Perspectives and perceptions on the consumption of a healthy diet in Soweto, an urban African community in South Africa

In Soweto, like in many other urban communities in sub-Saharan Africa, rapid urbanisation and epidemiological transition have left this urban African population vulnerable to diseases of lifestyle such as obesity, cardiovascular disease, hypertension and diabetes. The Heart of Soweto (HOS) study was established to examine the emergence of heart disease in Soweto and other African communities in epidemiological transition and found multiple threats to the current and future heart health of Soweto. Food intake data from the HOS has shown damaging food choices and potential nutritional deficiencies in a subgroup of urban black African patients diagnosed with CHF, living in Soweto. This preliminary data focused on the impact of changing dietary patterns, low income levels and a probable lack of knowledge of what constitutes a healthy diet and the contribution of these, to cardiovascular disease. It seems that the traditional diet is being abandoned in favour of a more Western diet typified by increased consumption of processed and convenience foods, and therefore an increased intake of salt, sugar and saturated fat. The decreased intake of fruit and vegetables has lead to a decreased consumption of fibre and vitamins and minerals. The traditional diet is associated with a low prevalence of degenerative diseases, whereas the Western diet is associated with increased prevalence. Factors that might possibly contribute to the change in dietary patterns include socio-economic circumstances, urbanisation, food insecurity, awareness around healthy food choices, as well as perceptions on obesity and overweight. Our comparison, based on currently available food prices, shows that the consumption of a healthy diet in Soweto represents a more cost effective and affordable choice than an unhealthy diet. Healthy food choices therefore, should be promoted both from a health, as well as a financial perspective. Creating awareness around risk factors that might contribute to chronic diseases of lifestyle and the prevention thereof, has become essential in this urban African population. Nutrition education and intervention programmes should focus on foods that are varied, available, culturally acceptable and popular, with the emphasis on affordability, as well as being consistent with the South African Food Based Dietary Guidelines

Lessons from the Heart of Soweto Study and future directions

South Africa is concurrently experiencing epidemiological transition with diseases of lifestyle on the increase, while still burdened by poverty related diseases. Chronic diseases of lifestyle such as CVD are rapidly becoming major causes of death in developing countries and by all predictions, will continue rising.(4,7,8,9) Of concern is the fact that in developing countries, CVD is occurring in younger individuals than in the developed countries and as the epidemic evolves, the poor are affected the most in both developed and developing countries.(1) The Heart of Soweto (HOS) study aimed to investigate and describe this emerging problem of CVD, and especially heart disease, amongst the urban African population in Soweto, who presented for the first time to a tertiary-care centre. Overall we found multiple challenges to the community of Soweto and surrounding regions from a combination of high levels of modifiable CV risk factors (with the exception of lipid disorders) and surprisingly high levels of advanced and deadly forms of heart disease affecting predominantly younger cases and women. Lessons learned from the HOS include, (1) building partnerships, (2) establish clear objectives with achievable goals, (3) think big and assume nothing, (4) provide an enabling environment, (5) be innovative and (6) never compromise on quality. The prevention of CVD other chronic diseases of lifestyle, as well as the management thereof, needs to be a multidisciplinary effort with all the necessary healthcare workers involved, implemented at the primary, as well secondary level. Our goal is the development of specific community based intervention programmes directed towards prevention and management of chronic diseases of lifestyle in Soweto and to document the aetiology, presentation and management thereof. Our data collection will be not only meaningful for the population in Soweto, but also in other areas of South Africa and the broader Africa. It will be indicative of any urban African population in transition

Is there an association between sleeping patterns and other environmental factors with obesity and blood pressure in an urban African population?

Beyond changing dietary patterns, there is a paucity of data to fully explain the high prevalence of obesity and hypertension in urban African populations. The aim of this study was to determine whether other environmental factors (including sleep duration, smoking and physical activity) are related to body anthropometry and blood pressure (BP). Data were collected on 1311 subjects, attending two primary health care clinics in Soweto, South Africa. Questionnaires were used to obtain data on education, employment, exercise, smoking and sleep duration. Anthropometric and BP measurements were taken. Subjects comprised 862 women (mean age 41 ± 16 years and mean BMI 29.9 ± 9.2 kg/m 2 ) and 449 men (38 ± 14 years and 24.8 ± 8.3 kg/m 2 ). In females, ANOVA showed that former smokers had a higher BMI (p 30 minutes was related to a lower BMI (β = -0.04, p30 minutes/day was related to lower systolic (β = -0.02, p<0.05) and lower diastolic BP (β = -0.02, p = 0.05). Longer night time sleep duration was associated with higher diastolic (β = 0.005, p<0.01) and systolic BP (β = 0.003, p<0.05) in females. No health benefits were noted for physical activity. These data suggest that environmental factors rarely collected in African populations are related, in gender-specific ways, to body anthropometry and blood pressure. Further research is required to fully elucidate these associations and how they might be translated into public health programs to combat high levels of obesity and hypertension

Adverse cardiovascular effects of exposure to cadmium and mercury alone and in combination on the cardiac tissue and aorta of Sprague–Dawley rats

