A high burden of hypertension in the urban black population of Cape Town: the cardiovascular risk in Black South Africans (CRIBSA) study

Objective To determine the prevalence, associations and management of hypertension in the 25-74-year-old urban black population of Cape Town and examine the change between 1990 and 2008/09 in 25-64-year-olds. METHODS: In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Cardiovascular disease risk factors were determined by administered questionnaires, clinical measurements and fasting biochemical analyses. Logistic regression models evaluated the associations with hypertension. RESULTS: There were 1099 participants, 392 men and 707 women (response rate 86%) in 2008/09. Age-standardised hypertension prevalence was 38.9% (95% confidence interval (CI): 35.6-42.3) with similar rates in men and women. Among 25-64-year-olds, hypertension prevalence was significantly higher in 2008/09 (35.6%, 95% CI: 32.3-39.0) than in 1990 (21.6%, 95% CI: 18.6-24.9). In 2008/09, hypertension odds increased with older age, family history of hypertension, higher body mass index, problematic alcohol intake, physical inactivity and urbanisation. Among hypertensive participants, significantly more women than men were detected (69.5% vs. 32.7%), treated (55.7% vs. 21.9%) and controlled (32.4% vs. 10.4%) in 2008/09. There were minimal changes from 1990 except for improved control in 25-64-year-old women (1990∶14.1% vs. 2008/09∶31.5%). CONCLUSIONS: The high and rising hypertension burden in this population, its association with modifiable risk factors and the sub-optimal care provided highlight the urgent need to prioritise hypertension management. Innovative solutions with efficient and cost-effective healthcare delivery as well as population-based strategies are required

Differing patterns of overweight and obesity among black men and women in Cape Town: the CRIBSA study

Objectives To ascertain the prevalence and determinants of overweight/obesity in the 25-74-year-old urban black population of Cape Town and examine the changes between 1990 and 2008/09. METHODS: In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Data were collected by questionnaires, clinical measurements and biochemical analyses. Gender-specific linear regression models evaluated the associations with overweight/obesity. RESULTS: There were 1099 participants, 392 men and 707 women (response rate 86%) in 2008/09. Mean body mass index (BMI) and waist circumference (WC) were 23.7 kg/m 2 (95% confidence interval (CI): 23.1-24.2) and 84.2 cm (95% CI: 82.8-85.6) in men, and 33.0 kg/m 2 (95% CI: 32.3-33.7) and 96.8 cm (95% CI: 95.5-98.1) in women. Prevalence of BMI ≥25 kg/m 2 and raised WC were 28.9% (95% CI: 24.1-34.3) and 20.1% (95% CI: 15.9-24.9) in men, and 82.8% (95% CI: 79.3-85.9) and 86.0% (95% CI: 82.9-88.6) in women. Among 25-64-year-olds, BMI ≥25 kg/m 2 decreased between 1990 (37.3%, 95% CI: 31.7-43.1) and 2008/09 (27.7%, 95% CI: 22.7-33.4) in men but increased from 72.7% (95% CI: 67.6-77.2) to 82.6% (95% CI: 78.8-85.8) in women. In the regression models for men and women, higher BMI was directly associated with increasing age, wealth, hypertension and diabetes but inversely related to daily smoking. Also significantly associated with rising BMI were raised low-density lipoprotein cholesterol and being employed compared to unemployed in men, and having >7 years of education in women. CONCLUSIONS: Overweight/obesity, particularly in urban black women, requires urgent action because of the associations with cardiovascular disease risk factors and their serious consequences

