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Publications (216)
Objective
The aim was to determine the prevalence, distribution, concordance and associations of chronic kidney disease (CKD) assessed by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town.
Design and method
In this population-based cross-sectional study, stratified for age and gender, data collection included adm...
Aim
In view of the current context of poverty and socio-economic inequalities and the high and rising burdens of HIV infection and non-communicable diseases in South Africa, this study aims to describe the distribution of adverse life events (ALEs) by age and gender, and examine the socio-demographic characteristics, psychosocial coping mechanisms,...
Background:
To determine the prevalence, distribution, concordance and associations of chronic kidney disease (CKD) determined by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town.
Methods:
Data collection in this cross-sectional study included interviews, clinical measurements and biochemical analyses, includi...
This study determined the associations of resting heart rate (RHR) with cardiovascular disease risk factors (CVDRF) in 25–74-year-old black South Africans. This cross-sectional study determined CVDRF by administered questionnaires, clinical measurements and biochemical analyses, including oral glucose tolerance tests. Multivariable linear regressio...
Background:
The use of waist-to-height ratio has been suggested as a better proxy indicator of central obesity.
Objective:
To compare the utility of waist-to-height ratio with commonly used adiposity indices of body mass index, waist circumference and waist-to-hip ratio to identify cardio-metabolic diseases in 25-74-year-old black residents of C...
The South African strategic plan to reduce cardiovascular disease (CVD) includes reducing population salt intake to less than 5 g/day. A mass media campaign was undertaken to increase public awareness of the association between high salt intake, blood pressure and CVD, and focused on the reduction of discretionary salt intake. Community based surve...
Objective
The present study set out to determine whether morning spot urine samples can be used to monitor Na (and K) intake levels in South Africa, instead of the ‘gold standard’ 24 h urine sample.
Design
Participants collected one 24 h and one spot urine sample for Na and K analysis, after which estimations using three different formulas (Kawasa...
As a first step in combating the high hypertension rate in South Africa, the Government has recently implemented a mandatory regulation (R.214) pertaining to the sodium content of foodstuffs with targets for 2016 and 2019. We aimed to measure the sodium content and establish whether industry is complying with the targets set in Regulation R.214. Th...
On 2 September 2016, 25 local and international participants from various sectors met in Cape Town to take stock of South Africa (SA)’s progress in salt reduction and develop a roadmap for action. SA is centre stage on salt reduction globally, being the first country to mandate salt reduction across a wide range of processed foods. Excessive salt i...
On 2 September 2016, 25 local and international participants from various sectors met in Cape Town to take stock of South Africa (SA)’s progress in salt reduction and develop a roadmap for action. SA is centre stage on salt reduction globally, being the first country to mandate salt reduction across a wide range of processed foods. Excessive salt i...
Background. Low socioeconomic status is associated with the risk of hypertension. There are few reports of the effect of socioeconomic and potentially modifiable factors on the control of hypertension in South Africa (SA).
Objectives. To investigate associations between patients’ socioeconomic status and characteristics of primary healthcare facil...
Background:
Low socioeconomic status is associated with the risk of hypertension. There are few reports of the effect of socioeconomic and potentially modifiable factors on the control of hypertension in South Africa (SA).
Objectives:
To investigate associations between patients' socio-economic status and characteristics of primary healthcare fa...
Background. Low socioeconomic status is associated with the risk of hypertension. There are few reports of the effect of socioeconomic and potentially modifiable factors on the control of hypertension in South Africa (SA).
Objectives. To investigate associations between patients’ socioeconomic status and characteristics of primary healthcare facil...
Background:
In many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries is limited. Primary Care 101 (PC101)...
Patient information sheet and consent form.
(PDF)
Template for Intervention Description and Replication (TIDieR) checklist.
(DOCX)
Aims:
Black Africans are disproportionally affected by type 2 diabetes, but the pathophysiology is poorly understood. The study aimed to examine the effect of sex and age on insulin sensitivity and insulin response in black South African adults.
Methods:
This cross-sectional study included a random sample of 179 men and 260 women aged 25-74years...
Introduction
South African and international health experts met with government officials and health organisations in Cape
Town on 2nd September 2016, in a landmark meeting to discuss progress and challenges for South Africa’s salt reduction strategy. South Africa’s legislation, mandating maximum salt levels for a wide range of food products, is th...
