Non-communicable disease comorbidities in KwaZulu-Natal Province, South Africa

Background. The prevalence of chronic non-communicable disease (NCD) comorbidity in low- to middle-income countries is increasing, yet evidence on the pattern, prevalence, awareness and treatment of NCD comorbidity is inadequate.Objectives. To investigate the prevalence, awareness, treatment and control of comorbid hypertension and diabetes, and the underlying risk factors in Mpumza, KwaZulu-Natal Province, South Africa (SA).Methods. Data were gathered by the SA Human Sciences Research Council from 587 participants in KwaZulu-Natal in 2015. Percentages were used to describe all the variables. Cross-tabulations and χ2 tests were used to describe variations in the prevalences of hypertension, diabetes and comorbidities according to sociodemographic and socioeconomic variables and lifestyle risk factors.Results. Approximately a third of the participants had hypertension (32%) and 9% had diabetes. The prevalence of comorbid hypertension and diabetes was 6%, and this was significantly higher among women, the aged, the obese, and the formerly married compared with their counterparts. Comorbidity awareness was high (86%). Although most of the participants with comorbidities were being treated with lifestyle changes, insulin and antihypertensive medication (74%), control of comorbidities was low (13%).Conclusions. The study reported a higher burden of comorbid hypertension and diabetes among vulnerable populations in Mpumza, SA, particularly women, the obese, and those with a low level of education. In addition, control of comorbidities was low. Developing appropriate interventions to improve control of comorbidities can reduce the risk of macrovascular and microvascular diseases in this population

The association of physical activity, body mass index and the blood pressure levels among urban poor youth in Accra, Ghana

BACKGROUND: Globally, there is an increasing prevalence of high blood pressure (HBP) among adults and youth. However, the mechanisms of how the risk factors (physical inactivity and obesity) relate with blood pressure (BP) are not well known especially among the urban poor youth in low and middle income countries. Meanwhile childhood and adolescent physical inactivity and obesity, particularly in conditions of poverty, predispose individuals to cardiovascular diseases (CVDs) in later life. The aim of this study was to assess the BP levels and to examine its associations with physical activity (PA) and body mass index (BMI) amongst urban poor youth in Accra, Ghana. METHODS: We studied 201 youth aged 15-24 years in three urban poor communities in Accra, Ghana. Height, weight and BP were measured in all subjects. PA levels were assessed using the Edulink Urban Health and Poverty project questionnaire. Multiple linear regression analysis was used to determine the factors influencing BP levels. RESULTS: The proportion of pre-hypertension and hypertension among the youth was 32.3% and 4%, respectively. The rates of pre-hypertension (42.0 vs. 24.8) and hypertension (6.8 vs. 1.8) were higher in males than in females. More than three-quarters (84.1%) of the youth were not physically active. Females were more physically inactive compared to the males (94.7% vs. 70.5%). The average BMI was 22.8 kg/m(2). For overweight (17.7 vs. 6.8) and obesity (13.3 vs. 2.3), females had higher rates than males. BMI was positively related to systolic BP, and significantly associated with systolic BP (β = 1.4, p < 0.000 and β = 0.8, p < 0.000; respectively for male and female youth) compared to diastolic BP. Youth with low PA had raised BP. CONCLUSION: The positive association of BMI and BP in the study communities suggests the need for health measures to tackle their increase and related public health consequences. Further studies on BP and other risk factors among the youth of rural populations and other developing countries will be important to stall the rising prevalence and implications for adult morbidity and mortality

Knowledge and perceptions of type 2 diabetes among Ghanaian migrants in three European countries and Ghanaians in rural and urban Ghana: The RODAM qualitative study

