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BackgroundAnti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.MethodsPooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.FindingsAmong 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.InterpretationEvidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.

Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations. Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models. Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies. Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.

Healthcare professionals (HCPs) have vital roles in providing evidence‐based care to promote healthy micronutrient nutrition in early life. Providing such care requires scalable training to strengthen knowledge and confident application of effective behaviour change skills. Among 33 public and private HCPs (primarily dietitians) in South Africa, we evaluated the behaviour change aspects of a technology‐enabled National Qualification Sub‐Framework level 6 programme, Improving Early Nutrition and Health in South Africa (‘ImpENSA’). This programme comprises two self‐directed micronutrient and behaviour change knowledge‐based eLearning and one facilitated online practical skills modules to improve maternal and infant micronutrient nutrition. Using assessments, questionnaires and interviews, we collected data at baseline, after module completion and at 3‐month follow‐up after programme completion. Questionnaire and interview data showed major improvements in understanding of and attitudes towards person‐centred behaviour change support immediately following the eLearning module on behaviour change. The assessment pass rate increased from 38% at baseline to 88% postmodule, demonstrating significant knowledge gain in behaviour change support. Intention to change practice towards a person‐centred approach was high and many had already started implementing changes. Three months postprogramme, support was centred around patients' needs. Open relationships with patients, improved patient outcomes and increased job satisfaction were among reported outcomes. Many reported becoming better change facilitators and reflective practitioners. Additional improvements in understanding and attitudes to behaviour change support were evident, reinforced by making changes and experiencing positive outcomes. The findings suggest that technology‐enabled learning can equip HCPs with knowledge and skills to effectively support behaviour change for healthy micronutrient nutrition during pregnancy and infancy. [ABSTRACT FROM AUTHOR]

Background: Low socio‐economic status is associated with poor birth outcomes, however, few studies on this topic have been conducted in South Africa. We determined associations between socio‐demographic variables of pregnant women and birth outcome in their offspring. Methods: This study was nested in a prospective cohort study conducted at an antenatal clinic at a regional hospital in Bloemfontein, South Africa. Questionnaires on socio‐demographic information were completed on 682 pregnant women in a structured interview. Post‐delivery, 331 participants provided the Road to Health Booklets for 347 infants, in which birth data were recorded. Associations between socio‐demographic variables and birth outcome (defined as premature delivery or low length‐for‐age or low weight‐for‐length at birth) were investigated. Logistic regression with backward selection (p < 0.05) was used to select independent factors that were significantly associated with birth outcome. Variables with a p‐value of <0.15 on bivariate analysis were considered for inclusion in the model. Results: Poor birth outcome was observed in 36.3% (116/320) of women. The odds of experiencing poor birth outcome were lower for women who owned a stove versus those who did not (OR 0.11, 95% CI: 0.02–0.67), and higher for women with grade 8–10 (OR 5.84, 95% CI: 1.90–17.91) or grade 10–12 (OR 4.33, 95% CI: 1.50–12.49) as their highest level of education versus tertiary education. The odds of experiencing poor birth outcomes were also higher for those employed part‐time (OR 2.55, 95% CI: 1.10–5.93) versus full‐time and/or self‐employed. Conclusion: Our findings confirm that the presence of basic amenities such as a stove, better education and employment improve the chances of better birth outcomes. Early screening of pregnant women for the identification of socio‐demographic risk factors that may impact on birth outcome is recommended. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations. METHODS: We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individual-level data on one or more of the following traits in HIV+ and HIV-, or ART+ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants. RESULTS: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, -0.59; 95% CI, -0.86 to -0.31), BMI (SMD, -0.32; 95% CI, -0.45 to -0.18), SBP (SMD, -0.40; 95% CI, -0.55 to -0.25) and DBP (SMD, -0.34; 95% CI, -0.51 to -0.17). Among HIV+ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, -0.34; 95% CI, -0.62 to -0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits. CONCLUSIONS: Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA.

Objective: A study was undertaken to explore the differences in nutrition knowledge, attitudes, beliefs and practices and their correlations among adults in both urban and rural communities in the Free State province of South Africa. Design: This study forms part of the cross-sectional Assuring Health for All in the Free-State (AHA-FS) study. Setting: The AHA-FS study is conducted in urban and rural parts of the Free State province of South Africa. The rural and urban stages of the study were conducted in 2007 and 2009, respectively. Subjects: The sample included 846 adult household members, aged between 25 and 65 years, from both rural and urban areas of the Free State province. Outcome measures: Nutrition knowledge, attitudes, beliefs and practices were measured. Results: The sample included predominantly females (78.2%). Rural adults had significantly better nutrition knowledge (p < 0.001), positive attitudes (p < 0.001) and positive beliefs (p < 0.001) and their nutrition knowledge and attitudes (r = 0.27, p < 0.001), nutrition knowledge and beliefs (r = 0.16, p < 0.001), and nutrition attitudes and beliefs (r = 0.38, p < 0.001) were significantly correlated with each other. However, nutrition knowledge, attitudes and beliefs were not correlated with nutrition practices among our sample in either the urban or rural setting. Conclusion and implication: The results of the current study confirm that relevant and culturally acceptable nutrition education interventions for translating nutrition-related knowledge, attitudes and beliefs into practices are required. [ABSTRACT FROM AUTHOR]

