Determinants and treatment of hypertension in South Africans: the first demographic and health survey

Objectives: To identify the groups of patients with high prevalence and poor control of hypertension in South Africa. Methods: In the first national Demographic and Health Survey, 12 952 randomly selected South Africans, aged 15 years and older were surveyed. Trained interviewers completed questionnaires on socio-demographic characteristics, lifestyle and the management of hypertension. This cross-sectional survey also included blood pressure, height and weight measurements. Logistic regression analyses identified the determinants of hypertension and the treatment status in this dataset. Results: A high risk of hypertension was associated with less than tertiary education, older age groups, overweight and obese people, using alcohol in excess, and a family history of stroke and hypertension. Rural Africans had the lowest risk of hypertension, which was significantly higher in obese African women than in women with normal body mass index. Improved hypertension control was found in the wealthy, women, older persons, being Asian, and having medical insurance. Conclusions: Rural African people had lower hypertension prevalence rates than the other groups. The poorer, younger men, without health insurance had the worst level of hypertension control

The contribution of dark-green leafy vegetables to total micronutrient intake of two- to five-year-old children in a rural setting

This study determined the contribution of dark-green leafy vegetables (DGLV) to total micronutrient intake of two- to fiveyear- old children residing in two neighbouring rural villages in KwaZulu-Natal where production and consumption of these vegetables were promoted. A repeated cross-sectional study that included five repeated 24 h dietary recalls per study period was done during February (n=79), May (n=74), August (n=75) and November (n=78) of 2005 by interviewing the caregivers. Consumption of spinach (mostly Swiss chard) and imifino (a collective term for various dark-green leaves) complemented each other, with imifino being consumed mostly during the first and last quarter of the year, and spinach (mostly Swiss chard) during the 3rd quarter. The proportion of children who consumed DGLV during the 5 d recall period ranged from 36% (May survey) to 86% (February survey), and the average number of times that children consumed it ranged from 1.4 (May survey) to 2.2 (February survey). The average portion size consumed was approximately ½ cup (87 ± 56 g for spinach; 87 ± 38 g for imifino). For children consuming DGLV, these vegetables contributed significantly to dietary intake of calcium (21 to 39% of total intake), iron (19 to 39%), vitamin A (42 to 68%) and riboflavin (9 to 22%).In conclusion, DGLV made a significant contribution towards total nutrient intake of the children for several of the micronutrients. This contribution can potentially be increased should these vegetables be consumed more frequently and by a larger proportion of the children.Keywords: dark-green leafy vegetables, dietary intake, micronutrients, children, rural, South Afric

Trends in adult tobacco use from two South African demographic and health surveys conducted in 1998 and 2003

Introduction: Since tobacco use peaked in the early 1990s in South Africa, it has declined significantly. This reduction has been attributed to the government’s comprehensive tobacco control policies that were introduced in the 1990s. Objective: To assess the pattern of tobacco use between the South African Demographic and Health Surveys in 1998 and 2003. Methods: Multi-stage sampling was used to select approximately 11 000 households in cross-sectional national surveys. Face-to-face interviews, conducted with 13 826 adults (41% men) aged ≥15 years in 1998 and 8 115 (42% men) in 2003, included questions on tobacco use according to the WHO STEP-wise surveillance programme. Logistic regression analysis was used to assess the independent effects of selected characteristics on smoking prevalence. Results: Daily or occasional smoking prevalence among women remained unchanged at 10-11%; among men it decreased from 42% (1998) to 35% (2003). The decline for men was significant among the poorest and those aged 25-44 years. Strong age patterns were observed, peaking at 35-44 years, which was reduced for men in 2003. Higher income and education were associated with low prevalence of smoking while living in urban areas was associated with higher rates. African men and women smoked significantly less than other population groups. Conclusion: Despite decreasing smoking rates in some subgroups, a gap exists in the efforts to reduce tobacco use as smoking rates have remained unchanged in women and young adults, aged 15-24 years

Estimating the burden of disease attributable to high blood pressure in South Africa in 2000

