Relationships between physical activity, body mass index, waist circumference and handgrip strength amongst adults from the North West province, South Africa: The PURE study

BACKGROUND

 Handgrip strength (HGS) serves as a proxy for the functional ability and its association with body composition (BC) and physical activity (PA) in South African adults are less clear.

AIM

 We investigated the relationships between PA, body composition and HGS amongst adults.

SETTING

 Rural and urban population from North West Province, South Africa.

METHODS

 A cross-sectional study design was performed on 688 (198 men; 490 women) adults aged 35-70 years from the 2015 measurement wave of the Prospective Urban and Rural Epidemiological (PURE) study from the North West province of South Africa. The International Physical Activity Questionnaire-Short Form (IPAQ-SF) assessed and a dynamometer determined HGS in kilogram. Body mass index (BMI) and waist circumference were used as measures of body composition. Spearman correlation coefficients determined the relationship between PA, BMI and HGS.

RESULTS

 In the study, 22% and 26%, respectively, were overweight and obese with women being more overweight and obese compared to men. Sixty percent of the participants met the recommended 150 min or more of moderate to vigorous PA (MVPA) per week. Handgrip strength of the participants in the study was weaker than the published norms. Handgrip strength significantly (p  0.05) differed by age. A significant positive association was found between HGS and BMI. Age negatively (r = -0.12; p = 0.001) correlated with MVPA per week.

CONCLUSION

 High prevalence of overweight and obesity exists in the current adults' sample. It was also evident that poor upper limb muscle strength and MVPA were negatively associated with ageing. Given the health implications of poor strength indicators, PA intervention programmes, comprised of strength activities, for an adult population are urgently recommended.

Geographical variation in HIV testing in South Africa: Evidence from the 2017 national household HIV survey

Background

Identification of the geographical areas with low uptake of HIV testing could assist in spatial targeting of interventions to improve the uptake of HIV testing.

Objectives

The objective of this research study was to map the uptake of HIV testing at the district level in South Africa.

Method

The secondary analysis used data from the Human Sciences Research Council's 2017 National HIV Prevalence, Incidence, Behaviour and Communication Survey, where data were collected using a multistage stratified random cluster sampling approach. Descriptive spatial methods were used to assess disparities in the proportion of those ever tested for HIV at the district level in South Africa.

Results

The districts with the highest overall coverage of people ever having tested for HIV (> 85%) include West Rand in Gauteng, Lejweleputswa and Thabo Mofutsanyane in Free State, and Ngaka Modiri Molema in North-West. These provinces also had the least variation in HIV testing coverage between their districts. Districts in KwaZulu-Natal had the widest variation in coverage of HIV testing. The districts with the lowest uptake of HIV testing were uMkhanyakude (54.7%) and Ugu (61.4%) in KwaZulu-Natal and Vhembe (61.0%) in Limpopo. Most districts had a higher uptake of HIV testing amongst female than male participants.

Conclusion

The uptake of HIV testing across various districts in South Africa seems to be unequal. Intervention programmes must improve the overall uptake of HIV testing, especially in uMkhanyakude and Ugu in KwaZulu-Natal and Vhembe in Limpopo. Interventions must also focus on enhancing uptake of HIV testing amongst male participants in most districts. Strategies that would improve the uptake of HIV testing include HIV self-testing and community HIV testing, specifically home-based testing.

South African Fathers Involvement and Their Adolescents' Sexual Risk Behavior and Alcohol Consumption

Although considerable research has examined the influence of parent-adolescent relationships on the sexual health of adolescents, there is a great need for research to understand the influence of fathers on their children's HIV sexual risk behavior, particularly in sub-Saharan Africa. We examined how the residence and the involvement of fathers are related to their children's HIV sexual risk and alcohol consumption behaviors. A cross-sectional survey was completed by 175 sixth-grade adolescents in the Eastern Cape Province, South Africa. Analyses showed that adolescents living with their fathers had fewer sexual partners (B = - 0.606, SE = 0.299, p = .043) and consumed alcohol less frequently (B = - 0.642, SE = 0.294, p = .029). Adolescents who spent more quality days with their fathers in the past 30 days had fewer sexual partners (B = - 0.103, SE = 0.039, p = .008) and had condomless sex less frequently (B = - 0.097, SE = 0.047, p = 0.041). It was also found that there were significant father-residence × child-gender interactions on sexual debut (B = 1.132, SE = 0.564, p = .045) and on frequency of condomless sex (B = - 2.140, SE = 0.924, p = .021). These interactions indicate that boys living with their fathers were less likely to have had vaginal intercourse than girls and that girls living with their fathers were less likely to have unprotected sex than boys. This study highlights the importance of South African fathers' roles in their adolescent children's HIV sexual risk and alcohol drinking behaviors and the need to promote father-child relationships for adolescent health. The results suggest that health programs aiming to reduce South African adolescents' HIV sexual risk behaviors and alcohol consumption consider strategies that target their fathers.

