Cardiovascular risk among community members in three communities in the Cape Metropole of the Western Cape.

BACKGROUND:  Cardiovascular diseases pose a risk to population health in South Africa and are responsible for almost one in six deaths (17.3%). AIM:  To determine the cardiovascular risk among community members who attended a community outreach programme. SETTING:  Three communities in the Cape Metropole of the Western Cape. METHODS:  A health survey was conducted with 783 participants, 18 years and older, conveniently sampled. The survey included questions about cardiovascular risk factors, and biometric measurements of blood pressure (BP), height and weight were conducted. RESULTS:  A total of 777 participants were included in the study. Most participants were female (529, 68.1%), with an average age of 42.3 years (s.d. 14.2). Risk behaviours reported included smoking (216, 27.8%), consuming more than two drinks of alcohol daily (78, 10%), low physical activity (384, 49.4%), being stressed on most days (436, 56.1%) and unhealthy eating habits (253, 32.6%). More than half of the participants (402, 51.7%) had a body mass index (BMI) ≥ 30, 26.0% (202) had a systolic BP of ≥ 140 mm Hg and 22.4% (174) had a diastolic BP of ≥ 90 mm Hg; 16.6% (130) had a cardiovascular disease (CVD) risk of 10-20 and 19.3% (150) had a CVD risk of 20%. CONCLUSION:  Nearly a fifth of the participants had a significant probability of developing heart disease or experiencing a stroke over the next 10 years.Contribution: There is an urgent need for comprehensive health promotion and behaviour change interventions focused on reducing CVD risk factors at the community level.

Information-seeking in first visit pregnant women in Khayelitsha, South Africa.

BACKGROUND: The quality of the decisions made by women during pregnancy, especially their first visit, depends on their health needs, their health-seeking behaviour and the type of information available to them. AIM: This study describes the health education needs, information barriers and health information-seeking behaviour of pregnant women on their first visit to antenatal clinics in a low-income setting in the Western Cape. SETTING: The setting was two antenatal facilities in Khayelitsha Health District facilities in South Africa. METHODS: A quantitative descriptive survey was conducted. A systematic random sample of 261 antenatal first visit attendees between May and July 2016 was selected. Data were collected using a researcher-administered questionnaire and was analysed using descriptive statistics, 95% confidence intervals and non-parametric tests. RESULTS: The response rate of the study was 92% (n = 240). Pregnant women attending an antenatal clinic for the first time reported high information needs with low health information-seeking behaviours and high information barriers. Doctors, nurses (2.2, ±1.0), family and friends (2.0, ±0.6) were the most frequently used sources of health information, while watching television or listening to the radio (1.5, ±0.9) were the least used sources of health information. Having a medical diagnosis (p < 0.001) and being of an advanced maternal age (p = 0.005) were predictive of higher health-seeking behaviour. The reliance on passively receiving information from health sources may indicate low levels of health literacy and its inverse relationship to health promoting behaviours which should be the subject of further investigation.

Mortality rates increase dramatically below a systolic blood pressure of 105-mm Hg in septic surgical patients.

BACKGROUND: This study used a prospective surgical database, to investigate the level of systolic blood pressure (SBP) at which the mortality rates begin to increase in septic surgical patients. METHODS: All acute, septic general surgical patients older than 15 years of age admitted between January 2012 and January 2015 were included in these analyses. RESULTS: Of a total of 6,020 adult surgical patients on the database, 3,053 elective patients, 1,664 nonseptic, 52 duplicates, and 11 patients with missing SBP were excluded to leave a cohort of 1,232 acute, septic surgical patients. The median age (intraquartile range [IQR]): 48 (32 to 62) and roughly 50:50 sex ratio (620 female: 609 male). Most of the patients were African: 988 (80.2%) followed by Asians (128 or 10.4%). More than two-thirds (852 or 69.2%) of the patient cohort underwent some form of surgery, and 152 or 12.3% required intensive care unit (ICU) admission. The median length of ICU stay (IQR) was 2 (1 to 4.5) days. The median length of total hospital stay (IQR) was 4 (2 to 9) days. The median SBP (IQR) on admission was 122 (107 to 138). A total of 167 patients died (13.6%). Those that died did have a significantly lower mean SBP compared with the survivors (116 vs 125, P <. 001). Six of 10 patients (60%) with a SBP less than 70 died. The receiver operating characteristic analysis suggests an optimal SBP cut-off of 111 when predicting mortality (area under the receiver operating characteristic curve: .6 [.551, .65]). This cut-off yields a moderate sensitivity (70%), high positive predictive value (90%) but low specificity, and negative predictive value when predicting mortality. Based on this optimal cut-off, 388 or 31.5% of the patients would be classified as shocked. The inflection curve below with fitted nonlinear curve (95% confidence intervals) clearly shows the upward change in observed mortality frequency at lower systolic and base excess (ie base deficit) values. Shocked patients had a significantly higher frequency of mortality (20% vs 11%, P < .001), a significantly higher median lactate (1.9 vs 1.5, P < .001), and mean base deficit (-2.8 vs -1.0, P = .001). No significant difference in mean age, ICU admission, duration of ICU admission, and total length of hospital stay was observed by shocked status. CONCLUSIONS: Our data suggest that patients who die have a significantly lower SBP and clinically significant hypotension in sepsis with regard to increased mortality risk begins at a level of âˆ¼111-mm Hg. This finding needs to be incorporated into bundles of care for surgical sepsis.