Objectives\ud \ud To estimate the burden of disease attributable to high blood pressure (BP) in adults aged 30 years and older in South Africa in 2000. \ud \ud Design\ud \ud World Health Organization comparative risk assessment (CRA) methodology was followed. Mean systolic BP (SBP) estimates by age and sex were obtained from the 1998 South African Demographic and Health Survey adult data. Population-attributable fractions were calculated and applied to revised burden of disease estimates for the relevant disease categories for South Africa in 2000. Monte Carlo simulation modelling techniques were used for uncertainty analysis. \ud \ud Setting\ud \ud South Africa\ud \ud Subjects\ud \ud Adults aged 30 years and older. \ud \ud Outcome measures\ud \ud Mortality and disability-adjusted life years (DALYs) from ischaemic heart disease (IHD), stroke, hypertensive disease and other cardiovascular disease (CVD). \ud \ud Results\ud \ud High BP was estimated to have caused 46 888 deaths (95% uncertainty interval 44 878 - 48 566) or 9% (95% uncertainty interval 8.6 - 9.3%) of all deaths in South Africa in 2000, and 390 860 DALYs (95% uncertainty interval 377 955 - 402 256) or 2.4% of all DALYs (95% uncertainty interval 2.3 - 2.5%) in South Africa in 2000. Overall, 50% of stroke, 42% of IHD, 72% of hypertensive disease and 22% of other CVD burden in adult males and females (30+ years) were attributable to high BP (systolic BP ≥ 115 mmHg). \ud \ud Conclusions\ud \ud High BP contributes to a considerable burden of CVD in South Africa and results indicate that there is considerable potential for health gain from implementing BP-lowering interventions that are known to be highly costeffective

Reversal in childhood mortality trend in rural KwaZulu-Natal, South Africa

Abstract This study uses pregnancy history information from a demographic surveillance site in rural KwaZulu-Natal, along the eastern coastal board of South Africa, to investigate the mortality levels, trends and selected factors associated with childhood mortality. Life table analysis of the data reveals a reversal of the downward trend in mortality rates over time that began around 1990 in this population. Between 1990 and 2000 infant mortality increased from 43 to 65 per 1000 live births and under-five mortality from 65 to 116 per 1 000 live births which translates into a RR of 1.85 over the 10 year period (p-value <0.001). Maternal HIV prevalence in this area is among the highest in South Africa and rose from 4.2% to 26.0% during this period, making it probable that much of the increase in child deaths is attributable to mother to child transmission of HIV. Negative binomial regression identified the source of water, level of maternal education at the time of the survey and being a recipient of the child support grant as important factors associated with child mortality. However, their joint effect is attenuated by the overwhelming impact of HIV which also appears to have swamped the anticipated health benefit expected from various health care reforms.Keywords: Child mortality; rural South Africa; factors associated with child mortality; HIV prevalence; Demographic Surveillance SiteResume Renversement de tendance du taux de mortalite infantile dans la zone rurale du Kwazulu Natal en Afrique du Sud. Cette étude utilise des informations historiques sur les naissances dans un site rural de surveillance démographique au KwaZulu-Natal sur la cote orientale de l'Afrique du Sud pour evaluer le taux de mortalité et leurs tendances et identifier les facteurs associés à la mortalité infantile. L’analyse des table de vie révèle une inversion de la tendance à la baisse du taux de mortalité entre 1990 et 2000 ., Pendant cette periode, la mortalité infantile a augmenté de 43 à 65 par 1000 naissances et celle des moins de 5 ans de 65 à 116 pour 1 000 naissances, ce qui se traduit par un RR de 1,85 pour la periode etudiee. (p-valeur < 0,001). La prévalence du VIH dans cette region est parmi les plus élevées en Afrique du Sud et a augmenté de 4,2 % à 26,0 % pendant cette période, il est donc probable que l'augmentation des décès d'enfants est en grande partie attribuable à la transmission du VIH de la mere a l’enfant. Une régression binomiale négative a identifie l’acces a léau potable , le niveau d'éducation de la mere au moment de l'enquête et à si la mere est bénéficiaire d’ allocation sociale pour lénfant comme des facteurs importants associés à la mortalité infantile. Cependant leur effet meme combine, est atténué par l'immense impact du VIH qui semble avoir submerge les bénéfices attendus des diverses réformes de la santé.Mot clefs: Mortalite infantile, L’Afrique Du Sud rurale, facteurs associes a la mortalite infantile, prevalence du SIDA, Site de Surveillance Demographique

COVID-19 and all-cause mortality in South Africa – the hidden deaths in the first four waves

