Gestational diabetes mellitus in Africa: a systematic review.

BACKGROUND: Gestational diabetes mellitus (GDM) is any degree of impaired glucose tolerance first recognised during pregnancy. Most women with GDM revert to normal glucose metabolism after delivery of their babies; however, they are at risk of developing type 2 diabetes later in life as are their offspring. Determining a country's GDM prevalence can assist with policy guidelines regarding GDM screening and management, and can highlight areas requiring research. This systematic review assesses GDM prevalence in Africa. METHODS AND FINDINGS: Three electronic databases were searched without language restrictions; PubMed, Scopus and the Cochrane Library. Thirty-one search terms were searched. Eligible articles defined GDM, stated what GDM screening approaches were employed and reported GDM prevalence. The reporting quality and risk of bias within each study was assessed. The PRISMA guidelines for systematic reviews were followed. The literature search identified 466 unique records. Sixty full text articles were reviewed of which 14 were included in the systematic review. One abstract, for which the full text article could not be obtained, was also included. Information regarding GDM classification, screening methods and prevalence was obtained for six African countries; Ethiopia (n = 1), Morocco (n = 1), Mozambique (n = 1), Nigeria (n = 6), South Africa (n= 4) and Tanzania (n = 1). Prevalence figures ranged from 0% (Tanzania) to 13.9% (Nigeria) with some studies focussing on women with GDM risk factors. Most studies utilised the two hour 75 g oral glucose tolerance test and applied the World Health Organization's diagnostic criteria. CONCLUSIONS: Six countries, equating to 11% of the African continent, were represented in this systematic review. This indicates how little is known about GDM in Africa and highlights the need for further research. Considering the increasing public health burden of obesity and type 2 diabetes, it is essential that the extent of GDM is understood in Africa to allow for effective intervention programmes.This is the final published version of the article. It was originally published here: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0097871

High prevalence of cardiovascular risk factors and insulin resistance 6 years after hyperglycemia first detected in pregnancy in Cape Town, South Africa

Objective To investigate the prevalence and associated cardiovascular risk factors 6 years after hyperglycemia first detected in pregnancy (HFDP) in Cape Town, South Africa. Research design and methods Data were collected during the index pregnancy from all women diagnosed with HFDP at a major referral hospital in Cape Town. Participants were evaluated 6 years later using a cross-sectional study. At follow-up participants had a 75 g oral glucose tolerance test, fasting lipogram, blood pressure and anthropometric measurements, and a fieldworker administered the questionnaire. We used the Adult Treatment Panel III criteria for the diagnosis of metabolic syndrome and individual risk factors. Insulin resistance was assessed using the homeostatic model of insulin resistance. Results At follow-up 220 women were reviewed. Their mean age at follow-up was 37.2 (SD 6.0) years. The prevalence of cardiovascular disease (CVD) risk factors was 60.9% (95% CI 54.3 to 67.2) for metabolic syndrome, 75% (95% CI 65.9 to 82.3) for insulin resistance, 62.3% (95% CI 55.6 to 68.5) for dysglycemia, 41.4% (95% CI 35.0 to 48.0) for raised blood pressure, and 74.6% (95% CI 683 to 79.9) for dyslipidemia. Women with diabetes in pregnancy compared with those with gestational diabetes during the index pregnancy had a higher prevalence of metabolic syndrome (74.3% vs 54.7%, p=0.010) and dysglycemia (88.6% vs 50.0%, p<0.001) at follow-up. Lower school education attainment, having a subsequent pregnancy, waist circumference at follow-up, and fasting blood glucose at HFDP diagnosis were associated with metabolic syndrome. Conclusion We found a high prevalence of CVD risk factors in South African women within 6 years of HFDP, which highlights the need to develop and evaluate interventions optimizing the cardiometabolic health of this vulnerable group. The main limitations of our research are the lack of a comparative group of women without HFDP and that we did not assess for CVD risk factors before HFDP. - Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Funding This research was funded by the Chronic Disease Initiative for Africa. We acknowledge funding from the International Development Research Centre (IDRC) (fund number: 411592) for TC (under the IINDIAGO project).Scopu

