2018, to April 06 2018. Binary logistic regression analysis was carried out to identify predictors of hypertension. Results Patients had a mean age of 41.17 years (95% CI: 39.77–42.57). The prevalence of hypertension was 14% (95% CI: 13.653–14.347), and 30 (53.57%) were males. Alcohol drinkers were 11.844 times more likely to be hypertensive as compared to non-alcohol drinkers (AOR = 11.844, 95% CI: 3.596–39.014). Cigarette smokers were 16.511 times more likely to be hypertensive as compared to non-cigarette smokers (AOR = 16.511, 95% CI: 4.775–57.084). Khat chewers were 6.964 times more likely to be hypertensive as compared to non-khat chewers (AOR = 6.964, 95% CI: 1.773–26.889). Conclusion The prevalence of patients with hypertension was 14%. Alcohol drinking, cigarette smoking, khat chewing, body mass index ≥25 kg/m2, and age ≥44 years old are major determinants identified by this study. Hence, appropriate management of patients focusing on the relevant associated factors would be of great benefit in controlling hypertension.
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Shahbazian H, Latifi SM, Saffarian S, Karandish M, Cheraghian B, Jalaly MT. The Incidence and Awareness of Hypertension, among Adults in Ahvaz: A 5-Year Cohort Study in Southwestern Iran. Int J Prev Med 2020; 11:61. [PMID: 32577191 PMCID: PMC7297416 DOI: 10.4103/ijpvm.ijpvm_474_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 05/08/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND According to the World Health Organization in 2009, hypertension is responsible for 13% of all deaths. Hypertension can increase the risk of stroke, coronary artery disease, dementia, heart disorder, kidney, and other chronic diseases. In this study, the prevalence and incidence of hypertension and knowledge and awareness of it among adults in Ahvaz are investigated. METHODS This cohort study was carried out on 688 participants in a study on the prevalence of metabolic syndrome investigated in adults in the city of Ahvaz in 2009. In 2014, participants were again recruited. Based on the standard method and disease history, blood pressure, height, and weight were measured, and a demographic information questionnaire was completed through interviews. RESULTS In this study, 688 individuals over 20 years of age participated with an average age of 42.7 ± 13.3 years, 300 men (43.6%), and 388 women (56.4%). Hypertension incidence was 65/1000 person-years which included 67.7 and 57.8/1000 person-years in men and women, respectively. The awareness of patients about hypertension was 51.2% in phase 2 (hypertension new cases). CONCLUSIONS In this study conducted in Ahvaz, the incidence rate of hypertension was 65/1000 person-years, higher in men than women. Hypertension awareness was 50.5%, 45.1% in men, and 55.1% in women.
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Affiliation(s)
- Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mahmoud Latifi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sara Saffarian
- Department of Endocrinology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Karandish
- Nutrition and Metabolic Diseases Research Centre, Faculty of Paramedical, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahman Cheraghian
- Department of Biostatistic and Epidemiology, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Taha Jalaly
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Darikwa TB, Manda SO. Spatial Co-Clustering of Cardiovascular Diseases and Select Risk Factors among Adults in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103583. [PMID: 32443772 PMCID: PMC7277617 DOI: 10.3390/ijerph17103583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022]
Abstract
Background: Cardiovascular diseases (CVDs) are part of the leading causes of mortality and morbidity in developing countries, including South Africa, where they are a major public health issue. Understanding the joint spatial clustering of CVDs and associated risk factors to determine areas in need of enhanced integrated interventions would help develop targeted, cost-effective and productive mediations. We estimated joint spatial associations and clustering patterns of 2 CVDs (stroke and heart attack) and 3 risk factors (hypertension, high blood cholesterol (HBC) and smoking) among adults in South Africa. Methods: We used cross-sectional secondary adult (15–64-year olds) health data from the South African Demographic Health Survey 2016. Age and gender standardized disease incidence ratios were analyzed using joint spatial global and local bivariate Moran’s Index statistics. Results: We found significantly positive univariate spatial clustering for stroke (Moran; s Index = 0.128), smoking (0.606) hypertension (0.236) and high blood cholesterol (0.385). Smoking and high blood cholesterol (0.366), smoking and stroke (0.218) and stroke and high blood cholesterol (0.184) were the only bivariate outcomes with significant bivariate clustering. There was a joint stroke-smoking local “hot spots” cluster among four districts in the urban western part of the country (City of Cape Town; Cape Winelands; Overberg and Eden) and a joint “cold spots” cluster in the rural north-western part of the country. Similar joint “hot spots” clustering was found for stroke and high blood cholesterol, which also had “cold spots” cluster in the rural east-central part of the country. Smoking and high blood cholesterol had a “hot spots” cluster among five districts in the urban western part of the country (City of Cape Town; Cape Winelands; Overberg; Eden, and West Coast) and “cold spots” around the rural districts in east-southern parts of the country. Conclusions: Our study showed that districts tended to co-cluster based on the rates of CVDs and risk factors, where higher rates were found in urban places than in rural areas. These findings are suggestive of a more contagious and spatial diffusion process among interdependent districts in urban districts. Urbanization or rurality needs to be considered when intervention initiatives are implemented with more general approaches in rural areas. The finding of “hot spot” co-clusters in urban areas means that integrated intervention programmes aimed at reducing the risk of CVDs and associated risk factors would be cost-effective and more productive.