Objective:
Because of the overwhelming effect of sodium, as reflected in the high prevalence of hypertension in South Africans, the South African Department of Health is in the process of implementing a nationwide sodium reduction strategy, which will come into effect in June 2016. An establishment of a data platform which will provide a basis for...
Limited number of studies on salt intake have been conducted in the South African. The present study established the sodium and potassium excretion (24-hour urine collection) of three different South African populations. In total, 692 successful 24-hour urine collections were analyzed for sodium, potassium and iodine levels. The median sodium and p...
Introduction:
To determine dietary intake of 19 to 64 years old urban Africans in Cape Town in 2009 and examine the changes between 1990 and 2009.
Methods:
A representative cross-sectional sample (n = 544), stratified by gender and age was randomly selected in 2009 from the same areas sampled in 1990. Socio-demographic data and a 24-h dietary re...
Background:
People living with HIV (PLHIV) in African countries are living longer due to the rollout of antiretroviral drug therapy programs, but they are at increasing risk of non-communicable diseases (NCDs). However, there remain many gaps in detecting and treating NCDs in African health systems, and little is known about how NCDs are being man...
Aims:
To compare dysglycaemia prevalence (impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or diabetes) in HIV-infected persons, stratified by antiretroviral therapy (ART), with a community-based survey (CBS) in Cape Town, South Africa.
Methods:
Three groups of HIV-infected adults without known diabetes were conveniently sampled...
Background:
Currently available tools for assessing high cardiovascular risk (HCR) often require measurements not available in resource-limited settings in low- and middle-income countries (LMIC). There is a need to assess HCR using a pragmatic evidence-based approach.
Objectives:
This study sought to report the prevalence of HCR in 10 LMIC area...
Background:
Hypertension is the leading cause of cardiovascular disease and premature death worldwide. The prevalence of this public health problem is increasing in low- and middle-income countries (LMICs) in both urban and rural communities.
Objective:
The aim of this study was to examine hypertension prevalence, awareness, treatment, and contr...
Stemming the tide of noncommunicable diseases (NCDs) worldwide requires a multipronged approach. Although much attention has been paid to disease control measures, there is relatively little consideration of the importance of training the next generation of health-related researchers to play their important role in this global epidemic. The lack of...
Background:
Cost-effective primary prevention of cardiovascular disease (CVD) in low- and middle-income countries requires accurate risk assessment. Laboratory-based risk tools currently used in high-income countries are relatively expensive and impractical in many settings due to lack of facilities.
Objectives:
This study sought to assess the c...
Background:
Diabetes mellitus is one of the leading causes of death and disability worldwide. Approximately three-quarters of people with diabetes live in low- and middle-income countries, and these countries are projected to experience the greatest increase in diabetes burden.
Objectives:
We sought to compare the prevalence, awareness, treatmen...
Stemming the tide of noncommunicable diseases (NCDs) worldwide requires amultipronged approach. Although
much attention has been paid to disease control measures, there is relatively little consideration of the importance of
training the next generation of health-related researchers to play their important role in this global epidemic. The
lack of...
Background:
-We assessed the effect of automated treatment adherence support delivered via mobile-phone short message system (SMS) text-messages on blood pressure.
Methods and results:
-In this pragmatic single-blind, three-arm randomized trial (StAR), undertaken in South Africa, patients treated for high blood pressure were randomly allocated i...
As part of a comprehensive programme to prevent non- communicable disease in South Africa, there is a need to develop public education campaigns on healthy eating. Urban populations of lower socioeconomic status are a priority target population. This study involved formative research to guide the development of a nutrition resource appropriate to t...
Background:
Socioeconomic predictors and consequences of depression and its treatment were investigated in 4393 adults with specified non-communicable diseases attending 38 public sector primary care clinics in the Eden and Overberg districts of the Western Cape, South Africa.
Methods:
Participants were interviewed at baseline in 2011 and 14 mon...
Background:
To examine the associations of cardiovascular disease risk factors (CVDRF) with wealth, defined by the asset index, in 25- to 74-year-old black Africans in Cape Town.
Methods:
Assets, including consumer durable goods, and CVDRF were determined in a randomly selected cross-sectional sample. A principal component analysis of the pooled...
