Thandi Puoane

University of the Western Cape | uwc · School of Public Health

Health systems in many low- and middle-income countries are struggling to manage type 2 diabetes (T2D). Management of glycaemia via well-organized care can reduce T2D incidence, and associated morbidity and mortality. The primary aim of this study was to evaluate the effectiveness of facility plus community care interventions (integrated care), com...

Background Low- and middle-income countries (LMICs) are experiencing major increases in diabetes and cardiovascular conditions linked to overweight and obesity. Lifestyle interventions such as the United States National Diabetes Prevention Program (DPP) developed in high-income countries require adaptation and cultural tailoring for LMICs. The obje...

Background Understanding motivational determinants of physical activity (PA) is essential to guide the implementation of PA at individual and population level. Knowledge about the cross-cultural generalizability of these determinants is lacking and they have mostly been studied as separate factors. This study compares a motivational process model a...

To address the issue of obesity, the World Health Organization (WHO) recommends a set of comprehensive programmes aimed at changing the obesogenic environments to provide opportunities for healthy food options and increased physical activity in the school, home, and at the population level. The objectives of this study were to examine the nature an...

Evidence shows that investing in children’s nutrition early in the life course can enhance their survival, health, development and school achievement. It is important to prevent stunting, overweight, obesity and micronutrient deficiencies (e.g. vitamin A, zinc, iron and iodine) in childhood as these are risk factors for child mortality, poor develo...

Background: South Africa established chronic disease management programmes (CDMPs) called ‘clubs’ to ensure quality diabetes care. However, the effectiveness of these clubs remains unclear in terms of disease risk factor monitoring and complication prevention. Aim: We assessed risk factor monitoring, prevalence and determinants of diabetes related...

Background Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems in most countries. Process evaluations facilitate understanding why and how interventions work through analysing the interaction between intervention theory,...

Objective To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD). Design Prospective cohort study. Setting 21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China). Partic...

Background Understanding motivational determinants of physical activity (PA) is essential to guide the implementation of PA at individual and population level. Knowledge about the cross-cultural generalizability of these determinants is lacking and they have mostly been studied as separate factors. This study compares a motivational process model a...

Background. Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems in most countries. Process evaluations facilitate understanding why and how interventions work through analysing the interaction between intervention theory,...

The SARS-CoV-2 infection, which causes the coronavirus disease (COVID-19), has affected lives, with very adverse outcomes in specific populations in the United States of America (USA), a high-income country, and two middle-income countries, Brazil and South Africa. This paper aims to discuss the relationship of race/ethnicity with COVID-19-associat...

Objective To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries. Design Population-based prospective observational study. Setting Urban and rural communities in 20 high income, middle income and low incom...

Objective To evaluate the association between intakes of refined grains, whole grains, and white rice with cardiovascular disease, total mortality, blood lipids, and blood pressure in the Prospective Urban and Rural Epidemiology (PURE) study. Design Prospective cohort study. Setting PURE study in 21 countries. Participants 148 858 participants w...

Introduction Community Health Workers play an important role in supporting patients with chronic non-communicable diseases (NCDs), therefore they need to be constantly updated with current knowledge to enable them to perform their activities effectively. The purpose of this study was to assess the knowledge of NCDs risk factors among Community Heal...

IntroductionThe burden of type 2 diabetes is growing rapidly in sub-Saharan Africa. Healthy eating has been shown to prevent the disease but is challenging to maintain. Self-determination theory offers a motivational framework for maintaining a healthy diet based on evidence from western settings. This study aims to assess whether self-determinatio...

Objective To identify factors associated with food purchasing decisions and expenditure of South African supermarket shoppers across income levels. Design Intercept surveys were conducted, grocery receipts collated and expenditure coded into categories, with each category calculated as percentage of the total expenditure. In-supermarket food quali...

To assess the sociodemographic, anthropometric and glycaemic profile of patients with newly diagnosed type 2 diabetes, or at risk of type-2 diabetes.

The SMART2D study

Supporting self-management among patients at risk of, and with newly diagnosed diabetes in a suburban township, south Africa: The SMART2D trial

Malnutrition in South African children and adolescents: Impact, causes, policy, implementation and recommendations Sanders D, Hendricks M, Kroll F, Puoane T, Ramokoloe V, Swart R and Tsolekileg L. Evidence shows that investing in children’s nutrition early in the life course can enhance their survival, health, development and school achievement....

Diabetes, a serious disease resulting in significant morbidity and early mortality, is currently on the rise globally. A major contributor to this observed increase in low- and middle-income countries, such as South Africa, has been the observed change in diet at the population level-a shift from a traditional diet, to one consisting of more energy...

Introduction This study examined the association between sociodemographic factors, Physical Activity (PA) engagement, and the selected Food Purchasing Practices (FPP) among people living in a low socioeconomic peri-urban and rural area of two provinces of South Africa. Methodology Four hundred participants were randomly selected from two communiti...

A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high inc...

Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and...

Exposure to air pollution has been linked to elevated blood pressure (BP) and hypertension, but most research has focused on short-term (hours, days, or months) exposures at relatively low concentrations. We examined the associations between long-term (3-year average) concentrations of outdoor PM2.5 and household air pollution (HAP) from cooking wi...

Rates of cardiovascular disease and diabetes are rising in low- and middle-income countries (LMIC), but there is a dearth of research devoted to developing and evaluating chronic disease interventions in these settings, particularly in Africa. Lifestyle Africa is a novel, culturally adapted version of the Diabetes Prevention Program (DPP) being eva...

Background: Overweight/obesity is an emerging health concern among African children. The aim of this study was to summarise available evidence from school-based interventions that focused on improving nutrition and physical activity knowledge, attitude, and behaviours, and weight status of children aged 6-15 years in the African context. Methods:...

