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Peer N.,Chronic Diseases of Lifestyle Unit | Steyn K.,University of Cape Town | Lombard C.,Biostatistics Unit | Gwebushe N.,Biostatistics Unit | Levitt N.,University of Cape Town
PLoS ONE | Year: 2013

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. © 2013 Peer et al.

Peer N.,Chronic Diseases of Lifestyle Unit | Steyn K.,University of Cape Town | Lombard C.,Biostatistics Unit | Lambert E.V.,University of Cape Town | And 2 more authors.
PLoS ONE | Year: 2012

Objective: To examine the prevalence of and the association of psychosocial risk factors with diabetes in 25-74-year-old black Africans in Cape Town in 2008/09 and to compare the prevalence with a 1990 study. Research Design and Methods: A randomly selected cross-sectional sample had oral glucose tolerance tests. The prevalence of diabetes (1998 WHO criteria), other cardiovascular risk factors and psychosocial measures, including sense of coherence (SOC), locus of control and adverse life events, were determined. The comparison of diabetes prevalence between this and a 1990 study used the 1985 WHO diabetes criteria. Results: There were 1099 participants, 392 men and 707 women (response rate 86%). The age-standardised (SEGI) prevalence of diabetes was 13.1% (95% confidence interval (CI) 11.0-15.1), impaired glucose tolerance (IGT) 11.2% (9.2-13.1) and impaired fasting glycaemia 1.2% (0.6-1.9). Diabetes prevalence peaked in 65-74-year-olds (38.6%). Among diabetic participants, 57.9% were known and 38.6% treated. Using 1985 WHO criteria, age-standardised diabetes prevalence was higher by 53% in 2008/09 (12.2% (10.2-14.2)) compared to 1990 (8.0% (5.8-10.3)) and IGT by 67% (2008/09: 11.7% (9.8-13.7); 1990: 7.0% (4.9-9.1)). In women, older age (OR: 1.05, 95%CI: 1.03-1.08, p<0.001), diabetes family history (OR: 3.13, 95%CI: 1.92-5.12, p<0.001), higher BMI (OR: 1.44, 95%CI: 1.20-1.82, p = 0.001), better quality housing (OR: 2.08, 95%CI: 1.01-3.04, p = 0.047) and a lower SOC score (≤40) was positively associated with diabetes (OR: 2.57, 95%CI: 1.37-4.80, p = 0.003). Diabetes was not associated with the other psychosocial measures in women or with any psychosocial measure in men. Only older age (OR: 1.05, 95%CI: 1.02-1.08, p = 0.002) and higher BMI (OR: 1.10, 95%CI: 1.04-1.18, p = 0.003) were significantly associated with diabetes in men. Conclusions: The current high prevalence of diabetes in urban-dwelling South Africans, and the likelihood of further rises given the high rates of IGT and obesity, is concerning. Multi-facetted diabetes prevention strategies are essential to address this burden. © 2012 Peer et al.

Everett-Murphy K.,Chronic Diseases of Lifestyle Unit | Paijmans J.,Maastricht University | Steyn K.,Chronic Diseases of Lifestyle Unit | Matthews C.,University of Cape Town | And 2 more authors.
Midwifery | Year: 2011