South Africa's rates of statin use are among the world's lowest, despite statins' demonstrated effectiveness for people with a high blood cholesterol level or history of cardiovascular disease. Almost 5 percent of the country's total mortality has been attributed to high cholesterol levels, fueled in part by low levels of statin adherence. Drawing...
Background:
Diabetes and hypertension constitute a significant and growing burden of disease in South Africa. Presently, few patients are achieving adequate levels of control. In an effort to improve outcomes, the Department of Health is proposing a shift to a patient-centred model of chronic care, which empowers patients to play an active role in...
Background:
South Africa (SA) is facing a heavy burden of non-communicable diseases (NCDs). Few studies address multimorbidity, control and treatment of NCDs in patients attending primary healthcare (PHC) clinics.
Objectives:
To describe multimorbidity, related risk factors, disease severity and treatment status of patients with four important N...
Background
South Africa currently faces an increasing burden of cardiovascular disease. Although referred to clinics after community screening initiatives, few individuals who are identified to be at high risk for developing cardiovascular disease attend. Low health literacy and risk perception have been identified as possible causes. We investigat...
To assess the evidence from systematic reviews on the effect on morbidity and mortality of blanket screening for hypertension or diabetes, mellitus compared with targeted, opportunistic or no screening, we searched for relevant systematic reviews and conducted duplicate study selection, data extraction and quality appraisal. Results were summarised...
To determine the obesity indices, specifically waist circumference (WC), that identified ≥2 other metabolic syndrome (MS) components (2009 criteria) in 25- to 74-year-old Africans in Cape Town.
Data were collected from a cross-sectional sample by administered questionnaires, clinical measurements and biochemical analyses. The obesity cut points wer...
Objectives:
To establish the prevalence and determinants of the 10-year risk of a cardiovascular disease (CVD) event in 25 - 74-year-old black Africans in Cape Town, South Africa, using Framingham laboratory- and non-laboratory-based and National Health and Nutrition Examination Survey (NHANES) I non-laboratory-based equations.
Methods:
CVD risk...
Objectives
To ascertain the prevalence and determinants of overweight/obesity in the 25–74-year-old urban black population of Cape Town and examine the changes between 1990 and 2008/09.
Methods
In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Data were c...
Aims:
To determine the metabolic syndrome prevalence by the 2009 harmonised criteria in 25-74-year-old urban Africans in Cape Town.
Methods:
In 2008/2009, a representative cross-sectional sample, stratified by age and gender, was randomly selected. Cardiovascular risk factors were determined with questionnaires, clinical measurements and biochem...
Background:
Primary prevention of cardiovascular disease (CVD),by identifying individuals at risk is a well-established, but costly strategy when based on measurements that depend on laboratory analyses. A non-laboratory, paper-based CVD risk assessment chart tool has previously been developed to make screening more affordable in developing countr...
To examine the prevalence and determinants of tobacco use in the 25-74-year-old urban Black population of Cape Town and to examine the changes between 1990 and 2008/09 in the 25-64-year-old sample.
In 2008/09 (n = 1,099), a representative cross-sectional sample was randomly selected from the same townships sampled in 1990 (n = 986). Sociodemographi...
Community health workers (CHWs) are increasingly being recognised as a crucial part of the health workforce in South Africa and other parts of the world. CHWs have taken on a variety of roles, including community empowerment, provision of services and linking communities with health facilities. Their roles are better understood in the areas of mate...
To determine the prevalence and determinants of problematic alcohol use (CAGE ≥2) in 25-74-year-old black population in Cape Town in 2008/2009 and examine the changes in self-reported alcohol consumption between 1990 and 2008/2009 in 25-64-year-olds.
In 2008/2009, a representative cross-sectional sample, stratified for age and sex, was randomly sel...
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.
In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Cardiov...
Background and objectives
Many clinical management guidelines for chronic diseases have been published, but they have not been put into practice by busy clinicians at primary care levels. This study evaluates the implementation of national guidelines incorporated within a structured diabetes and hypertension clinical record (SR) in Cape Town in a r...
All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory...
To determine the prevalence, determinants, and management of dyslipidaemia in the 25-74-year-old urban black population of Cape Town and examine the changes between 1990 and 2008/09 in the 25-64-year-old sample.
