Disparities in the non-laboratory INTERHEART risk score and its components in selected countries of Europe and sub-Saharan Africa: analysis from the SPICES multi-country project.

Aims: Accurate prediction of a person's risk of cardiovascular disease (CVD) is vital to initiate appropriate intervention. The non-laboratory INTERHEART risk score (NL-IHRS) is among the tools to estimate future risk of CVD. However, measurement disparities of the tool across contexts are not well documented. Thus, we investigated variation in NL-IHRS and components in selected sub-Saharan African and European countries. Methods and results: We used data from a multi-country study involving 9309 participants, i.e. 4941 in Europe, 3371 in South Africa, and 997 in Uganda. Disparities in total NL-IHRS score, specific subcomponents, subcategories, and their contribution to the total score were investigated. The variation in the adjusted total and component scores was compared across contexts using analysis of variance. The adjusted mean NL-IHRS was higher in South Africa (10.2) and Europe (10.0) compared to Uganda (8.2), and the difference was statistically significant (P < 0.001). The prevalence and per cent contribution of diabetes mellitus and high blood pressure were lowest in Uganda. Score contribution of non-modifiable factors was lower in Uganda and South Africa, entailing 11.5% and 8.0% of the total score, respectively. Contribution of behavioural factors to the total score was highest in both sub-Saharan African countries. In particular, adjusted scores related to unhealthy dietary patterns were highest in South Africa (3.21) compared to Uganda (1.66) and Europe (1.09). Whereas, contribution of metabolic factors was highest in Europe (30.6%) compared with Uganda (20.8%) and South Africa (22.6%). Conclusion: The total risk score, subcomponents, categories, and their contribution to total score greatly vary across contexts, which could be due to disparities in risk burden and/or self-reporting bias in resource-limited settings. Therefore, primary preventive initiatives should identify risk factor burden across contexts and intervention activities need to be customized accordingly. Furthermore, contextualizing the risk assessment tool and evaluating its usefulness in different settings are recommended.

Mental health needs among pregnant and parenting adolescent girls and young women in South Africa: A scoping review.

Teenage pregnancy and parenting pose a greater risk of developing mental health problems among pregnant and parenting adolescent girls and young women. We report on a scoping review of peer-reviewed articles to identify mental health needs and challenges among pregnant and parenting adolescent girls and young women. We adopted only five steps of the Arksey and O'Malley framework to facilitate the scoping review of 125 articles published between July 2002 and August 2022 from these databases (MEDLINE, SABINET, EBSCOhost, Science Direct) using search syntax. Major themes emerged from the thematic content analysis; challenges experienced by pregnant and parenting adolescent girls and young women and the recommended interventions, factors associated with mental health in pregnant women and parenting adolescent girls and young women, and the implications of mental health problems. Mental health challenges, among others, include depression, stress and anxiety, post-traumatic stress disorders, and suicidal thoughts. Limited mental health interventions are provided to the group, including social support, parental coaching and counselling, and guidance, which translates to an imbalance between targeted mental health interventions and mental health challenges. We recommend involvement and education of the community on social support, development of digital health programs and integration of mental health services amongst schools, clinics, and community development to support pregnant and parenting adolescent girls and young women.

Retrospective Analysis of the Outcome of Hospitalized COVID-19 Patients with Coexisting Metabolic Syndrome and HIV Using Multinomial Logistic Regression.