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Affiliation(s)
- Timotheus B. Darikwa
- Department of Statistics and Operations Research, University of Limpopo, Sovenga 0727, South Africa
- Correspondence: ; Tel.: +27-1526-8367-4
| | - Samuel O. Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa;
- Department of Statistics, University of Pretoria, Hatfield 0083, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3201, South Africa
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Sackou JK, Tiadé ML, Hounsa AA, Malik SK, Coulibaly M, Desquith AA, Kadjo FK, Agoua SA, Oga S, Kouadio LK. Prevalence and factors associated with hypertension in Anonkoi 3, a peri-urban area in Abidjan (Côte d'Ivoire). J Public Health Afr 2019; 10:1106. [PMID: 32257082 PMCID: PMC7118436 DOI: 10.4081/jphia.2019.1106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/17/2019] [Indexed: 11/23/2022] Open
Abstract
Hypertension affects more than a quarter of the world adult population, with ruralurban disparities. In Cote d'Ivoire, the prevalence was 21.7% in 2005. The aim of this study was to determine factors associated with hypertension in a peri-urban community in Abidjan. A cross-sectional study was conducted at Anonkoi 3 a peri-urban area in Abidjan. The sample was of 360 subjects aged 18 and older. Behavioral, anthropometric and blood pressure characteristics were determined using WHO STEPS questionnaire and multivariate logistic regression was performed. Prevalence of hypertension was 18.61%. Subjects were low fruit and vegetable consumption (3.3%), low level of physical activity (64.2%) and abdominal obesity at 40%. The risk of hypertension was significant from age 45, in subjects living with a partner and in those with low level of physical activity. Health education programs are essential to prevent cardiovascular risks.
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Affiliation(s)
- Julie K Sackou
- Department of Public Health, Hydrology and Toxicology, UFR Pharmacy, Abidjan.,National Institute of Public Health, Abidjan
| | - Marie L Tiadé
- Department of Public Health, Hydrology and Toxicology, UFR Pharmacy, Abidjan.,Laboratory of Hygiene, National Institute of Public Hygiene, Abidjan
| | - Annita A Hounsa
- Department of Public Health, Hydrology and Toxicology, UFR Pharmacy, Abidjan
| | - Simone K Malik
- Department of Public Health, Hydrology and Toxicology, UFR Pharmacy, Abidjan.,National Institute of Public Health, Abidjan
| | - Madikiny Coulibaly
- Department of Public Health, Hydrology and Toxicology, UFR Pharmacy, Abidjan.,National Institute of Public Health, Abidjan
| | - Angèle A Desquith
- Department of Public Health, Hydrology and Toxicology, UFR Pharmacy, Abidjan
| | - Florence K Kadjo
- Department of Public Health, Hydrology and Toxicology, UFR Pharmacy, Abidjan.,Laboratory of Hygiene, National Institute of Public Hygiene, Abidjan
| | - Serge A Agoua
- Faculty of Medical Sciences of Abidjan, Côte d'Ivoire
| | - Serge Oga
- Department of Public Health, Hydrology and Toxicology, UFR Pharmacy, Abidjan
| | - Luc K Kouadio
- Department of Public Health, Hydrology and Toxicology, UFR Pharmacy, Abidjan.,Laboratory of Hygiene, National Institute of Public Hygiene, Abidjan
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25
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Wandai ME, Norris SA, Aagaard-Hansen J, Manda SO. Geographical influence on the distribution of the prevalence of hypertension in South Africa: a multilevel analysis. Cardiovasc J Afr 2019; 31:47-54. [PMID: 31544203 PMCID: PMC8762766 DOI: 10.5830/cvja-2019-047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/31/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As a response to the growing burden of non-communicable diseases, the South African government has set targets to reduce the prevalence of people with raised blood pressure, through lifestyle changes and medication, by 20% by the year 2020. It has also recognised that the prevalence varies at local administrative level. The study aim was to determine the geographical variation by district of the prevalence of hypertension among South African adults aged 15 years and above. METHODS Data from all five waves of the National income Dynamics Study, a panel survey, were used for estimation by both design-based and multilevel analysis methods. In the multilevel analysis, a three-level hierarchy was used with panel participants in the first level, repeated measurements on patients in the second level, and districts in the third level. RESULTS After accounting for demographic, behavioural, socio-economic and environmental factors, significant variation remained in the prevalence of hypertension at the district level. Districts with higher-than-average prevalence were found mostly in the south-western part of the country, while those with a prevalence below average were found in the northern area. Age, body mass index and race were the individual factors found to have a strong effect on hypertension prevalence for this sample. CONCLUSIONS There were significant differences in hypertension prevalence between districts and therefore the method of analysis and the results could be useful for more targeted preventative and control programmes.