In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in...
Objective
Universal salt iodization is an effective strategy to optimize population-level iodine. At the same time as salt-lowering initiatives are encouraged globally, there is concern about compromised iodine intakes. This study investigated whether salt intakes at recommended levels resulted in a suboptimal iodine status in a country where salt...
Background:
Non-communicable chronic diseases (NCDs) have increased in South Africa over the past 15 years. While these usually manifest during mid-to-late adulthood, the development of modifiable risk factors that contribute to NCDs are usually adopted early in life.
Objective:
To describe the urban-rural and gender patterns of NCD risk factors...
Aim:
To evaluate the effectiveness of group education, led by health promoters using a guiding style, for people with type 2 diabetes in public sector community health centres in Cape Town.
Methods:
This was a pragmatic clustered randomized controlled trial with 17 randomly selected intervention and 17 control sites. A total of 860 patients with...
Group diabetic education. Training manual for health promoters.
Introduction:
previous research has suggested that pregnant women prefer a person-centred approach for smoking cessation interventions. However few studies have illustrated the mechanism through which such an approach has an influence on quitting or reduction rates among pregnant women in resource poor settings.
Purpose:
to explore the role of d...
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...
Average salt intake in South African (SA) adults, 8.1 g/day, is higher than the recommended 4 - 6 g/day recommended by the World Health Organization. Much salt consumption arises from non-discretionary intake (the highest proportion from bread, with contributions from margarine, soup mixes and gravies). This contributes to an increasing burden of h...
Sub-Saharan Africa is experiencing a multiple disease burden. Noncommunicable diseases (NCDs) are emerging, and their risk factors are becoming more common as lifestyles change and rates of urbanization increase. Simultaneously, epidemics of infectious diseases persist, and HIV/AIDS has taken hold in the region, although recent data indicate a decr...
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.
a qualitative study using individual, in-depth interviews for data collection.
24 nurses providing antenatal care to pregnant smokers attending public sector clinic...
Dopamine via G-protein-coupled receptor kinase 4 (GRK-4) regulates sodium (Na) balance in the proximal tubule of the kidney. Single-nucleotide polymorphisms of GRK-4 have been linked to impaired natriuresis and salt-sensitive hypertension. The purpose of this report was to determine the effect of GRK-4 gene polymorphisms on the blood pressure (BP)...
Cognitive behavioral interventions consisting of brief counseling and the provision of self-help material designed for pregnancy have been documented as effective smoking cessation interventions for pregnant women. However, there is a need to understand how such interventions are perceived by the targeted group.
To understand the cognitive, emotion...
To evaluate the effect of a smoking cessation intervention, based on best practice guidelines on the quit rates of disadvantaged, pregnant women in Cape Town, South Africa.
Quasi-experimental using a natural history cohort as a control group, consisting of women attending antenatal care in 2006 and an intervention cohort, attending the same clinics...
The objective was to determine the practices and beliefs of disadvantaged women with high smoking rates, their perceptions of antenatal services and their preference for smoking cessation intervention materials. The readiness of smokers to quit, in terms of stages of change, was also determined.
The study took place in public sector antenatal clini...
Since peaking in the early 1990s in South Africa, tobacco use has declined significantly. The reduction has been attributed to the government's comprehensive tobacco control policies that were introduced at the time.
To assess the pattern of tobacco use in the South African Demographic and Health Surveys of 1998 and 2003.
Multi-stage sampling was u...
High levels of wealth inequality with improved health statistics in South Africa (SA) provide an important opportunity to investigate non-communicable diseases (NCDs) among the poor.
This paper uses two distinct national data sets to contrast patterns of mortality in rich and poor areas and explore the associations between poverty, risk factors, he...
To assess the impact of a food-based intervention on blood pressure (BP) in free-living South African men and women aged 50-75 years, with drug-treated mild-to-moderate hypertension.
A double-blind controlled trial was undertaken in eighty drug-treated mild-to-moderate hypertensive subjects randomised to an intervention (n 40) or control (n 40) arm...
To identify health care provider-related determinants of diabetes and hypertension management in patients attending public sector community health centres (CHCs).