Accurate statistics are essential for policy guidance and decisions. However, the reported number of cases and COVID-19 deaths are known to be biased due to under-ascertainment of SARS-CoV-2 and incomplete reporting of deaths. Making use of death data from the National Population Register has made it possible to track in near-real time the number of excess deaths experienced in South Africa. These data reveal considerable provincial differences in the impact of COVID-19, likely associated with differences in population age structure and density, patterns of social mixing, and differences in the prevalence of known comorbidities such as diabetes, hypertension, and obesity. As the waves unfolded, levels of natural immunity together with vaccination began to reduce levels of mortality. Mortality rates during the second (Beta) wave were much higher than mortality in the third (Delta) wave, which were higher than in either the first or the fourth (Omicron) waves. However, the cumulative death toll during the second (Beta) wave was of a similar order of magnitude as that during the third (Delta) wave due to the longer duration of the Delta wave. Near-real time monitoring of all-cause deaths should be refined to provide more granular-level information to enable district-level policy support. In the meanwhile, there is an urgent need to re-engineer the civil registration and vital statistics system to enable more timely access to cause of death information for public health actions.Significance:This study highlights that in South Africa there were about three times the number of excess deaths from natural causes during 2020 and 2021 than reported COVID-19 deaths. Although the cause of death remains unknown, the strong temporal correlation between excess deaths and reported COVID-19 deaths within each province indicates that the majority of excess deaths were associated with COVID-19. Many countries have found it difficult to estimate excess deaths, or to identify and report COVID-19 deaths accurately, demonstrating the value of near-real time monitoring of mortality through the use and demographic analysis of data obtained from the country’s National Population Register

South African cause-of death profile in transition - 1996 and future trends

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Retail cost and energy adjusted cost are associated with dietary diversity and nutrient adequacy for diets of 6–24 months children

Poor nutrition during the first two years of life has long term consequences, but resourcepoor households often do not have the means to access nutrient-dense and diverse diets. Pooled data of 24-h dietary recalls (n = 3336) and 2019 retail food prices were analyzed to determine associations of retail cost and energy cost (per 100 kcal) with diet quality indicators for diets of 6–24-monthold South African children who were breastfed (BF-diet) and not breastfed (NBF-diet) during the 24-h recall period. Compared to the BF-diet, retail cost for the NBF-diet was three times higher for age 6–11 months, and double for age 12–17 months

Unabated rise in number of adult deaths in South Africa

Mortality statistics are a fundamental cornerstone of the health status data needed for planning and monitoring the impact of health programmes. In developed countries, such data are generated through the death registration system, dating back to the 19th century in the case of the UK and Sweden. Until recently, South Africa’s death registration system was recognised as inadequate to provide such statistics for the majority of the population,1 but the postApartheid government has prioritised the collection of such statistics, as evidenced by a new-found collaboration between the Departments of Health and Home Affairs and Statistics South Africa.2 Registration of adult deaths improved from about 50% in 1990 to over 90% in 20003 as a result of the incorporation of the former homelands as well as national efforts to improve coverage. However, the production of timely cause of death statistics remains a challenge; the most recent year with full officially published statistics is 1996

Weight-loss strategies of South African female university students and comparison of weight management-related characteristics between dieters and non-dieters

Abstract Background Female university students are at risk for weight gain and use of inappropriate weight-loss strategies. By gaining a greater understanding of the weight-loss strategies used by and weight management related characteristics of these students, effective weight management interventions for this vulnerable group can be developed. Methods Two hundred and fifty female students from South Africa universities, aged 18–25 years, participated in this cross-sectional study; 162 attempted weight loss during the year preceding the study (dieters) and 88 were non-dieters. Weight and height were measured and BMI (kg/m 2 ) computed. A self-administered questionnaire was used to record all other variables. Weight loss strategies were described for dieters and compared between BMI groups within the dieters group. Weight management related characteristics were compared between dieters and non-dieters. Statistical tests included Pearson Chi-square test, independent samples t-test or Mann-Whitney U test (depending on distribution of the data). Predictors for a higher BMI and being overweight/obese (BMI ≥25 kg/m 2 ) were identified using regression models. Results Healthy weight-loss strategies included increased exercise and fruit/vegetable intake and decreased intake of sugar and fat containing items; unhealthy methods included eating little food and skipping meals; and extreme weight loss strategies included laxatives and vomiting. The most commonly used weight-loss product was Herbex. Dieters were characterized by a higher BMI, overestimation of their weight (especially normal weight students), dissatisfaction with weight and select body parts, higher intake of breakfast and healthy foods, lower intake of unhealthy foods, higher levels of vigorous physical activity, higher use of select informal weight-loss information sources and experiencing more pressure to lose weight from mothers, siblings and friends. Predictors of higher BMI and/or increased risk for BMI ≥25 included weight-loss attempt during the past year, race, dissatisfaction with waist, perception of currently being “chubby,” and higher frequencies of intake of a snack and fatty foods. Conclusion Attempting weight-loss is common among female students and predicts BMI. Healthy (mainly), unhealthy and extreme weight loss methods are used. Dieters are characterized by a less realistic body image, lower body satisfaction, higher pressure to lose weight, use of informal weight-management information and a healthier life-style