Cross-Cultural Comparison of Mental Health Between German and South African Employees: Shame, Self-Compassion, Work Engagement, and Work Motivation

The negative impact of the coronavirus disease outbreak 2019 (COVID-19) on work mental health is reported in many countries including Germany and South Africa: two culturally distinct countries. This study aims to compare mental health between the two workforces to appraise how cultural characteristics may impact their mental health status. A cross-sectional study was used with self-report measures regarding (i) mental health problems, (ii) mental health shame, (iii) self-compassion, (iv) work engagement and (v) work motivation. 257 German employees and 225 South African employees have completed those scales. This study reports results following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. T-tests, correlation and regression analyses were performed. German employees had lower mental health problems and mental health shame, and higher self-compassion than South Africans. Mental health problems were positively associated with mental health shame and amotivation, and negatively associated with work engagement and intrinsic motivation in both groups. Lastly, self-compassion, a PP 2.0 construct, was the strongest predictor for mental health problems in both countries. Our results suggest (i) that German culture's long-term orientation, uncertainty avoidance and restraint may help explain these differences, and (ii) that self-compassion was important to mental health in both countries. While the levels of mental health differed between the two countries, cultivating self-compassion may be an effective way to protect mental health of employees in those countries. Findings can help inform managers and HR staff to refine their wellbeing strategies to reduce the negative impact of the pandemic, especially in German-South African organizations.

An evaluation of the Acsádi and Nemeskéri Complex Method of adult age estimation in a modern South African skeletal sample

The Acsádi and Nemeskéri Complex Method is a multifactorial adult age estimation method that makes use of weighting systems. The Complex Method employs the use of four skeletal elements in assessing age, including the degree of endocranial suture closure, age-related changes to the pubic symphyseal surface, and the internal structural changes observable in the proximal humerus and femur. Acsádi and Nemeskéri reported a very optimistic error margin of ±2.5 years when all four skeletal elements were used. Despite these promising results, the Complex Method's effectiveness has been questioned, suggesting that it results in a constant over- and underestimation of age in younger and older groups, respectively. In this study, the Complex Method was tested on a modern South African skeletal sample (n = 313) with individuals of known age-at-death. Results from this study to some extent justify the critique levelled against the Complex Method's tendency to over- and underestimate age. Nevertheless, the Complex Method still performed surprisingly well for certain skeletal element combinations. Contrary to Acsádi and Nemeskéri's findings, the use of all four skeletal elements did not provide more accurate age estimates. For the most part, combinations making use of three or two skeletal elements outperformed the use of all four skeletal indicators. Results from this study indicate caution in using a blanket approach when it comes to deciding on the best combination of skeletal elements used in multifactorial methods. It is suggested that the Complex Method may be optimised by making use of sex- and population-specific skeletal element combinations and weighting systems in the future.

Spectrum of MYO7A Mutations in an Indigenous South African Population Further Elucidates the Nonsyndromic Autosomal Recessive Phenotype of DFNB2 to Include Both Homozygous and Compound Heterozygous Mutations

MYO7A gene encodes unconventional myosin VIIA, which, when mutated, causes a phenotypic spectrum ranging from recessive hearing loss DFNB2 to deaf-blindness, Usher Type 1B (USH1B). MYO7A mutations are reported in nine DFNB2 families to date, none from sub-Saharan Africa.In DNA, from a cohort of 94 individuals representing 92 families from the Limpopo province of South Africa, eight MYO7A variations were detected among 10 individuals. Family studies identified homozygous and compound heterozygous mutations in 17 individuals out of 32 available family members. Four mutations were novel, p.Gly329Asp, p.Arg373His, p.Tyr1780Ser, and p.Pro2126Leufs*5. Two variations, p.Ser617Pro and p.Thr381Met, previously listed as of uncertain significance (ClinVar), were confirmed to be pathogenic. The identified mutations are predicted to interfere with the conformational properties of myosin VIIA through interruption or abrogation of multiple interactions between the mutant and neighbouring residues. Specifically, p.Pro2126Leufs*5, is predicted to abolish the critical site for the interactions between the tail and the motor domain essential for the autoregulation, leaving a non-functional, unregulated protein that causes hearing loss. We have identified MYO7A as a possible key deafness gene among indigenous sub-Saharan Africans. The spectrum of MYO7A mutations in this South African population points to DFNB2 as a specific entity that may occur in a homozygous or in a compound heterozygous state.