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Affiliation(s)
- Muchiri E Wandai
- MRC Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Shane A Norris
- MRC Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jens Aagaard-Hansen
- MRC Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Health Promotion, Steno Diabetes Centre, Copenhagen, Gentofte, Denmark
| | - Samuel O Manda
- Department of Statistics, University of Pretoria, Pretoria, South Africa
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Abstract
Hypertension prevalence is on the rise in low- and middle-income countries (LMICs) like South Africa, and migration and its concomitant urbanization are often considered to be associated with this rise. However, relatively little is known about the relationship between blood pressure (BP) and internal migration - a highly prevalent population process in LMICs. This study employed data for a group of 194 adult men and women from an original pilot dataset drawn from the Agincourt Health and Demographic Surveillance System in north-east South Africa conducted in 2012. Migrants in the sample were identified, tracked and interviewed. The relationship between BP and migration distance and the number of months an individual spent away from his/her home village was estimated using robust OLS regression, controlling for a series of socioeconomic, health and behavioural characteristics. It was found that migrants who moved a longer distance and for longer durations had significantly higher systolic and diastolic blood pressures compared with shorter-term migrants and those who remained nearby or in their home village. These associations remained robust and statistically significant when adjusting for measures of socioeconomic conditions, as well as body mass index and the number of meals consumed per day. Migration, both in terms of distance and time away, explained significant variation in the blood pressure of migrants in this typical South African context. The findings suggest the need for further studies of the nutritional and psycho-social factors associated with geographic mobility that may be important to understand rising hypertension levels in LMICs.
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Noubiap JJ, Nansseu JR, Endomba FT, Ngouo A, Nkeck JR, Nyaga UF, Kaze AD, Bigna JJ. Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis. Sci Rep 2019; 9:588. [PMID: 30679752 PMCID: PMC6345945 DOI: 10.1038/s41598-018-37858-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/15/2018] [Indexed: 12/27/2022] Open
Abstract
The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6–15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6–16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.
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Affiliation(s)
- Jean Jacques Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Francky Teddy Endomba
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Anderson Ngouo
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jan René Nkeck
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Arnaud D Kaze
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon. .,Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France.