Hypertension and Diabetes: Poor care for patients at community health centres

ABSTRACT OBJECTIVES: To identify health-care and provider-related determinants of diabetes and hypertension patients attending public sector community health centres (CHCs). METHODS: A random sample of 18 CHCs in the Cape Peninsula providing hypertension and diabetes care was selected. Twenty-five diabetes and 35 hypertension patients were selected per clinic and interviewed by trained fieldworkers and their medical records audited. Regression analyses identified predictors of controlled hypertension (< 140/90 mmHg) and diabetes (HbA1c < 7%). Analyses of in-depth interviews with nurses and doctors explored their experiences at the CHCs. Height, weight and blood pressure (BP) were measured and a random blood sample collected for lipids, glucose, HbA1c and creatinine. RESULTS: Hypertension and diabetes participants numbered 923 and 455, respectively (289 had both conditions). There were 33% hypertensive patients with a BP < 140/90 mmHg, while 42% of diabetes patients had non-fasting glucose levels below 11.1 mmol/ℓ. Knowledge about their conditions was poor. Prescriptions for drugs were not recorded in medical records of 22.6% of the diabetes and 11.4% of the hypertension patients. CONCLUSIONS: Primary care for patients with hypertension and diabetes at public sector CHCs is suboptimal. This highlights the urgent need to improve health care for patients with these conditions in the public sector of the Cape Peninsula

Hypertension and diabetes: poor care for patients at community health centres

Objectives. To identify health care provider-related determinants of diabetes and hypertension management in patients attending public sector community health centres (CHCs). Methods. A random sample of 18 CHCs in the Cape Peninsula providing hypertension and diabetes care was selected. Twenty-five patients with diabetes and 35 with hypertension per clinic were selected and interviewed by trained fieldworkers, and their medical records were audited. Regression analyses identified predictors of controlled hypertension (<140/90 mmHg) and diabetes (HbA1c <7%). In-depth interviews with nurses and doctors explored their experiences in working at the CHCs. Height, weight and blood pressure (BP) were measured for all patients and random blood samples collected for lipids, glucose, HbA1c and creatinine. Results. Of the participants 923 had hypertension and 455 diabetes (289 had both conditions). Of the hypertensive patients 33% had a BP <140/90 mmHg, while 42% of the patients with diabetes had non-fasting glucose levels below 11.1 mmol/l. Patients' knowledge about their conditions was poor. Prescriptions for drugs were not recorded in medical records of 22.6% of the patients with diabetes and 11.4% of those with hypertension. Conclusions. Primary care for patients with hypertension and diabetes at public sector CHCs is suboptimal. This study highlights the urgent need to improve health care for patients with these conditions in public sector clinics in the Cape Peninsula

A food-based dietary strategy lowers blood pressure in a low socio-economic setting: a randomised study in South Africa

OBJECTIVE: To assess the impact of a food-based intervention on blood pressure (BP) in free-living South African men and women aged 50-75 years, with drug-treated mild-to-moderate hypertension. METHODS: A double-blind controlled trial was undertaken in eighty drug-treated mild-to-moderate hypertensive subjects randomised to an intervention (n 40) or control (n 40) arm. The intervention was 8-week provision of six food items with a modified cation content (salt replacement (SOLO ), bread, margarine, stock cubes, soup mix and a flavour enhancer) and 500 ml of maas (fermented milk)/d. The control diet provided the same quantities of the targeted foods but of standard commercial composition and 500 ml/d of artificially sweetened cooldrink. FINDINGS: The intervention effect estimated as the contrast of the within-diet group changes in BP from baseline to post-intervention was a significant reduction of 6.2 mmHg (95 % CI 0.9, 11.4) for systolic BP. The largest intervention effect in 24 h BP was for wake systolic BP with a reduction of 5.1 mmHg (95 % CI 0.4, 9.9). For wake diastolic BP the reduction was 2.7 mmHg (95 % CI -0.2, 5.6). CONCLUSIONS: Modification of the cation content of a limited number of commonly consumed foods lowers BP by a clinically significant magnitude in treated South African hypertensive patients of low socio-economic status. The magnitude of BP reduction provides motivation for a public health strategy that could be adopted through lobbying of the food industry by consumer and health agencies

Did HealthKick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?