Globally, the coexistence of metabolic syndrome (MetS) and HIV has become an important public health problem, putting coronavirus disease 19 (COVID-19) hospitalized patients at risk for severe manifestations and higher mortality. A retrospective cross-sectional analysis was conducted to identify factors and determine their relationships with hospitalization outcomes for COVID-19 patients using secondary data from the Department of Health in Limpopo Province, South Africa. The study included 15,151 patient clinical records of laboratory-confirmed COVID-19 cases. Data on MetS was extracted in the form of a cluster of metabolic factors. These included abdominal obesity, high blood pressure, and impaired fasting glucose captured on an information sheet. Spatial distribution of mortality among patients was observed; overall (21-33%), hypertension (32-43%), diabetes (34-47%), and HIV (31-45%). A multinomial logistic regression model was applied to identify factors and determine their relationships with hospitalization outcomes for COVID-19 patients. Mortality among COVID-19 patients was associated with being older (≥50+ years), male, and HIV positive. Having hypertension and diabetes reduced the duration from admission to death. Being transferred from a primary health facility (PHC) to a referral hospital among COVID-19 patients was associated with ventilation and less chance of being transferred to another health facility when having HIV plus MetS. Patients with MetS had a higher mortality rate within seven days of hospitalization, followed by those with obesity as an individual component. MetS and its components such as hypertension, diabetes, and obesity should be considered a composite predictor of COVID-19 fatal outcomes, mostly, increased risk of mortality. The study increases our understanding of the common contributing variables to severe manifestations and a greater mortality risk among COVID-19 hospitalized patients by investigating the influence of MetS, its components, and HIV coexistence. Prevention remains the mainstay for both communicable and non-communicable diseases. The findings underscore the need for improvement of critical care resources across South Africa.

Screening and Interventions for Cardiovascular Disease Prevention in the Limpopo Province, South Africa: Use of the Community Action Model.

The rise in non-communicable diseases (NCDs) has been attributed to economic growth in developing countries, shifts in societal norms, and behaviors such as dietary habits and physical activity. Up to 80% of NCDs could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diets, physical inactivity, and the harmful use of alcohol. The South African government's national strategic plan to control NCDs, which includes cardiovascular disease (CVD) prevention, places a strong emphasis on the need to improve the prevention, detection, early intervention, and management of NCDs. In line with the above recommendations, this study aimed to screen rural communities using the non-laboratory INTERHEART Risk Score tool (NLIRS) and develop relevant and suitable intervention strategies for a patient at moderate risk of developing a heart attack. A quantitative research approach applying a household-based design was used to conduct this study and the community action model (CAM). The difference between pre-intervention and post-intervention results were analyzed using a t-test and Analysis of covariance (ANCOVA) with age, smoke, hypertension, and diabetes as the covariates. The study found a significant difference in proportions between pre and post-intervention for raised Systole (SBP), obesity by body mass index (BMI), and waist circumference (WC). In rural communities, using CAM to improve knowledge and behavioral practices of NCD risk factors is feasible and effective. This basket of interventions will assist community members in reducing their risk of developing metabolic syndromes as well as their risk of developing CVDs. Continued investment and research in CVD prevention interventions are required to improve health, reduce costs, and have long-term benefits for conflict-affected individuals and communities.

Overweight Prevalence among Rural Adolescents by Household Head Obesity and Socio-Economic Status in Limpopo, South Africa.

Background: Childhood obesity has become the most important and growing public health problem in the world. They add to public health challenges by increasing the burden of chronic non-communicable diseases. However, in spite of its importance, there is limited literature that evaluates the prevalence of obesity among rural adolescents in sub-Saharan Africa. We report the first study to present an insight into rural black overweight South African children and the physical characteristics and socio-economic status of the household head. A quantitative cross-sectional population study was conducted involving 51 selected primary villages within the DIMAMO surveillance area in the Capricorn District of Limpopo Province, South Africa. The study involved 294 adolescents, 154 girls and 140 boys, who were under the age of 18. Of these participants, 127 (43%) were within the normal weight range, and 167 (57%) were overweight. Gender made a significant difference, with more girls being overweight than boys. Adolescents who did not receive child grants and whose heads of household were 45−54 years old, poor, and overweight had a higher prevalence of obesity (p-value < 0.05). This study suggests that public health interventionists need to target both the heads of household and their children in hopes of reducing the prevalence of overweight and obese South African children. We further propose a better understanding of the causes of childhood overweight and obesity to guide policy development and implementation in rural settings.

Health System- and Patient-Related Factors Associated with COVID-19 Mortality among Hospitalized Patients in Limpopo Province of South Africa's Public Hospitals.

