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Objectives: We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention., Design: Cross-sectional study., Setting: Community-based study in four sub-Saharan African countries., Participants: 10 700 individuals, aged 40-60 years., Primary and Secondary Outcome Measures: The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG <7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis., Results: Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes., Conclusions: There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes., Competing Interests: Competing interests: ANW declares an honorarium received from Sanofi for serving as a panel member at an educational event on thyroid cancer. SAN declares participation in a data safety monitoring board of a Phase IV open-label trial to assess bone mineral density in a cohort of African women on Depo-Provera and tenofovir disoproxil fumarate switched to tenofovir alafenamide fumarate based antiretroviral therapy and Council membership in the International Society of Developmental Origins of Health and Disease., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To determine the prevalence of multimorbidity, to identify which chronic conditions cluster together and to identify factors associated with a greater risk for multimorbidity in sub-Saharan Africa (SSA)., Design: Cross-sectional, multicentre, population-based study., Setting: Six urban and rural communities in four sub-Saharan African countries., Participants: Men (n=4808) and women (n=5892) between the ages of 40 and 60 years from the AWI-Gen study., Measures: Sociodemographic and anthropometric data, and multimorbidity as defined by the presence of two or more of the following conditions: HIV infection, cardiovascular disease, chronic kidney disease, asthma, diabetes, dyslipidaemia, hypertension., Results: Multimorbidity prevalence was higher in women compared with men (47.2% vs 35%), and higher in South African men and women compared with their East and West African counterparts. The most common disease combination at all sites was dyslipidaemia and hypertension, with this combination being more prevalent in South African women than any single disease (25% vs 21.6%). Age and body mass index were associated with a higher risk of multimorbidity in men and women; however, lifestyle correlates such as smoking and physical activity were different between the sexes., Conclusions: The high prevalence of multimorbidity in middle-aged adults in SSA is of concern, with women currently at higher risk. This prevalence is expected to increase in men, as well as in the East and West African region with the ongoing epidemiological transition. Identifying common disease clusters and correlates of multimorbidity is critical to providing effective interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

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).

Background: The aim of the study was to determine the prevalence and determinants of chronic non-communicable disease (NCD) risk factors in a rural community in the Limpopo Province of South Africa., Methods: This survey was conducted using the WHO "STEPwise approach to the surveillance of non-communicable diseases" (STEPS) methodology. Participants were residents of the Dikgale HDSS site and standardised international protocols were used to measure behavioural risk factors (smoking, alcohol consumption, fruit and vegetable intake and, physical activity) and physical characteristics (weight, height, waist and hip circumferences and blood pressure-BP). Fasting blood glucose, triglyceride, cholesterol and HDL-C were determined in 732 participants. Data were analysed using STATA 12 for Windows., Results: The prevalence of current smokers amongst the participants was 13.7%, of which 81.3% were daily smokers. Alcohol was consumed by 16.3% of the participants. The majority of participants (88.6%) had low daily intake of fruit and vegetables and low physical activity (66.5%). The prevalence of hypertension amongst the participants was 38.2%. Overweight, obesity and high waist circumference were prevalent in females. The cardio-metabolic risk profile was not significantly different between men and women. People who were older than 40 years, overweight or obese and those who consumed alcohol were more likely to be hypertensive. Smoking was associated significantly with older age, males, never married and divorced people. Alcohol consumption was associated with older age, males, low educational status and low income., Conclusion: High levels of risk factors for NCDs among adults in the Dikgale HDSS suggest an urgent need for health interventions to control these risk factors at the population level in order to reduce the prevalence of NCDs.

Background: Hypertension is problem already faced by urban populations of South Africa, but little is known about its prevalence and risk factors in rural areas., Aim: To assess the prevalence of and risk factors associated with hypertension amongst adults in a rural community in South Africa., Setting: Dikgale Health and Demographic Surveillance Site, Limpopo Province, South Africa., Methods: A community-based cross-sectional survey was carried out at this site where individuals aged 15 years and older were screened using a locally adapted version of the World Health Organization STEPwise questionnaire. Demographics, anthropometry and three independent blood pressure (BP) readings were taken. The average of the three BP measurements was used in analysis, and hypertension taken as systolic and diastolic BP of ≥ 140 or ≥ 90 mmHg respectively, or at least a two-week history of antihypertensive treatment. Analysis included the Chi-square test and statistical significance was set at p ≤ 0.05., Results: A total of 1407 individuals were interviewed, of whom 1281 had complete BP, weight and height measurements taken. The mean age of participants was 44.2 ± 2 0.9 years (range 15-98 years), 63% were female, 55% were single and 90% were unemployed, whilst 13% were tobacco smokers and 20% reported drinking alcohol. Overall prevalence of hypertension was 41% and this was significantly associated with age and marital status., Conclusion: The prevalence of hypertension was found to be high. Prevention strategies are urgently needed to address this life-threatening and important risk factor for cardiovascular disease in rural Limpopo Province.

Obesity is a growing epidemic that threatens to deplete healthcare resources by increasing the prevalence of diabetes, heart disease, high blood pressure, cancer, and chronic kidney disease. The prevalence of general and central obesity among the rural Black population in Limpopo Province is high; however, few studies have evaluated the association between obesity and its comorbidities among the rural Black population, and, hence, this study aims to determine the relationship between obesity and associated comorbidities. This study was cross-sectional and retrospective in design, using secondary data from the Africa Wits-INDEPTH Partnership for Genomic (AWI-Gen) research phase 1 study. A sample size of 791 participants was collected conveniently. Data were analysed using the Statistical Package for Social Sciences version 27 (SPSS). A chi-square, unpaired Student's t-test, bivariate and partial correlation, and multivariate regression analysis were used for analysis. General obesity correlated positively and significantly with LDL-C/HDL-C ratio and hypertension, while central obesity correlated positively and significantly with diabetes, hypertension, chronic kidney disease, LDL-C/HDL-C ratio, and TC/HDL-C ratio. In the present study, obese participants were more likely to be hypertensive, and have an increased LDL-C/HDL-C ratio. Centrally obese participants were more likely to be diabetic, hypertensive, have dyslipidaemia, and exhibit reduced kidney function. [ABSTRACT FROM AUTHOR]