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Wollum A, Gabert R, McNellan CR, Daly JM, Reddy P, Bhatt P, Bryant M, Colombara DV, Naidoo P, Ngongo B, Nyembezi A, Petersen Z, Phillips B, Wilson S, Gakidou E, Duber HC. Identifying gaps in the continuum of care for cardiovascular disease and diabetes in two communities in South Africa: Baseline findings from the HealthRise project. PLoS One 2018; 13:e0192603. [PMID: 29538420 PMCID: PMC5851537 DOI: 10.1371/journal.pone.0192603] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/28/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The HealthRise initiative seeks to implement and evaluate innovative community-based strategies for diabetes, hypertension and hypercholesterolemia along the entire continuum of care (CoC)-from awareness and diagnosis, through treatment and control. In this study, we present baseline findings from HealthRise South Africa, identifying gaps in the CoC, as well as key barriers to care for non-communicable diseases (NCDs). METHODS This mixed-methods needs assessment utilized national household data, health facility surveys, focus group discussions, and key informant interviews in Umgungundlovu and Pixley ka Seme districts. Risk factor and disease prevalence were estimated from the South Africa National Health and Nutrition Examination Survey. Health facility surveys were conducted at 86 facilities, focusing on essential intervention, medications and standard treatment guidelines. Quantitative results are presented descriptively, and qualitative data was analyzed using a framework approach. RESULTS 46.8% of the population in Umgungundlovu and 51.0% in Pixley ka Seme were hypertensive. Diabetes was present in 11.0% and 9.7% of the population in Umgungundlovu and Pixley ka Seme. Hypercholesterolemia was more common in Pixley ka Seme (17.3% vs. 11.1%). Women and those of Indian descent were more likely to have diabetes. More than half of the population was found to be overweight, and binge drinking, inactivity and smoking were all common. More than half of patients with hypertension were unaware of their disease status (51.6% in Pixley ka Seme and 51.3% in Umgungundlovu), while the largest gap in the diabetes CoC occurred between initiation of treatment and achieving disease control. Demand-side barriers included lack of transportation, concerns about confidentiality, perceived discrimination and long wait times. Supply-side barriers included limited availability of testing equipment, inadequate staffing, and pharmaceutical stock outs. CONCLUSION In this baseline assessment of two South African health districts we found high rates of undiagnosed hypercholesterolemia and hypertension, and poor control of hypercholesterolemia, hypertension, and diabetes. The HealthRise Initiative will need to address key supply- and demand-side barriers in an effort to improve important NCD outcomes.
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Affiliation(s)
- Alexandra Wollum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Rose Gabert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Claire R. McNellan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Jessica M. Daly
- Medtronic Foundation, Minneapolis, Minnesota, United States of America
| | | | - Paurvi Bhatt
- Medtronic Foundation, Minneapolis, Minnesota, United States of America
| | - Miranda Bryant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Danny V. Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Pamela Naidoo
- Human Sciences Reseach Council, Cape Town, South Africa
| | - Belinda Ngongo
- Medtronic Foundation, Minneapolis, Minnesota, United States of America
- Public Health Institute, Global Health Fellows Program, Washington, DC, United States of America
| | - Anam Nyembezi
- Human Sciences Reseach Council, Cape Town, South Africa
| | | | - Bryan Phillips
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Shelley Wilson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Herbert C. Duber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
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Salt Use Behaviours of Ghanaians and South Africans: A Comparative Study of Knowledge, Attitudes and Practices. Nutrients 2017; 9:nu9090939. [PMID: 28846641 PMCID: PMC5622699 DOI: 10.3390/nu9090939] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/30/2022] Open
Abstract
Salt consumption is high in Africa and the continent also shares the greatest burden of hypertension. This study examines salt-related knowledge, attitude and self-reported behaviours (KAB) amongst adults from two African countries—Ghana and South Africa—which have distributed different public health messages related to salt. KAB was assessed in the multinational longitudinal World Health Organisation (WHO) study on global AGEing and adult health (WHO-SAGE) Wave 2 (2014–2015). Respondents were randomly selected across both countries—Ghana (n = 6746; mean age 58 years old; SD 17; 41% men; 31% hypertensive) and South Africa (n = 3776, mean age 54 years old; SD 17; 32% men; 45% hypertensive). South Africans were more likely than Ghanaians to add salt to food at the table (OR 4.80, CI 4.071–5.611, p < 0.001) but less likely to add salt to food during cooking (OR 0.16, CI 0.130–0.197, p < 0.001). South Africans were also less likely to take action to control their salt intake (OR 0.436, CI 0.379–0.488, p < 0.001). Considering the various salt reduction initiatives of South Africa that have been largely absent in Ghana, this study supports additional efforts to raise consumer awareness on discretionary salt use and behaviour change in both countries.