Objective: The elderly living in Africa are prone to malnutrition which is complicated by the high prevalence of poverty. This study assessed the nutritional status of the elderly and factors associated with malnutrition. Method: In a cross-sectional survey, the nutritional status of 300 participants aged 65 years and older was determined using the Mini Nutritional Assessment (MNA) questionnaire consisting of 18 questions. Socio-demographic data was obtained using a questionnaire. Results: Sixty-six percent were at risk of malnutrition, while 14.6% (n = 44) were malnourished. Participants that did not use electricity as a fuel for cooking versus those that did, had higher odds of being malnourished/ at risk of malnutrition (OR = 1.85 [1.04; 3.31]). Those that did not experience psychological stress or acute disease versus those that did, had lower odds of being malnourished/at risk of malnutrition (OR = 0.33 [0.12; 0.90]). Participants that did not perceive nutritional problems versus those that did, had lower odds of being malnourished/at risk of malnutrition (OR = 0.18 [0.09; 0.34]). Similarly, those that did not perceive their health status as poor versus those that did, had lower odds of being malnourished/at risk of malnutrition (OR = 0.17 [0.08; 0.34]). Discussion: The findings indicate that the elderly with more resources, less stress, and better actual and perceived health were less likely to be malnourished. In such communities, routine screening in the elderly is required to identify those with compromised health and nutritional status. [ABSTRACT FROM AUTHOR]

Estimation equations based on different body segments are commonly used to predict height in patients whose height cannot be directly measured. This study aimed to assess the agreement between measured (reference) height and height predicted from published equations derived from measurement of body segments, in a South African public hospital setting. A descriptive cross-sectional study was undertaken. Medical, surgical, pulmonary, orthopaedic, cardiovascular and general wards at three public hospitals in Bloemfontein. Admitted patients, 20–50 years old; able to stand upright without assistance and without medical conditions or treatments affecting height. Stadiometer height, recumbent height, arm span, demi-span, ulna length, knee height, tibia length, fibula length and foot length were measured with standardised techniques. Height, predicted by 12 published equations, was compared with stadiometer height by 95% confidence intervals (CI) and Bland–Altman analysis. The median stadiometer height of the sample (n = 141; 38.3% female; median age 38.8 years, IQR 33.3–44.4 years) was 165.5 cm (males 169.3 cm; females 158.4 cm). Only a set of equations based on knee height and standardised on a large population of adults < 65 years in the United States estimated height without statistically significant deviance from the stadiometer height. Most standardised equations applied to hospitalised adults in a South African public health setting resulted in height estimations that differed significantly from height. Thus, equations standardised on other populations may not be suitable for the South African population, possibly due to differences in genetic and environmental factors. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to determine the knowledge, perceptions and practices of HIV-infected mothers regarding human immunodeficiency virus (HIV) and infant feeding. Design: A cross-sectional study design was applied. Setting: The study was undertaken at a regional hospital in Bloemfontein. Subjects: A total of 100 mother–infant pairs that were still in hospital after the delivery of the baby were included. All mothers were HIV-infected. Outcome measures: Sociodemographic information, medical history, and knowledge, perceptions and practices related to infant feeding in the context of HIV were noted. Results: The median age of mothers was 31 years, and most mothers reported anti-retroviral therapy (ART) use (93.0%). The median CD4 cell count was 383 cells/mm3, and median haemoglobin level was 11.4 g/dl. Most mothers planned to breastfeed their infant(s) (70.0%). A large percentage of the mothers reported that they did not know or were not aware of the fact that HIV can be transmitted to an infant via breastfeeding (43.0%). Only half of the mothers had been shown how to either breastfeed or formula feed by healthcare staff (depending on their choice). Conclusion: The knowledge, perceptions and practices related to infant feeding were inadequate in mothers included in this study. Providing scientifically based, unbiased information is fundamental during counselling on infant feeding to ensure the success of prevention of mother-to-child transmission (PMTCT) programmes. If women feel confident in their acquired knowledge, they are more likely to be self-empowered and make informed decisions related to infant feeding. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes mellitus (T2DM) is a global health problem with high morbidity and mortality in patients who are mostly still economically active. The growing incidence and health implications for those affected make T2DM a major public health issue. Objectives: To compile a demographic, anthropometric and knowledge, attitude and practices (KAP) profile of adult patients with T2DM in the public health sector of the Free State province, South Africa. Design: A descriptive observational study was conducted. Setting: A total of 255 participants attending public health facilities in the Free State were interviewed. Outcome Measures: Questionnaires were completed in an interview to determine demographics and KAP. Anthropometric measurements were obtained by standard techniques. Results: The majority of the participants (n = 222; 87.1%) were black women from urban areas, who were overweight and obese. The median age at diagnosis was 48 years (range 15–80 years), and 25 participants (9.8%) lacked formal schooling. In 212 participants (83.1%), a waist circumference above cut-off points was observed. Only half of the participants knew the normal range for blood glucose. Approximately 80% felt that they would be a different person if they did not have diabetes. Although 96.1% of participants were knowledgeable about the benefits of physical exercise, only 31.0% reported exercising on a daily basis. A statistically significant association was found between knowledge and attitudes, indicating that better knowledge about diabetes could be associated with a more positive attitude towards diabetes. Conclusion: Poor knowledge, a negative attitude and poor practices related to diabetes were observed in a very high percentage of participants, which may contribute to morbidity and mortality. The fact that knowledge was associated with attitude indicates that interventions aimed at improving knowledge could benefit patients in more than one way. Interventions to equip patients to successfully manage their condition are urgently required. [ABSTRACT FROM AUTHOR]