Objective: to investigate how midwives are currently communicating with women about smoking during pregnancy with a view to involving them in a smoking cessation intervention in antenatal clinics. Design: a qualitative study using individual, in-depth interviews for data collection. Setting and participants: 24 nurses providing antenatal care to pregnant smokers attending public sector clinics in five major cities in South Africa. Findings: three archetypes of midwives, characterised by different styles of communication and approaches to smoking cessation, emerged from the analysis of the interview data. These were described as the 'Angry Scolders', the 'Benign Carers' and the 'Enthusiastic Friends'. The first type conformed to the traditional, authoritarian style of communication, where the midwife assumed a dominant, expert role. When women failed to comply with their advice, these midwives typically became angry and confrontational. The second type of midwife used a paternalistic communication style and emphasised the role of education in changing behaviour. However, these midwives had little confidence that they could influence women to quit. The third type embraced a patient-centred approach, consciously encouraging more interaction with their patients and attempting to understand change from their point of view. These midwives were optimistic of women's capacity to change and more satisfied with their current health education efforts than the first two types. The Benign Carers and Enthusiastic Friends were more open to participation in the potential intervention than the Angry Scolders. Key conclusions: the prevailing traditional, authoritarian style of communication is inappropriate for smoking cessation education and counselling as it provokes resistance and avoidance on the part of pregnant smokers. The paternalistic approach appears to be largely ineffectual, whereas the patient-centred approach elicits the most positive response from pregnant women and enhances the possibility of a trusting and cooperative relationship with the midwife. Midwives using this style are more open to fulfilling their role in smoking cessation. Implications for practice: smoking cessation interventions need to attend to not only what midwives say to pregnant women about smoking, but also how they communicate about the issue. The use of a patient-centred approach, such as brief motivational interviewing, is recommended as a means of improving counselling outcomes among pregnant smokers. © 2010 Elsevier Ltd.

Temple N.J.,Athabasca University | Steyn N.P.,Human science Research Council | Fourie J.,Chronic Diseases of Lifestyle Unit | De Villiers A.,Chronic Diseases of Lifestyle Unit
Nutrition | Year: 2011

Objective: We investigated the availability of healthier food choices and whether a healthier diet costs more than a diet commonly eaten by low-income families in South Africa. Methods: We visited 21 food stores in 14 rural towns of the Western Cape province of South Africa. We recorded the price and availability of 66 food items, including both commonly consumed foods as well as healthy options. Results: Healthier food choices are available in supermarkets. However, many towns only have small food stores with a limited selection of healthy foods. We compared the prices of six commonly consumed foods with healthier versions of those foods (e.g., whole-wheat bread in place of white bread). Healthier foods typically cost between 10% and 60% more when compared on a weight basis (Rand per 100 g), and between 30% and 110% more when compared based on the cost of food energy (Rand per 100 kJ). Next, we compared the extra cost of a healthier diet compared to a typical South African menu. On average, for an adult male, the healthier diet costs Rand 10.2 (US$1.22) per day more (69% more). For a household with five occupants, the increased expenditure on food by eating a healthier diet is approximately Rand 1090 per month (US$140); this represents a high proportion (>30%) of the total household income for most of the population. Conclusion: Healthier food choices are, in general, considerably more expensive than commonly consumed foods. As a result, a healthy diet is unaffordable for the large majority of the population. © 2011 Elsevier Inc.

McHiza Z.J.,Chronic Diseases of Lifestyle Unit | Temple N.J.,Athabasca University | Steyn N.P.,Human science Research Council | Abrahams Z.,Human science Research Council | Clayford M.,Chronic Diseases of Lifestyle Unit
Public Health Nutrition | Year: 2013

Objective: To determine the frequency and content of food-related television (TV) advertisements shown on South African TV.Design: Four national TV channels were recorded between 15.00 and 21.00 hours (6 h each day, for seven consecutive days, over a 4-week period) to: (i) determine the number of food-related TV advertisements; and (ii) evaluate the content and approach used by advertisers to market their products. The data were viewed by two of the researchers and coded according to time slots, food categories, food products, health claims and presentation.Results: Of the 1512 recorded TV advertisements, 665 (44 %) were related to food. Of these, 63 % were for food products, 21 % for alcohol, 2 % for multivitamins, 1 % for slimming products and 13 % for supermarket and pharmacy promotions. Nearly 50 % of food advertisements appeared during family viewing time. During this time the most frequent advertisements were for desserts and sweets, fast foods, hot beverages, starchy foods and sweetened drinks. The majority of the alcohol advertisements (ninety-three advertisements, 67 %) fell within the children and family viewing periods and were endorsed by celebrities. Health claims were made in 11 % of the advertisements. The most frequently used benefits claimed were 'enhances well-being', 'improves performance', 'boosts energy', 'strengthens the immune system' and 'is nutritionally balanced'.Conclusions: The majority of food advertisements shown to both children and adults do not foster good health despite the health claims made. The fact that alcohol advertisements are shown during times when children watch TV needs to be addressed. Copyright © 2013 The Authors.

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