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Todowede OO, Sartorius B. Prevalence of metabolic syndrome, discrete or comorbid diabetes and hypertension in sub-Saharan Africa among people living with HIV versus HIV-negative populations: a systematic review and meta-analysis protocol. BMJ Open 2017; 7:e016602. [PMID: 28694350 PMCID: PMC5726114 DOI: 10.1136/bmjopen-2017-016602] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/12/2017] [Accepted: 04/21/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Metabolic disorder and high blood pressure are common complications globally, and specifically among people living with HIV (PLHIV). Diabetes, metabolic syndrome and hypertension are major risk factors for cardiovascular diseases and their related complications. However, the burden of metabolic syndrome, discrete or comorbid diabetes and hypertension in PLHIV compared with HIV-negative population has not been quantified. This review and meta-analysis aims to compare and analyse the prevalence of these trio conditions between HIV-negative and HIV-positive populations in sub-Saharan Africa (SSA). METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guides the methods for this study. Eligibility criteria will be published original articles (English and French language) from SSA that present the prevalence of metabolic syndrome, discrete and/or comorbid diabetes, and hypertension comparisons between PLHIV and HIV-negative populations. The following databases will be searched from January 1990 to February 2017: PubMed/Medline, EBSCOhost, Web of Science, Google Scholar, Scopus, African Index Medicus and Cochrane Database of Systematic Reviews. Eligibility screening and data extraction will be conducted independently by two reviewers, and disagreements resolved by an independent reviewer. Methodological quality and risk of bias will be assessed for individual included studies, while meta-analysis will be used to estimate study outcomes prevalence according to subgroups. Sensitivity analysis will also be performed to further test the robustness of the findings. ETHICS AND DISSEMINATION This proposed study does not require ethical approval. The results will be published as a scientific article in a peer-reviewed journal, and presented at conferences and to relevant health agencies. TRIAL REGISTRATION NUMBER PROSPERO registration number (CRD42016045727).
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Affiliation(s)
- Olamide O Todowede
- Public Health Medicine, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
| | - Benn Sartorius
- School of Nursing and Public Health, UKZN, Durban, KwaZulu-Natal, South Africa
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Low fruit consumption and omission of daily meals as risk factors for increased blood pressure in adults. Br J Nutr 2017; 116:683-91. [PMID: 27464462 DOI: 10.1017/s0007114516002397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A population-based cross-sectional survey with cluster sampling design and with inverse sampling was conducted in 2010, in a sample of 1590 adults (19-60 years old) exposed to a high prevalence of food insecurity, in the municipality of Duque de Caxias, metropolitan region of Rio de Janeiro, Brazil. The objective of the study was to evaluate the association of socio-demographic factors, the consumption of fruits and vegetables and the number of meals with increased blood pressure (BP). A hierarchical model that considered variables related to the basic, intermediate and immediate determinants of increased BP was adopted. By using Poisson's regression, univariate models were tested to obtain the prevalence ratio (PR) and its respective 95 % CI. After fitting the model, age (age group 50-59 years) (PR 1·62; 95 % CI 1·09, 2·41), low consumption of fruits in a week (PR 1·37; 95 % CI 1·07, 1·74), fewer meals per day (PR 1·72; 95 % CI 1·21, 2·43) and overweight (PR 1·78; 95 % CI 1·31, 2·20) remained significantly associated with increased BP. Therefore, the results found here reinforce the importance of encouraging and developing strategies that ensure access to healthy foods to minimise increased BP in similar populations.
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Pinchevsky Y, Butkow N, Chirwa T, Raal F. Treatment Gaps Found in the Management of Type 2 Diabetes at a Community Health Centre in Johannesburg, South Africa. J Diabetes Res 2017; 2017:9536025. [PMID: 29130053 PMCID: PMC5654246 DOI: 10.1155/2017/9536025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/18/2017] [Accepted: 09/12/2017] [Indexed: 01/13/2023] Open
Abstract
AIMS The management of cardiometabolic goals or "ABCs" (HbA1c, blood pressure (BP), and cholesterol) ultimately determines the morbidity and mortality outcomes in patients with type 2 diabetes mellitus (T2DM). We sought to determine if patients with T2DM attending an urbanized public sector community health centre (CHC) were having their ABCs measured, were treated with appropriate cardioprotective agents and finally, were achieving guideline-based targets. METHODS AND RESULTS A cross-sectional record review of 519 patients was conducted between May and August 2015. The mean age was 54 years (SD: ±11.5) and 54% (n = 280) were females. Testing of ABCs occurred in 68.8% (n = 357) for HbA1c, 95.4% (n = 495) for BP, and 58.6% (n = 304) for LDL-C. Achievement of ABC targets was as follows: 19.3% (HbA1c < 7%), 22.0% (BP < 140/80 mmHg), and 56.3% (LDL-C < 2.5 mmol/l). CONCLUSION There were a significant number of patients who were not tested nor received adequate pharmacotherapy or achieved their ABC targets. This places these patients at an increased risk for the development of diabetes-related complications. Although the realities of resource constraints exist in South Africa's public sector settings, a wider implementation of evidence-based guidelines must be instituted in order to ensure better patient outcomes.
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Affiliation(s)
- Yacob Pinchevsky
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil Butkow
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederick Raal
- Carbohydrate and Lipid Metabolism Research Unit, Division of Endocrinology and Metabolism, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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