Morphometric profile of tendocalcaneus of South Africans of European ancestry using a cadaveric approach

BACKGROUND

Tendocalcaneus is a strong tendon that is vital for bipedalism in humans. Despite its tremendous strength, the tendocalcaneus is prone to damage and degeneration causing mobility problems and pain. Morphometric dimension of the tendocalcaneus is of benefit to the surgical repair and reconstruction of the damaged tendon. Cadaveric approach provides a realistic method for determining tendocalcaneus morphometry and as at present only two cadaveric studies on Indian population is available. Thus this study presents data on tendocalcaneus morphometry in South Africans of European ancestry using a cadaveric approach.

MATERIALS AND METHODS

A total of 66 lower limbs (32 left and 34 right legs) sourced from 49 male and female cadavers were used. After careful dissection of the posterior aspect of leg, the medial and lateral length, distal width, distal circumference and proximal width of the tendocalcaneus were measured.

RESULTS

The data showed a high degree of reproducibility indicating that the measurements obtained using cadaveric approach were precise and accurate. There was no difference in measurements between the sides. Measurements in the males were generally higher than in the females. Strong associations were observed between the paired measurements of the medial and lateral tendon length and between the distal width and distal circumference.

CONCLUSIONS

The data obtained will be useful in predicting tendocalcaneus size during the surgical reconstruction of the tendocalcaneus.

Screening of the glucocerebrosidase (GBA) gene in South Africans of African ancestry with Parkinson's disease

Sequence variants in glucocerebrosidase (GBA) are a major genetic risk factor for Parkinson's disease (PD), and display ethnic-dependent frequencies, for example, variants such as p.N370S and 84insGG are common in Ashkenazi Jewish patients. Notably, there are limited studies on black patients from the African continent; hence, we conducted a study on 30 South African black PD patients. All 11 exons of GBA were screened using a nested PCR approach to avoid pseudogene contamination. We identified previously described Gaucher's disease-associated variants, p.R120W in one patient [age at onset (AAO) of 35 years], and p.R131L in another patient (AAO 30 years) and in her affected sibling (AAO 45 years). In addition, we found 3 previously identified [p.K(-27)R, p.T36del, and p.Q497*] and 2 novel (p.F216L and p.G478R) variants. Screening of ethnic-matched controls for the novel variants revealed that the allele frequency of p.F216L was 9.9%, whereas p.G478R was not found in the controls. Studies such as these are important and necessary to reveal the genetic architecture underlying PD in the understudied patients of African ancestry.

Where are they working? A case study of twenty Cuban-trained South African doctors

BACKGROUND

The year 2017 marked the 21st anniversary of the South African Cuban Medical Collaboration (SACMC) programme that offers disadvantaged South African (SA) students an opportunity for medical training in Cuba. Graduates are expected to return to practice at a primary care level in rural communities; however, little is known about the professional trajectories and career choices of graduates from the programme.

AIM

This study explored the reasons why students enrolled in the programme, their professional and career choices as graduates and their career intentions.

SETTING

The study setting was the whole of SA although participants were primarily drawn from KwaZulu-Natal.

METHODS

An exploratory, qualitative case study used a purposive sampling strategy to gather data through semi-structured interviews from participants.

RESULTS

Graduates (N = 20) of the SACMC programme were all practicing in local SA settings. Participants preferred the SACMC programme as it offered them a full scholarship for medical training. Nineteen doctors had fulfilled their obligation to work in rural areas. Thirteen doctors are engaged in primary healthcare practice, either as private practice generalists or as public service medical officers. Three doctors had completed specialty training: one doctor was training towards specialisation, one doctor was employed at national government and two doctors were employed as medical managers. At the time of the study, 11 doctors were practicing in rural locations and 19 had indicated a long-term intention to work and live within South Africa.