The aim of this study was to identify cardiovascular effects of relevant concentrations of Cd and Hg alone and in combination as a mixture in water. This was achieved by administering to male Sprague–Dawley rats via gavage 0.62 mg/kg Cd or 1.23 mg/kg Hg, or a combination of 0.62 mg/kg Cd and 1.23 mg/kg Hg in the co-exposure group for 28 days. Concentrations were the rat equivalence dosages of 1,000 times the World Health Organization’s limits of 0.003 mg/L and 0.006 mg/L for Cd and Hg, respectively, for water. With termination, blood levels of the metals were increased. For all metal exposed groups, histological evaluation and transmission electron microscopy of the myocardium revealed myofibrillar necrosis, increased fibrosis, vacuole formation and mitochondrial damage. Cd caused the most mitochondrial damage while Hg to a greater degree induced fibrosis. In the aorta, both Cd and Hg also increased collagen deposition adversely altering the morphology of the fenestrated elastic fibers in the tunica media. Co-exposure resulted in increased cardiotoxicity with increased mitochondrial damage, fibrosis and distortion of the aortic wall as a result of increased collagen deposition, as well as altered elastin deposition, fragmentation and interlink formation. These are typical features of oxidative damage that correlates with a phenotype of premature ageing of the CVS that potentially can lead to hypertension and premature cardiac failure.The National Research Foundationhttp://www.tandfonline.com/loi/lesa202022-03-15hj2022Anatom

Drowning in data, thirsty for information and starved for understanding: A biodiversity information hub for cooperative environmental monitoring in South Africa

The world is firmly cemented in a notitian age (Latin: notitia, meaning data) – drowning in data, yet thirsty for information and the synthesis of knowledge into understanding. As concerns over biodiversity declines escalate, the volume, diversity and speed at which new environmental and ecological data are generated has increased exponentially. Data availability primes the research and discovery engine driving biodiversity conservation. South Africa (SA) is poised to become a world leader in biodiversity conservation. However, continent-wide resource limitations hamper the establishment of inclusive technologies and robust platforms and tools for biodiversity informatics. In this perspectives piece, we bring together the opinions of 37 co-authors from 20 different departments, across 10 SA universities, 7 national and provincial conservation research agencies, and various institutes and private conservation, research and management bodies, to develop a way forward for biodiversity informatics in SA. We propose the development of a SA Biodiversity Informatics Hub and describe the essential components necessary for its design, implementation and sustainability. We emphasise the importance of developing a culture of cooperation, collaboration and interoperability among custodians of biodiversity data to establish operational workflows for data synthesis. However, our biggest challenges are misgivings around data sharing and multidisciplinary collaboration

Drowning in data, thirsty for information and starved for understanding: A biodiversity information hub for cooperative environmental monitoring in South Africa

The world is firmly cemented in a notitian age (Latin: notitia, meaning data) – drowning in data, yet thirsty for information and the synthesis of knowledge into understanding. As concerns over biodiversity declines escalate, the volume, diversity and speed at which new environmental and ecological data are generated has increased exponentially. Data availability primes the research and discovery engine driving biodiversity conservation. South Africa (SA) is poised to become a world leader in biodiversity conservation. However, continent-wide resource limitations hamper the establishment of inclusive technologies and robust platforms and tools for biodiversity informatics. In this perspectives piece, we bring together the opinions of 37 co-authors from 20 different departments, across 10 SA universities, 7 national and provincial conservation research agencies, and various institutes and private conservation, research and management bodies, to develop a way forward for biodiversity informatics in SA. We propose the development of a SA Biodiversity Informatics Hub and describe the essential components necessary for its design, implementation and sustainability. We emphasise the importance of developing a culture of cooperation, collaboration and interoperability among custodians of biodiversity data to establish operational workflows for data synthesis. However, our biggest challenges are misgivings around data sharing and multidisciplinary collaboration

HIV prevention transformed : the new prevention research agenda.

We have entered a new era in HIV prevention whereby priorities have expanded from biomedical discovery to include implementation, effectiveness, and the effect of combination prevention at the population level. However, gaps in knowledge and implementation challenges remain. In this Review we analyse trends in the rapidly changing landscape of HIV prevention, and chart a new path for HIV prevention research that focuses on the implementation of effective and efficient combination prevention strategies to turn the tide on the HIV pandemic

Food choices and macro- and micronutrient intake of Sowetans with chronic heart failure

