Coronary heart disease risk factors in a rural and urban Orange Free State black population

Objective. To determine and compare the prevalence of ischaemic heart disease (IHD) risk factors in a rural and an urban black population.Design. A survey to determine the prevalence of hypertension, diabetes mellitus, smoking, obesity, central obesity and dyslipidaemia in black subjects 25 years and older.Setting. The indigenous black populations of QwaQwa and Mangaung.Participants. A random sample of 950 households was selected from each area. From each household an unrelated male and/or female subject was selected in a standardised way. From QwaQwa 853 subjects (279 men and 574 women) and from Mangaung 758 subjects (290 men and 468 women) participated in the study. The response rate was 68% and 62% respectively for QwaQwa and Mangaung.Main outcome measures. Few urban-rural differences in the prevalence of IHD risk factors were found in this study. A low prevalence of clustering of major IHD risk factors was noted.Results. The age- and sex-adjusted prevalences of hypertension were 29% in QwaQwa and 30,3% in Mangaung. Oiabetes was present in 4,8% of the QwaQwa sample and 6% of the Mangaung sample. The prevalence of heavy smoking in the Mangaung sample was almost double that of the QwaQwa sample and mostly confined to men. High-risk hypercholesterolaemia was present in 12,5% of QwaQwa and 6% of Mangaung men in the  25 - 34-year age group. The corresponding figures for moderate-risk hypercholesterolaemia were 34% and 44,8% and both levels of risk declined with increasing age. The mean body mass index of women in both samples exceeded 25 kg/m2.Conclusion. All the elements for a potential epidemic of atherosclerotic cardiovascular disease are present in the study populations. The similarity of findings in the two samples may be indicative of the advanced stage of urbanisation and westernisation of the rural group. It is alarming that subjects in the younger age groups tendeo to have the highest prevalences of moderate and even high-risk hypercholesterolaemia

The role of private general practitioners in the treatment of alcohol dependence in the Free State Province

OBJECTIVES : The study was undertaken to investigate the role of private general practitioners (GPs) in the treatment of alcohol dependence in the Free State province. DESIGN : A descriptive cross-sectional study. A questionnaire was used to describe the experiences of GPs with patients with alcohol dependence. OUTCOME MEASURESut : The treatment role of individual participants was defined in terms of the range of services provided and the enablers and obstacles faced in performing interventions in their local context. SETTING AND SUBJECTS : Seventy-seven private GPs were selected by means of a stratified randomised sampling process from areas in the immediate proximity of regional hospitals, district hospitals, or basic environments (without local hospital services), in three geographical areas defined by existing health service delivery boundaries. RESULTS : 29.9% of participants practised medical detoxification, either in hospital or in outpatient settings. Involvement related to the local organisation of treatment services in a geographical area. GPs in resource-constrained environments played an extended role outside of the traditional office-based model of care. Medical scheme funding policies were regarded as an obstacle to involvement in the treatment of alcohol-dependent patients by 76.5% of participants. Other major obstacles were lack of multidisciplinary teams, in-patient facilities and referral structures. CONCLUSION : Private GPs in the Free State play a context-dependent role in the treatment of alcohol-dependent patients in the province. This compensatory role needs to be acknowledged in service delivery planning in under-resourced areas, especially to ensure access to treatment and cost-effective management.The Hendrik Vrouwes Trust and the Faculty of Health Sciences, University of the Free State.http://www.safpj.co.zaam201

Management of the diabetic patient in a resource-constrained environment

A century ago diabetes was virtually unknown in Africa. Currently 10 million people are living with this disease in Africa and the number is predicted to double by 2025. Type 2 diabetes accounts for 85 to 95% of all cases in the region. The main factors responsible for the rapid increase in the prevalence of diabetes in sub-Saharan Africa are an aging population, unhealthy diet, overweight and obesity, and a sedentary lifestyle, closely related to rapid urbanisation of the population in the region