CONCLUSION

The participants of this study who graduated from the SACMC programme are fulfilling their obligations in rural communities. They all intend to contribute to the SA medical workforce in the long-term.

Hospital-acquired acute kidney injury prevalence in in adults at a South African tertiary hospital

BACKGROUND

Hospital Acquired Acute Kidney Injury (HA-AKI) prevalence has not been analysed in a South African setting. We investigated HA-AKI prevalence, using the KDIGO definition, with clinical characteristics and outcomes. The aim was to provide evidence for earlier treatment interventions to improve outcomes, such as recent UK NHS initiatives of automated electronic alerts in the laboratory information system.

METHODS

Retrospective laboratory and clinical data was analysed for a 6-month period at Tygerberg Hospital, Cape Town. Serum creatinine results and clinical records were analysed and collated into gender and age group specific results.

RESULTS

HA-AKI occurred in 6.2% of hospitalised patients for the period of analysis. The highest incident occurred in females aged 18-39 and males aged 40-59. The most common AKI stage reached was stage 1. HA-AKI increased length of stay by an average of 4.6 days and 20% of patients were readmitted at a later date with renal dysfunction.

CONCLUSION

AKI prevalence is significant and associated with adverse patient outcomes. Initiatives that allow front-line healthcare professionals to treat and manage AKI, such as introduction of automated electronic alerts, should be considered. Similar initiatives have been implemented in UK NHS hospitals with positive impacts.

The Effects of Three Types of Sexual Orientation Victimization on HIV Sexual Risk Behavior Among Black South African Men Who Have Sex With Men (MSM)

The goal of this study is to examine the relations between histories of three types of sexual orientation victimization (childhood, personal, and institutional) and HIV sexual risk behavior among Black South African men who have sex with men (MSM). Secondarily, this study examines whether marijuana use and problem drinking mediate the relations. Participants were 125 Black MSM recruited from neighborhoods in Eastern Cape Province, South Africa. Questionnaires administered through audio computerized self-interviewing assessed sexual orientation victimizations, problem drinking and marijuana use, and unprotected anal sex with casual partners. Data were analyzed using multiple regression and multiple mediation modeling.Personal and institutional sexual victimizations were associated with condomless anal sex. Childhood sexual orientation victimization was positively associated with problem drinking. Neither problem drinking nor marijuana use mediated the relations between sexual orientation victimizations and having condomless anal sex with casual partners.

Association of Kidney Function and Waist Circumference with Uric Acid Levels in South Africans

BACKGROUND

Recent evidence that hyperuricemia is associated with incident chronic kidney disease (CKD) provides a potential therapeutic target for CKD that has not been explored in Africans. With hyperuricemia and gout increasing globally, we sought to determine their prevalence in South Africans with varying kidney function levels.

METHODS

This was a cross-sectional study of ambulatory adult patients presenting at a General Internal Medicine Outpatients Clinic between September 2012 and March 2014. Demographic, clinical, and laboratory data collected were analyzed using STATA11. Odds ratios (ORs) and 95% confidence intervals were determined using multivariable logistic regression with bootstrapping.

RESULTS

There were 225/261 (86.2%) black/Africans, 31/261 (11.9%) Indian South Africans, 3/261 (1.1%) Caucasians, and 2/261 (<1%) mixed ancestry South Africans. Mean age was 51.3 ± 14.5 years. Median (interquartile range) estimated glomerular filtration rate (eGFR) was 71 (38) mL/min/1.73 m² and 39.8% (104/261) of patients had CKD. Hyperuricemia prevalence was 43.7% (114/261) and increased from 16.7% in patients with eGFR ≥90 mL/min/1.73 m² to 74.2% with eGFR <30 mL/min/1.73 m² (P < 0.001). Gout prevalence was 5.4% (14/261), with equal distribution across eGFR categories (0.814). Factors independently associated with hyperuricemia were eGFR <90 [ORs 3.24 (1.15-9.14), 7.28 (2.26-23.49), and 7.88 (1.95-31.82) for eGFR 60-89.9, 30-60, and <30, respectively], albuminuria [2.32 (1.11-4.85)], and waist circumference [1.04 (1.01-1.06) per 1 cm increase]. In univariate and multivariable analysis, gout was positively associated with male gender and cardiovascular disease, while it was negatively associated with African ancestry, but none of these factors remained significant after bootstrapping; ORs 6.65 (0.64-69.24), 4.14 (0.61-28.07), and 0.18 (0.01-2.21), respectively.