South Africa has recorded the highest COVID-19 morbidity and mortality compared to other African regions. Several authors have linked the least amount of death in African countries with under-reporting due to poor health systems and patients' health-seeking behaviors, making the use of clinical audits more relevant for establishing the root causes of health problems, and improving quality patient care outcomes. Clinical audits, such as mortality audits, have a significant role in improving quality health care services, but very little is documented about the outcomes of the audits. Therefore, the study sought to determine the health care system and patient-related factors associated with COVID-19 mortality by reviewing the COVID-19 inpatient mortality audit narration reports. This was a retrospective qualitative research approach of all hospitalized COVID-19 patients, resulting in death between the first and second COVID-19 pandemic waves. Thematic analysis employed inductive coding to identify themes from mortality audits from all 41 public hospitals in Limpopo Province, South Africa. Four themes with seventeen sub-themes emerged: sub-standard emergency medical care provided, referral system inefficiencies contributed to delays in access to health care services, the advanced age of patients with known and unknown comorbidities, and poor management of medical supplies and equipment, as a health system and patient-related factors that contributed to the high mortality of COVID-19 patients. There is a need to routinely conduct clinical audits to identify clinical challenges and make recommendations for health promotion, risk communication, and community engagement. We recommend reviewing and expanding the scope of practice for health-care providers during epidemics and pandemics that include aspects such as task-shifting.

Determinants of the Limpopo Province of South Africa's Response to COVID-19: A Mixed Methods Protocol to Analyze and Share Lessons Learned.

COVID-19 is a priority health research agenda item in South Africa. The World Health Organization declared the COVID-19 outbreak as a Public Health Emergency of International Concern, which requires all countries to respond and share data with others. Responses included the implementation of measures to reduce the spread of COVID-19 and protect health systems from being overwhelmed by seriously ill patients. Each country was mandated to assess its own risk and rapidly implement the necessary measures to reduce COVID-19 transmission and minimize its impact. Countries were further encouraged to share their experiences of responding to the COVID-19 pandemic. Media reports in South Africa suggest that the Limpopo Department of Health implemented a successful COVID-19 response. This study aims to analyze, document and publish those successes to make them accessible to other researchers and public health practitioners. The study will also allow for the participation of public health students to meet the requirements of their postgraduate degrees. This convergent parallel mixed method study will collect secondary data of responses to COVID-19 by the Limpopo Department of Health from the records the department keeps. Quantitative and qualitative data detailing activities and statistics describing facilitators and barriers to implementation of COVID-19 response from March 2020 will be extracted from records.

Influence of Environmental Factors on Injury Severity Using Ordered Logit Regression Model in Limpopo Province, South Africa.

Globally, road traffic accidents are a major cause of death and severe injuries. It is estimated that the number of deaths on the world's roads at 1.5 million per annum puts road traffic injuries as the eighth leading cause of death globally. Understanding the influence of environmental factors on deaths and severe injuries will help in policy-making and the development of strategies in Limpopo Province. We, therefore, aim to study environmental factors that influence road deaths and severe injuries and to identify whether their impact on injury severity levels varies. The study was based on secondary data on road traffic accidents obtained from the Department of Roads and Transport in Limpopo Province. The data comprised 18 029 road traffic accidents for the period January 2009-December 2015. The study found that weekends (Saturdays and Sundays) had the highest number of accidents when compared to weekdays. The proportion of observations in each severity level was not constant across explanatory variables. The generalized ordered logit regression (GOLR) models seemed to be an effective predicting model that can be adapted to determine the influence of environmental factors on injury severity compared to the ordered logit regression (OLR) model. The results of the GOLR model suggest that environmental factors such as slippery road conditions, rainy weather, and spring season lower the likelihood of severe crash occurrence. On the other hand, poor or defective road surface, time interval (6 a.m. to 11 p.m.), and provincial roads have a higher likelihood of severe crash occurrence. To decrease the severity of injuries in the province, provincial roadways must be maintained regularly.

The perceptions of professional nurses regarding factors affecting the provision of quality health care services at selected rural public clinics in the Capricorn district, Limpopo Province.

