https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)61087-4.pdf

The burden of non-communicable diseases in South Africa.

Objective: This article reviews information on the rapid changes in diet, activity and body composition that lower- and middle-income countries are undergoing and then examines some of the potential health implications of this transition. Design and Setting: Data came from numerous countries and also from national food balance (FAOSTAT) and World Bank sources. Nationally representative and nationwide surveys are used. The nationally representative Russian Longitudinal Monitoring Surveys from 1992–96 and the nationwide China Health and Nutrition Survey from 1989–93 are examined in detail. Results: Rapid changes in the structure of diet, in particular associated with urbanization, are documented. In addition, large changes in occupation types are documented. These are linked with rapid increases in adult obesity in Latin America and Asia. Some of the potential implications for adult health are noted. Conclusions: The rapid changes in diet, activity and obesity that are facing billions of residents of lower- and middle-income countries are cause for great concern. Linked with these changes will be a rapid increase in chronic diseases. Little to date has been done at the national level to address these problems.

/pdf/the-nutrition-transition-and-its-health-implications-in-44tgtb0zvd.pdf

The nutrition transition and its health implications in lower-income countries.

Objectives To determine the prevalence and treatment status of hypertension in South Africa.Design National cross-sectional survey.Setting 13 802 randomly selected South Africans, 15 years and older, were visited in their homes in 1998.Methods Trained fieldworkers completed questionnaires on lifesty

Hypertension in South African adults: results from the Demographic and Health Survey, 1998.

Background— Cardiovascular disease, the major cause of mortality and morbidity in modern societies, is set to overtake infectious diseases in the developing world as the most common cause of death. The increasing prevalence of major and emerging cardiovascular risk factors accounts for the growing burden of cardiovascular disease in the world. Diabetes in all its forms is one of the main cardiovascular risk factors. Two of 3 diabetic patients will die as a result of cardiovascular complications, and approximately 30% of patients treated in cardiovascular intensive care units have diabetes. Methods and Results— This review on the cardiovascular complications of diabetes in sub-Saharan Africa is a bibliographical MEDLINE search of published data over the past 2 decades. Diabetes-related cardiovascular disease complications are considered to be rare in Africa but are on the rise and are regularly associated with classic cardiovascular risk factors. Coronary heart disease may affect 5% to 8% of type 2 diabetic patients and cardiomyopathy, up to 50% of all patients. Close to 15% of patients with stroke have diabetes, and up to 5% of diabetic patients present with cerebrovascular accidents at diagnosis. Peripheral vascular disease prevalence varies across sites from 4% to 28%. Conclusions— It is obvious that diabetes mellitus and related cardiovascular complications are gaining more importance in sub-Saharan Africa. The relative contribution of putative risk factors is not well defined, and further research is therefore needed. (Circulation. 2005;112:3592-3601.)

Cardiovascular Complications of Diabetes Mellitus in Sub-Saharan Africa

http://ipenproject-org.heracenter.org/documents/publications_docs/krugernutr2002.pdf

Physical inactivity is the major determinant of obesity in black women in the North West province, South Africa: the THUSA study

Objective. The objective of this report was to review and describe the management of incomplete abortion by public sector hospitals. Design. A descriptive study in which data were collected prospectively from routine hospital records on all women admitted with incomplete abortion to a stratified random sample of hospitals between 14 and 28 September 1994. Setting. Public sector hospitals in South Africa. Patients. Women with incomplete abortions. Main outcome measures. Length of hospital stay, details of medical management, details of surgical management, determinants of the above. Main results. Data were collected on 803 patients from the 56 participating hospitals. Of these, 767 (95.9%) were in hospital for 1 day or more, and 753 (95.3%) women underwent evacuation of the uterus. Sharp curettage was the method employed in 726 (96.9%) and general anaesthesia was used for 601 (88%) of the women requiring uterine evacuation. Antibiotics were prescribed for 396 (49.5%) and blood transfusions were administered to 125 (17%) women. Statistical analysis showed length of stay to be longer in small hospitals (under 500 beds) and when the medical condition was more severe. Antibiotic  usage and blood transfusion were more common with increasing severity and a low haemoglobin level on admission. However, some inappropriate management was identified with regard to both. Main conclusions. It is suggested that uncomplicated incomplete abortion can be more effectively and safely managed using the manual vacuum aspiration technique with sedation/analgesia as an outpatient procedure. Attention should be directed at the introduction of this management routine at all types of hospital and to the ensuring of appropriate management of women with complicated abortion.