‘We were not allowed to gather even for Christmas.’ Impact of COVID-19 on South African young people: Exploring messaging and support

COVID-19 prevention measures including lockdowns, school closures, and restricted movement disrupted young people’s lives. This longitudinal qualitative study conducted in Soweto, South Africa aimed to explore young people’s knowledge and perceptions of COVID-19, vaccination, and the impact of infections. A convenience sample of 30 young black people (n = 15 men; n = 15 women, aged 16–21 years) from Soweto participated in 24 focus group discussions (FGDs), conducted in six phases – each phase had four FGDs stratified by gender and age. Young people’s understanding of COVID-19 deepened throughout the study, however, did not always translate into adherence (following the government’s COVID-19 prevention measures). Although deemed inadequate, TV and radio were preferred over internet COVID-19 information. Parents, teachers, and schools were trusted sources of information. Vaccines and limited access to information attributed to low-risk perception, while new COVID-19 variants attributed to high-risk perception. A low-risk perception and conspiracy theories contributed to non-adherence (disregarding COVID-19 preventative measures provided by the government), particularly among young men. Accessing reliable information that considers young people’s lives and their living context is important. Communities, scientists, and policymakers must learn from the COVID-19 experience and implement localised preventive strategies for education, awareness, and economic support in future emergencies

Eating attitudes in a group of 11-year-old urban South African girls

No Abstract. South African Journal of Clinical Nutrition Vol. 19(2) 2006: 80-8

Urban South African adolescents' perceptions of their neighborhood socio-economic environments: the Birth to Twenty plus cohort study

The Apartheid era led to major differences in the living conditions between population groups in South Africa. Subsequently, reforms have been implemented to reduce poverty and inequalities. This study aims to assess neighborhood and school socio-economic (SE) environments reported by adolescents to determine whether geographic and population group differences in the SE environment exist. Neighborhood SE status was assessed using a novel questionnaire adapted to the urban South African context. Black African and Mixed Ancestry participants lived in more deprived SE environments and reported studying in less favorable school environments compared to Whites. Among Black Africans, those living in Soweto versus metropolitan Johannesburg reported more deprived economic and school environments

How can we learn about community socioeconomic status and poverty in a developing country urban environment? An example from Johannesburg-Soweto, South Africa

Few tested tools exist to assess poverty and socio-economic status at the community level, particularly in urban developing country environments. Furthermore, there is no real sense of what the community concept actually means. Consequently, this paper aims to describe how formative qualitative research was used to develop a quantitative tool to assess community SES in Johannesburg-Soweto in terms of the terminology used, topics covered, and how it was administered, comparing it to the South African Living Standards and Measurement Study. It also discusses the level of aggregation respondents identified as defining a local community using a drawing/mapping exercise. Focus groups (n=11) were conducted with 15-year-old adolescents and their caregivers from the 1990 Birth-to-Twenty (Bt20) cohort and key informant in-depth interviews (n=17) with prominent members working in the Bt20 communities. This research recognises the importance of involving local people in the design of data collection tools measuring poverty and human well-being

Studying a population undergoing nutrition transition: a practical case study of dietary assessment in urban South African adolescents

The South African Medical Research Council food frequency questionnaire (FFQ) and protocol was used to determine food intake in 83 adolescents from the Birth To Twenty study. The FFQ was piloted on a small group (n=8). Specific problems which resulted in overestimation of energy intake were identified. The protocol was modified and administered to the remainder of the adolescents and their caregivers. Reasonable energy intakes were obtained, and time spent completing the FFQ was reduced. The modified protocol was more successful in determining habitual food intake although it would benefit from validation against other dietary intake techniques