BACKGROUND: Despite many initiatives made by the National Department of Health through the Minister of Health, the provision of quality health care services remains a serious challenge in South Africa, especially in public rural clinics. AIM: The study aims to determine the perceptions of professional nurses on the factors affecting the provision of quality health care services at selected public primary health care clinics in rural areas of the Capricorn District, Limpopo Province. SETTING: The study was conducted at selected public primary health care clinics in rural areas of the Capricorn District, Limpopo Province. METHODS: This study utilised a quantitative method, descriptive and a cross-sectional study conducted for three months at the selected public primary health care clinics. A structured self-administered questionnaire was used to collect data from 155 professional nurses who met the selection criteria. Data were analysed using Statistical Package for Social Sciences programme version 26.0. RESULTS: The results of 155 professional nurses were only 116 (74%) and reported that the use of modern technology such as electronic blood pressure, sonar machines and pulse reading computers improves the quality of health care services. Also 129 (84%), 124 (77%) and 118 (76%) reported that they were overwhelmed by the workload, the staff attitude and cleanliness of the clinic, respectively, which all affect the quality of health care services rendered. Moreover, only about 29 (19%) were satisfied with the salary they earned. CONCLUSION: Despite the effort and interventions put in place by the Department of Health with regard to the Ideal Clinic Realisation and Maintenance in response to the current deficiencies in the quality of primary health care services and to lay a strong foundation for the implementation of National Health Insurance. The quality of health care services is still hindered by several factors such as an overwhelming workload, the attitude of the staff and cleanliness in the work environment, poor infrastructure and the professional nurses perceive the environment as lacking equipment.

Indirect and direct effects of factors associated with diabetes amongst the rural black population in the Dikgale Health and Demographic Surveillance System, South Africa.

BACKGROUND: Diabetes is an enormous, growing clinical and public health problem, which together with hypertension contributes significantly to the high risk of cardiovascular diseases (CVDs) globally. AIM: To examine the indirect and direct effects of risk factors simultaneously as a network of multiple pathways leading to diabetes in the rurally based adult population (aged 15+) using a household survey. METHODS: This investigation was based on a predictive model using a cross-sectional community-based study to identify the direct and indirect effects of diabetes risk factors in the Dikgale Health and Demographic Surveillance System (HDSS) consisting of 15 villages, with 7200 households and a total population of approximately 36 000. Fasting blood glucose and total cholesterol were measured using ILAB 300 with the following cut-off values: high fasting blood glucose 7 mmol/L and triglycerides 1.70 mmol/L. RESULTS: A total of 1407 individuals were interviewed, of whom 1281 had their blood pressure (BP) measured. The conceptual model was validated by the goodness-of-fit indexes (comparative fit index [CFI] = 1.00, Tucker Lewis index [TLI] = 1.041, root mean square error of approximation [RMSEA] = 0.001). Hypertension had the strongest direct effect of 0.0918 on diabetes, followed by age (0.0039) and high waist circumference (-0.0023). Hypertension also mediates the effects that high waist circumference (0.0005) and triglycerides (0.0060) have on diabetes status. CONCLUSION: The results in this study confirm the conceptual model considered in the risk factors for diabetes and suggest that hypertension, age and high waist circumference are the key variables directly affecting the diabetes status in the South African rural black population. The direct effect of triglycerides on diabetes suggests mediation by some measured factor(s).

Obesity Indices to Use for Identifying Metabolic Syndrome among Rural Adults in South Africa.

Metabolic syndrome (MetS) is a cluster of metabolic conditions that aggravate the likelihood of cardiovascular diseases and type 2 diabetes mellitus. This study was aimed to identify the best obesity index to determine MetS. This was a cross-sectional study and part of Ellisras Longitudinal Study where 593 (289 males and 304 females) adults aged 22-30 years took part. Confirmatory factor analysis was used to test the single-factor models of MetS defined by mid arterial pressure, fasting blood glucose, triglycerides and commonly selected obesity indices such as Neck circumference (NC), Body mass index (BMI), Waist circumference (WC) and Waist to height ratio (WHtR) as indicators of MetS. It was found that a single model fit built based on WC and WHtR suggested a better fit index than NC and BMI in males, whereas, a model built on NC obtained a better fit index for females than other factor models. In conclusion, the result of the present study suggests that in rural Ellisras adult's, WC and WHtR are the best obesity indices for determining MetS in males and NC in females than other indices. Hence, longitudinal studies are recommended to allow causality to be drawn between obesity indices and MetS.