African migrants in Europe and continental Africans are disproportionately affected by type 2 diabetes (T2D). Both groups develop T2D at a younger age, and have higher morbidity and mortality from T2D and complications, compared to European populations. To reduce risk, and avoidable disability and premature deaths, culturally congruent and context specific interventions are required. This study aimed to: (a) assess perceptions and knowledge of T2D among Ghanaian migrants in Europe and their compatriots in Ghana and (b) identify specific perceptions and knowledge gaps that might predispose migrants to higher risk of diabetes. Data was gathered through 26 focus groups with 180 individuals, aged 21 to 70, from Amsterdam, Berlin and London and rural and urban Ashanti Region, Ghana. Thematic analysis of the data was informed by Social Representations Theory, which focuses on the sources, content and functions of social knowledge. Three key insights emerged from analysis. First, there was general awareness, across migrant and non-migrant groups, of T2D as a serious chronic condition with life threatening complications, and some knowledge of biomedical strategies to prevent diabetes (e.g healthy eating) and diabetes complications (e.g medication adherence). However, knowledge of T2D prevention and reduction of diabetes complications was not comprehensive. Secondly, knowledge of biomedical diabetes theories and interventions co-existed with theories about psychosocial and supernatural causes of diabetes and the efficacy of herbal and faith-based treatment of diabetes. Finally, migrants’ knowledge was informed by both Ghanaian and European systems of T2D knowledge suggesting enculturation dynamics. We discuss the development of culturally congruent and context-specific T2D interventions for the research communities

Adolescent health in rural Ghana: A cross-sectional study on the co-occurrence of infectious diseases, malnutrition and cardio-metabolic risk factors.

In sub-Saharan Africa, infectious diseases and malnutrition constitute the main health problems in children, while adolescents and adults are increasingly facing cardio-metabolic conditions. Among adolescents as the largest population group in this region, we investigated the co-occurrence of infectious diseases, malnutrition and cardio-metabolic risk factors (CRFs), and evaluated demographic, socio-economic and medical risk factors for these entities. In a cross-sectional study among 188 adolescents in rural Ghana, malarial infection, common infectious diseases and Body Mass Index were assessed. We measured ferritin, C-reactive protein, retinol, fasting glucose and blood pressure. Socio-demographic data were documented. We analyzed the proportions (95% confidence interval, CI) and the co-occurrence of infectious diseases (malaria, other common diseases), malnutrition (underweight, stunting, iron deficiency, vitamin A deficiency [VAD]), and CRFs (overweight, obesity, impaired fasting glucose, hypertension). In logistic regression, odds ratios (OR) and 95% CIs were calculated for the associations with socio-demographic factors. In this Ghanaian population (age range, 14.4-15.5 years; males, 50%), the proportions were for infectious diseases 45% (95% CI: 38-52%), for malnutrition 50% (43-57%) and for CRFs 16% (11-21%). Infectious diseases and malnutrition frequently co-existed (28%; 21-34%). Specifically, VAD increased the odds of non-malarial infectious diseases 3-fold (95% CI: 1.03, 10.19). Overlap of CRFs with infectious diseases (6%; 2-9%) or with malnutrition (7%; 3-11%) was also present. Male gender and low socio-economic status increased the odds of infectious diseases and malnutrition, respectively. Malarial infection, chronic malnutrition and VAD remain the predominant health problems among these Ghanaian adolescents. Investigating the relationships with evolving CRFs is warranted

Determinants of post-migration changes in dietary and physical activity behaviours and implications for health promotion : Evidence from Australian residents of sub-Saharan African ancestry

ISSUE ADDRESSED: Several studies have attributed excess weight gain after immigration to changes in dietary and physical activity behaviours. However, recognising the main factors that influence post-migration changes in dietary and physical activity behaviours is less clear, particularly among Australian residents of sub-Saharan African (SSA) ancestry. Drawing on acculturation theory, this study examines main factors driving changes in dietary and physical activity behaviours among Australian residents who were born in SSA and provides insight into the extent to which the factors are related to immigration. METHODS: A qualitative design based on a phenomenological approach was employed and a quota sampling technique was used to recruit 24 study participants for in-depth interviews. RESULTS: The study found significant self-reported changes in dietary and physical activity behaviours after immigration that increase the risk of excess weight gain. The changes in dietary and physical activity behaviours were mainly driven by issues related to availability, accessibility and affordability of dietary and physical activity products. Time management and factors related to convenience also emerged as key determinants of change in dietary and physical activity behaviours. Apparently, some factors noted by participants shape dietary and physical activity behaviours irrespective of immigration, and these factors include: tastes and cravings for foods; friends and family influence on behaviour; and misconceptions about food and exercise. CONCLUSION: Migration from SSA to Australia contributed to changes (mainly less healthy) in dietary and physical activity behaviours. To a large extent, post-migration changes in dietary and physical activity behaviours were driven by socio-economic and environmental factors. SO WHAT?: Health promotion programs that address the risky behaviours associated with excess weight gain among Australian residents of SSA ancestry should pay more attention to socio-economic and environmental factors