Background: Screening methods for childhood obesity are based largely on the published body mass index (BMI) criteria. Nonetheless, their accuracy in African children is largely unknown. The diagnostic accuracies of the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the International Obesity Taskforce (I...

Introduction Low and middle-income countries like South Africa are experiencing major increases in burden of non-communicable diseases such as diabetes and cardiovascular conditions. However, evidence-based interventions to address behavioural factors related to these diseases are lacking. Our study aims to adapt the CDC’s National Diabetes Prevent...

Background: Understanding patterns of physical activity among adults can lead to targeted approaches to improve activity levels in the African population. This study aimed to determine whether age, gender, location and employment status could predict physical activity among rural and urban South African adults, and to determine the participants' r...

In the present global economic crisis and continued rapid urbanization, street food (SF) vending has grown into a practical source of income for people in the developing world. SF are not only appreciated for their unique flavours, convenience, and affordability they also contribute to the economy of the country, the perseverance of cultural and so...

Background: Body image perception has an impact on modifiable cardiovascular disease (CVD) risk, lifestyle and psychological health in many populations. Aim: To assess weight discordance (underestimating own weight) and body size dissatisfaction (perceiving body size as either ‘too small’ or ‘too large’) among overweight and obese South Africans, t...

Introduction: Switching from polluting (e.g. wood, crop waste, coal) to clean cooking fuels (e.g. gas, electricity) can reduce household air pollution (HAP) exposures and climate-forcing emissions. While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel f...

Background Consumption of fruits and vegetables reduces the risk of obesity, diabetes, cancer, cardiovascular mortality and all-cause mortality. The study assessed the pattern of intake and the factors that influence daily intake of commonly available fruits and vegetables in economically disadvantaged South African communities. Methods This is a...

Introduction: The increasing trend in the global prevalence of childhood overweight and obesity presents a major public health challenge. This study reports the results of a systematic review and meta-analysis to estimate the prevalence of overweight and obesity among primary school learners residing in Africa according to the different body mass...

Background: Little is known about the impact of the school environmental context on the emerging trend of childhood obesity in Africa. We examined the association of the schools' contextual factors with body mass index (BMI), abdominal obesity and overweight (including obesity) in urban Ghana. Method: Using cross-sectional data from 543 school c...

Background: Household air pollution (HAP) from solid fuel use for cooking affects 2.5 billion individuals globally and may contribute substantially to disease burden. However, few prospective studies have assessed the impact of HAP on mortality and cardiorespiratory disease. Objectives: Our goal was to evaluate associations between HAP and morta...

Background There is limited data on risk factors associated with childhood overweight and obesity in Ghanaian school children. Therefore, the aim of this study was to assess the prevalence of overweight and obesity and associated risk factors in Ghanaian school children. Methods Data for this study were obtained from a cross-sectional survey of 54...

The burden of type 2 diabetes is increasing rapidly, not least in Sub-Saharan Africa, and disadvantaged populations are disproportionally affected. Self-management is a key strategy for people at risk of or with type 2 diabetes, but implementation is a challenge. The objective of this study is to assess the determinants of self-management from an i...

Objectives: This study examines the prospective association between sugar-sweetened beverages (SSB) consumption and change in body weight over a 4-5-year period in a socio-economically disadvantaged South African population. Methods: This is a longitudinal study involving 800 adults (212 men, 588 women); 247 from the original METS (Modelling the...

Using intercept surveys, we explored demographic and socioeconomic factors associated with food purchasing characteristics of supermarket shoppers and the perceptions of their neighborhood food environment in urban Cape Town. Shoppers (N = 422) aged ≥18 years, categorized by their residential socioeconomic areas (SEAs), participated in a survey aft...

This paper reports on the use of reciprocal learning for identifying, adopting and adapting a type 2 diabetes self-management support intervention in a multisite implementation trial conducted in a rural setting in a low-income country (Uganda), a periurban township in a middle-income country (South Africa) and socioeconomically disadvantaged subur...

Background The relationship between perceived neighbourhood safety from traffic and crime with overweight/obesity can provide intervention modalities for obesity, yet no relevant study has been conducted in sub-Saharan African contexts. We investigated the association between perceived neighbourhood safety from traffic and crime with overweight/obe...

Objectives: The aim was to determine participants’ dietary adherence by calculating a diet adherence score based on the Dietary Approaches to Stop Hypertension (DASH)-style diet; (2) to determine if there was an association between dietary adherence score, anthropometric measurements (waist circumference, body mass index (BMI), waist–hip ratio, wai...

Background: Evidence concerning the relationship between objectively-measured attributes of the built environment with cardio-metabolic risk in populations from lower- and middle-income countries is lacking. In this paper, we describe the association between the objectively-measured built environment with body mass index, blood pressure and physic...

Background Globally the number of people with Type 2 diabetes mellitus (T2DM) has risen significantly over the last few decades. Aligned to this is a growing use of community health workers (CHWs) to deliver T2DM self-management support with good clinical outcomes especially in High Income Countries (HIC). Evidence and lessons from these interventi...

Summary of the characteristics of selected studies II. (PDF)

Summary of the characteristics of selected studies I. (PDF)

Background: The current roles and capacity of community health workers (CHWs) in the management and control of non-communicable diseases (NCDs) remain poorly understood. Objectives: To assess CHWs’ current roles, training and knowledge about diabetes and hypertension in Khayelitsha, Cape Town. Methods: A cross-sectional study of 150 CHWs from two n...

Introduction Type 2 diabetes (T2D) is increasingly contributing to the global burden of disease. Health systems in most parts of the world are struggling to diagnose and manage T2D, especially in low-income and middle-income countries, and among disadvantaged populations in high-income countries. The aim of this study is to determine the added bene...