Hypertension Prevalence and Determinants among Black South African Adults in Semi-Urban and Rural Areas.

The burden of hypertension is reported to be on the rise in developing countries, such as South Africa, despite increased efforts to address it. Using a cross-sectional study design, we assessed and compared the prevalence of and risk factors associated with hypertension amongst adults aged ≥18 years in semi-urban and rural communities (1187 semi-urban and 1106 rural). Trained community health workers administered the INTERHEART Risk Score tool and performed blood pressure assessments using the MEDIC Pharmacists Choice Blood Pressure Monitor. Hypertension was defined to be a systolic blood pressure (BP) ≥ 140 mmHg and diastolic BP ≥ 90 mmHg. A multivariate logistic regression model was used to identify factors and determine their relationship with hypertension. The prevalence of hypertension amongst semi-urban and rural communities was 21% with no gender difference. In the semi-urban area, physical activity, family history, fruit intake, salty food, and eating meat were significantly associated with the odds of hypertension among women, whereas only the waist-to-hip ratio (WHR), diabetic status, and salty food were the predictors for rural women. Factors such as fried food and low fruit intake were significantly associated with the odds of hypertension among men in the semi-urban area, whereas only the WHR was significant among men in the rural area. Hypertension was found to be prevalent among semi-urban and rural adults in Limpopo Province, South Africa.

Multiple Points Change in the Association of Blood Pressure Subtypes with Anthropometric Indices of Adiposity among Children in a Rural Population.

BACKGROUND: Hypertension has gained global significance and risk of cardiovascular disease, and adiposity is the most important of the conditions associated with and considered responsible for hypertension in children. Therefore, the present study aimed to determine whether indices of adiposity independently predicted blood pressure at multiple points in gender-specific groups. METHODS: This was a cross-sectional study involving 10 randomly selected primary schools within the Ellisras Longitudinal Study, and involved 1816 adolescents (876 girls and 940 boys) aged 8 to 17 years. All the anthropometric indices and blood pressures (BP) were examined according to the International Society for the Advancement of Kinanthropometry protocol. RESULTS: In an adjusted linear quantile regression analysis of boys, waist circumference (WC) was associated with BP across all multiple points of systolic blood pressure (SBP). Furthermore, the triceps skinfold site was associated with high SBP. In girls, body mass index (BMI) was significantly associated with SBP after adjustment for potential confounders. Other anthropometric indices of adiposity, including WC, biceps, and triceps skinfold sites were not associated with SBP. CONCLUSIONS: The results of the present study suggest that in black South African children, variables such as WC and triceps skinfold site may provide stronger explanatory capacity to SBP variance and systolic hypertension risk in boys than other adiposity indices; whereas in girls, only WC and BMI predict diastolic blood pressure (DBP) and SBP, respectively.

Ellisras Longitudinal Study 2017: Childhood underweight and blood pressure status in a rural black population of South Africa (ELS 26).

AIM: Childhood underweight is a problem being faced by rural black South African populations but little is known about its risk factors. The aim of this study was to investigate the risk factors related to childhood underweight in rural black South African children within the area known as Ellisras. METHODS: A cross-sectional study was conducted as part of the ongoing Ellisras Longitudinal Study. The current study comprised a total of 1 811 pre-primary and primary school children (934 males and 877 females) aged between five and 16 years. The chi-squared automatic interaction detection (CHAID) decision tree model was used to identify factors and determine their relationships with childhood underweight. RESULTS: A total of 1 811 children were involved in the study, of whom about 81% were severely underweight. The CHAID model showed that the variables: nutrition, age group, gender and school level were the four main predicting variables affecting childhood underweight. Hypertension was not significantly associated with childhood underweight. CONCLUSIONS: The prevalence of childhood underweight was found to be high in children aged between five and 16 years. To address this problem, well-thought-out intervention systems are need.