Background: Numerous studies in schools in the Western Cape Province, South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat. HealthKick (HK) was a three-year randomised controlled trial aimed at promoting healthy eating habits. Methods: Sixteen schools were selected from two low-income school districts and randomly allocated to intervention (n = 8) or control school (n = 8) status. The HK intervention comprised numerous activities to improve the school nutrition environment such as making healthier food choices available and providing nutrition education support. Dietary intake was measured by using a 24-h recall in 2009 in 500 grade 4 learners at intervention schools and 498 at control schools, and repeated in 2010 and 2011. A dietary diversity score (DDS) was calculated from nine food groups and frequency of snack food consumption was determined. A school level analysis was performed. Results: The mean baseline (2009) DDS was low in both arms 4.55 (SD = 1.29) and 4.54 (1.22) in the intervention and control arms respectively, and 49 % of learners in HK intervention schools had a DDS ≤4 (=low diversity). A small increase in DDS was observed in both arms by 2011: mean score 4.91 (1.17) and 4.83 (1.29) in the intervention and control arms respectively. The estimated DSS intervention effect over the two years was not significant [0 .04 (95 % CI: −0.37 to 0.46)]. Food groups least consumed were eggs, fruit and vegetables. The most commonly eaten snacking items in 2009 were table sugar in beverages and/or cereals (80.5 %); followed by potato crisps (53.1 %); non-carbonated beverages (42.9 %); sweets (26.7 %) and sugar-sweetened carbonated beverages (16 %). Unhealthy snack consumption in terms of frequency of snack items consumed did not improve significantly in intervention or control schools. Discussion: The results of the HK intervention were disappointing in terms of improvement in DDS and a decrease in unhealthy snacking. We attribute this to the finding that the intervention model used by the researchers may not have been the ideal one to use in a setting where many children came from low-income homes and educators have to deal with daily problems associated with poverty.Conclusions: The HK intervention did not significantly improve quality of diet of children

Mortality trends and diff erentials in South Africa from 1997 to 2012: second National Burden of Disease Study

Background The poor health of South Africans is known to be associated with a quadruple disease burden. In the second National Burden of Disease (NBD) study, we aimed to analyse cause of death data for 1997–2012 and develop national, population group, and provincial estimates of the levels and causes of mortality. Method We used underlying cause of death data from death notifi cations for 1997–2012 obtained from Statistics South Africa. These data were adjusted for completeness using indirect demographic techniques for adults and comparison with survey and census estimates for child mortality. A regression approach was used to estimate misclassifi ed HIV/AIDS deaths and so-called garbage codes were proportionally redistributed by age, sex, and population group population group (black African, Indian or Asian descent, white [European descent], and coloured [of mixed ancestry according to the preceding categories]). Injury deaths were estimated from additional data sources. Age-standardised death rates were calculated with mid-year population estimates and the WHO age standard. Institute of Health Metrics and Evaluation Global Burden of Disease (IHME GBD) estimates for South Africa were obtained from the IHME GHDx website for comparison. Findings All-cause age-standardised death rates increased rapidly since 1997, peaked in 2006 and then declined, driven by changes in HIV/AIDS. Mortality from tuberculosis, non-communicable diseases, and injuries decreased slightly. In 2012, HIV/AIDS caused the most deaths (29·1%) followed by cerebrovascular disease (7·5%) and lower respiratory infections (4·9%). All-cause age-standardised death rates were 1·7 times higher in the province with the highest death rate compared to the province with the lowest death rate, 2·2 times higher in black Africans compared to whites, and 1·4 times higher in males compared with females. Comparison with the IHME GBD estimates for South Africa revealed substantial diff erences for estimated deaths from all causes, particularly HIV/AIDS and interpersonal violence. Interpretation This study shows the reversal of HIV/AIDS, non-communicable disease, and injury mortality trends in South Africa during the study period. Mortality diff erentials show the importance of social determinants, raise concerns about the quality of health services, and provide relevant information to policy makers for addressing inequalities. Diff erences between GBD estimates for South Africa and this study emphasise the need for more careful calibration of global models with local data

Prevalence of body mass index ≥25 kg/m² in 25–64-year-old men and women in 1990 and 2008/09.

<p>Prevalence of body mass index ≥25 kg/m² in 25–64-year-old men and women in 1990 and 2008/09.</p

Socio-demographic and cardiovascular disease risk factors in overweight/obese men and women in 2008/09.

<p>*Other: comprised of homemakers, students and those receiving disability grants.</p><p>Socio-demographic and cardiovascular disease risk factors in overweight/obese men and women in 2008/09.</p