CONCLUSION

Hyperuricemia prevalence was high, with CKD and waist circumference being the strongest predictors. Gout was uncommon in black Africans. With population data lacking, screening high-risk individuals may provide insight into the burden of hyperuricemia and gout in South Africa.

Exonic rearrangements in the known Parkinson's disease-causing genes are a rare cause of the disease in South African patients

Parkinson's disease (PD) is a neurodegenerative movement disorder characterized by the loss of dopaminergic neurons in the substantia nigra of the midbrain. To date, a number of PD-causing genes have been found, including SNCA, LRRK2, VPS35, PARK2, PINK1, DJ-1, ATP13A2, and most recently CHCHD2. Mutations in these genes range from point mutations to larger exonic rearrangements including deletions and duplications. This study aimed to detect possible copy number variation (CNV) in the known PD-causing genes in a cohort of South African patients with PD. Multiplex Ligation-dependent Probe Amplification (MLPA) analysis was performed on a total of 210 South African PD patients, and possible CNVs were verified using quantitative real time PCR. No homozygous or compound heterozygous exon rearrangements in the genes analysed were found in the patient group. A heterozygous PARK2 exon 4 deletion was found in a sporadic patient with an age at onset of 51 years. Sanger sequencing did not reveal any additional mutations in PARK2 in this patient. Combining our results with that of previous studies in a South African cohort, the frequency of exonic rearrangements in the known PD-causing genes is only 1.8% (8/439 patients). In conclusion, CNV in the known PD-causing genes are a rare cause of PD in a South African cohort, and there may be as yet unknown genetic causes of PD that are specific to patients of African ethnicity.

Derivation of South African water quality guidelines for Roundup(®) using species sensitivity distribution

Glyphosate-based herbicides are among the leading products used in South Africa to control weeds and invading alien plant species. Although these herbicides ultimately find their way into aquatic ecosystems, South Africa has no water quality guideline based on indigenous species to protect the country's aquatic biota against these biocides. In this study, South African water quality guidelines (SAWQGs) for Roundup(®) based on species sensitivity distribution (SSD) using indigenous aquatic biota were developed. Short-term and long-term toxicity tests were conducted with eight different aquatic species belonging to five different taxonomic groups. Static non-renewal experimental methods were employed for short-term lethal tests (≤4 days), and static renewal for long-term sublethal tests (≥4 days ≤21 days). LC50 values for animal exposure and EC50 values for algae were calculated using probit analysis and linear regression of transformed herbicide concentration as natural logarithm data against percentage growth inhibition, respectively. No effect concentration (NEC) was determined based on the dynamic energy budget model, using survival data. The LC50, EC50 and NEC values were used to develop species sensitivity distribution (SSD) concentrations for Roundup(®). Based on the SSD concentrations, the short-term and long-term SAWQGs for Roundup(®) were derived as 0.250 (0.106-0.589) mg/L, and 0.002 (0.000-0.021) mg/L, respectively. These WQGs may be useful in protecting South African aquatic life against transient or long-term exposure to glyphosate-based chemicals as part of integrated water resources management.

Rural Poverty Dynamics and Refugee Communities in South Africa: A Spatial-Temporal Model

The assimilation of refugees into their host community economic structures is often problematic. The paper investigates the ability of refugees in rural South Africa to accumulate assets over time relative to their host community. Bayesian spatial-temporal modelling was employed to analyse a longitudinal database that indicated that the asset accumulation rate of former Mozambican refugee households was similar to their host community; however, they were unable to close the wealth gap. A series of geo-statistical wealth maps illustrate that there is a spatial element to the higher levels of absolute poverty in the former refugee villages. The primary reason for this is their physical location in drier conditions that are established further away from facilities and infrastructure. Neighbouring South African villages in close proximity, however, display lower levels of absolute poverty, suggesting that the spatial location of the refugees only partially explains their disadvantaged situation. In this regard, the results indicate that the wealth of former refugee households continues to be more compromised by higher mortality levels, poorer education, and less access to high-return employment opportunities. The long-term impact of low initial asset status appears to be perpetuated in this instance by difficulties in obtaining legal status in order to access state pensions, facilities, and opportunities. The usefulness of the results is that they can be used to sharpen the targeting of differentiated policy in a given geographical area for refugee communities in rural Africa. Copyright © 2011 John Wiley & Sons, Ltd.