/pdf/management-of-incomplete-abortions-at-south-african-public-2mo5f212tb.pdf

Management of incomplete abortions at South African public hospitals

Although Depo-Provera is one of the most widely used reversible methods of contraception the influence of unopposed progestogen on the risk of breast cancer has not been addressed. An ongoing case-control study in South Africas Western Cape is investigating the relationship between injectable progestogen contraceptives (IPCs) and breast cancer. Enrolled to date have been the 122 cases of invasive breast cancer diagnosed in the previous 6 months among Colored and Black women under 55 years of age at the areas 2 tertiary care hospitals and 389 hospital controls matched for age race and area of residence. This phase of the study sought to describe the patterns of use of IPCs among controls. 280 controls (72%) reported ever-use of IPCs; 73 (19%) were current users 117 (30%) had used this method for 5 or more years and 232 (61%) had initiated use a decade or more ago. These findings indicate the broader study will have sufficient power to document or rule out increased breast cancer risks of the order of 1.5-fold even for 5 or more years of exposure that occurred as much as a decade earlier.

A case control study of breast cancer risk and exposure to injectable progestogen contraceptives : Methods and patterns of use among controls

A cross-sectional study of risk factors for ischaemic heart disease (IHO) in a random sample of 986 black people aged 15 - 64 years living in the Cape Peninsula revealed a population at lower risk for IHO than other South Africans. Blood pressures of 140/95 mmHg or above were found in 14,4% of males and 13,7% of females. Fifty-two per cent of males and 8,4% of females smoked, while 16,5% of males and 25,8% of females had a total cholesterol (TC) level imparting risk for developing IHO. In this population the TC level is not a good surrogate measure for low-density lipoprotein cholesterol because of the high level of high-density lipoprotein cholesterol (HOLC) found in this population. A protective HOLC/TC ratio of 20% was found in 96% of males and 96,1% of females. When considering the three major reversible IHO risk factors at a high level of risk, 30,8% of males and 12,5% of females had at least one such a risk factor. The population was frequently exposed to the media, with 80% listening to the radio every day and 55% watching television at least once a week. This suggests that a healthy lifestyle could be promoted successfully by means of these media. In addition, schools should promote a healthy lifestyle and the prevention of chronic degenerative diseases should be incorporated into the evolving primary health care services in South Africa.

/pdf/risk-factors-for-coronary-heart-disease-in-the-black-5ekd8t0mw0.pdf

Risk factors for coronary heart disease in the black population of the Cape Peninsula. The BRISK study.

A cross-sectional study of risk factors for ischaemic heart disease (IHD) in a random sample of 986 black people aged 15 - 64 years living in the Cape Peninsula revealed a population at lower risk for IHD than other South Africans. Blood pressures of 140/95 mmHg or above were found in 14,4% of males and 13,7% of females. Fifty-two per cent of males and 8,4% of females smoked, while 16,5% of males and 25,8% of females had a total cholesterol (TC) level imparting risk for developing IHD

Risk factors for coronary heart disease in the black population of the cape Peninsula

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Management of incomplete abortions at South African public hospitals

A case control study of breast cancer risk and exposure to injectable progestogen contraceptives : Methods and patterns of use among controls

Risk factors for coronary heart disease in the black population of the Cape Peninsula. The BRISK study.

Risk factors for coronary heart disease in the black population of the cape Peninsula