A random sample of 18 CHCs in the Cape Peninsula providing hypertension and diabetes care was selected. Twenty-five patients with diabetes and 35 with hypertension per clinic were selecte...
Whether lipoproteins are better markers than lipids and lipoproteins for coronary heart disease is widely debated. Our aim was to compare the apolipoproteins and cholesterol as indices for risk of acute myocardial infarction.
We did a large, standardised case-control study of acute myocardial infarction in 12,461 cases and 14,637 age-matched (plus...
In South Africa (SA) cardiovascular disease (CVD) is the second leading cause of death, with hypertension (HTN) being the predominant contributor to morbidity and mortality associated with this disease. We examined the prevalence and determinants of target organ damage (TOD) among urban black hypertensive South Africans attending primary health-car...
To identify the groups of patients with high prevalence and poor control of hypertension in South Africa.
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...
Coronary heart disease (CHD) is a leading cause of death among men and women globally. Women develop CHD about 10 years later than men, yet the reasons for this are unclear. The purpose of this report is to determine if differences in risk factor distributions exist between women and men across various age categories to help explain why women devel...
The prevalence of hypertension continues to rise across the world, and most patients who receive medical intervention are not adequately treated to goal. A Working Group including representatives of nine international health-care organizations was convened to review the barriers to more effective blood pressure control and propose actions to addres...
To develop and validate a short food-frequency questionnaire to assess habitual dietary salt intake in South Africans and to allow classification of individuals according to intakes above or below the maximum recommended intake of 6 g salt day-1.
Cross-sectional validation study in 324 conveniently sampled men and women.
Repeated 24-hour urinary Na...
To develop a reduced-sodium bread in which salt (NaCl) is partially replaced with potassium, magnesium and calcium salts.
Experimental bread was compared against standard brown bread, after a drop test (to assess whether bread quality deteriorates with abuse) and after the usual baking practices for baking properties (volume, crust colour, crumb co...
An assessment of the relative burden attributable to selected risk factors 1 provides an important evidence base for prioritising risk factors that should be targeted for public health interventions. Selecting interventions should be based on a robust and transparent process of scientific evaluations of their effectiveness, as well as assessment of...
To estimate the burden of disease attributable to high blood pressure (BP) in adults aged 30 years and older in South Africa in 2000.
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...
To estimate the burden of disease attributable to high cholesterol in adults aged 30 years and older in South Africa in 2000.
World Health Organization comparative risk assessment (CRA) methodology was followed. Small community studies were used to derive the prevalence by population group. Population-attributable fractions were calculated and appl...
To describe the HiHi Study and assess cardiovascular disease (CVD) risk profile and comorbid conditions of Black patients receiving hypertension (HTN) care.
Cross sectional, descriptive.
Public and private primary care sites in three townships near Cape Town, South Africa.
403 hypertensive Black patients (183 men, 220 women), ages 35-65 years.
Self...
To examine determinants of hypertension (HTN) care and control among peri-urban hypertensive Black South Africans.
Cross-sectional, descriptive.
Public and private primary care sites in three townships near Cape Town, South Africa.
403 hypertensive Black patients (183 men, 220 women), ages 35-65 years.
The Precede-Proceed Model guided the study. Se...
Steyn K, de Wet T, Saloojee Y, Nel H, Yach D. The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study. Paediatric and Perinatal Epidemiology 2006; 20: 90–99.
This article describes the patterns and effects of maternal snuff use, cigarette smoking and exposure to environmental tobacco...
Coronary heart disease (CHD) was uncommon in Black people living in Africa before 1970. Since then CHD risk factor levels have increased, while CHD rates have remained low.
This case-control study aims to assess the relationship between CHD and known risk factors in urban Black South Africans.
Eighty-nine cases with CHD and 356 controls attending t...
Chronic diseases, often referred to as noncommunicable diseases (NCDs), usually emerge in middle age after long exposure to an unhealthy lifestyle involving tobacco use, a lack of regular physical activity, and consumption of diets rich in highly saturated fats, sugars, and salt, typified by "fast foods." This lifestyle results in higher levels of...
Hypertension is prevalent, under-diagnosed, and inadequately treated in Black South Africans. However, few studies have addressed barriers to hypertension care and control in this community. The aim of this study was to validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB Comp Scale) for use in a South African primary healthca...