Thesis (MPhil (Rehabilitation))--University of Stellenbosch, 2011.ENGLISH ABSTRACT: In South Africa, rapid urbanisation and epidemiological transition have left the black urban population vulnerable to diseases of lifestyle such as chronic heart failure. This is in part due to the fact that changes in dietary patterns during urbanization play an important role in the increase of risk factors of these diseases. However, there is a lack of information on dietary choices of black urban populations. Therefore the current study evolved to describe the food choices and macro-and micronutrient intake of black, urban Sowetans, newly diagnosed with chronic heart failure, who attended the outpatient cardiac clinic at Chris Hani Baragwanath Hospital. A descriptive study methodology that made use of quantitative methods of data collection was used. Study participants comprised Sowetans with chronic heart failure who attended the Chris Hani Baragwanath Hospital outpatient cardiac clinic for the first time. Consecutive sampling followed by stratified random sampling was used to identify study participants. Participants were stratified for gender. Hundred persons participated in the study. Data was collected through the Food Frequency Questionnaire, a demographic questionnaire and measuring of height and weight. Data from the FFQ's was analysed for macro- and micronutrient intake by using the MRC "Food Finder 3‟ programme. Data were analysed by a statistician using StatSoft, Inc. (2009) STATISTICA, version 9.0. A p value of 0.05 was seen as statistically significant. The most significant clinical finding is an inadequate intake of certain micro nutrients and excessive salt consumption. Study participants continued to eat the more traditional carbohydrate foods. These staples were supplemented by highly refined carbohydrate sources, such as added sugar, sweets and chocolates, cakes, biscuits and cold drinks. Women ate significantly more maltabella (p=0.04), sweets and chocolates (p=0.01) than men, while men consumed significantly more, meat (p=0.01), milk and milk products (p=0.04), additional salt (p=0.02) and take away foods (p=0.05). Both genders had inadequate intake of Vitamin D [men 4 mcg/day (p=0.00), and women, 4 mcg/day (p=0.01)], selenium, [46 mcg/day (p=0.03) and 32 mcg/day (p=0.00)], folate [215 mcg/day (p=0.00) and 179 mcg/day (p=0.00)] and Vitamin C [71 mg/day (p=0.05) and 66 mg/day (p=0.07)]. Women had an inadequate intake of iron of 9 mg/day (P=0.00). It is recommended that dietary health promotion packages are developed and targeted specifically at this high risk community. Key words: Chronic heart failure, black, urban, food choices, macro-and micronutrients.AFRIKAANSE OPSOMMING: Die swart stedelike bevolking in Suid Afrika gaan gebuk onder 'n al groter wordende risiko vir leefstyl siektes soos kroniese hartversaking. Dit kan gedeeltelik toegeskryf word aan veranderinge in dieet patrone as gevolg van verstedeliking en die epidemiologiese oorgang. Daar is egter nie genoeg inligting oor die voedselkeuses van swart stedelike bevolkingsgroepe nie. Die huidige studie het dus ontwikkel uit die behoefte om die voedselkeuses en mikro- en makronutrient inname van swart, stedelike Soweto inwoners wat nuut gediagnoseer is met hartversaking en die buitepasiënt kardiologie kliniek by Chris Hani Baragwanath Hospitaal bygewoon het, te bepaal. Daar was gebruik gemaak van 'n beskrywende studie metodologie wat gebruik gemaak het van kwantitatiewe metodes van data insameling. Deelnemers aan die studie het bestaan uit swart inwoners van Soweto met kroniese hartversaking wat die buitepasiënt kardiologie kliniek by Chris Hani Baragwanath Hospitaal vir die eerste keer bygewoon het. 'n Opeenvolgende steekproef, gevolg deur gestratifiseerde steekproefneming was gebruik om die studie deelnemers te identifiseer. Deelnemers was gestratifiseer volgens geslag. Eenhonderd pesone het aan die studie deelgeneem. Data is ingesamel deur gebruik te maak van die Voedsel Frekwensie Vraelys, a demografiese vraelys en die meet van lengte en gewig. Data van die Voedsel Frekwensie Vraelyste was ge-analiseer vir mikro-en makronutrient inname met die MRC ”Food Finder 3” program. Data is ge-analiseer deur 'n statistikus met die „StatSoft, Inc. (2009) STATISTICA, version 9.0‟. 'n P waarde van 0.05 is gesien as statisties beduidend. Mees beduidendste kliniese bevinding was die ontoereikende inname van sekere mikro-nutriënte en die verhoogde inname van sout. Studie deelnemers het nog steeds die meer tradisionele koolhidraat voedsels geëet. Hierdie stapel voedsels was aangevul deur hoogs verfynde bronne van koolhidrate, soos ekstra suiker, lekkergoed en sjokolade, koek, koekies en koeldrank. Die vrouens het beduidend meer maltabella (p=0.01), lekkergoed en sjokolade (p=0.01) geëet as mans, terwyl mans beduidend meer vleis (p=0.01), melk en melkprodukte (p=0.04), bygevoegde sout (p=0.02) en wegneem kosse (p=0.05) ingeneem het. Beide geslagte het ontoereikende innames van vitamiene D [mans 4 mcg/dag (p=0.00), en vrouens, 4 mcg/dag (p=0.01)], selenium [46 mcg/dag (p=0.03) en 32 mcg/dag (p=0.00)], foliensuur [215 mcg/dag (p=0.00) en 179 mcg/dag (p=0.00)] en vitamiene C [71 mg/dag (p=0.05) en 66 mg/dag (p=0.07)]. Vrouens het 'n ontoereikende inname van yster van 9 mg/dag (p=0.00) gehad. Daar word aanbeveel dat gesonde voedingsprogramme ontwikkel word, spesifiek gemik op hierdie bevolkingsgroep. Sleutelwoorde: Kroniese hartversaking, swart, verstedeliking, voedselkeuses, makro- en mikronutriënte