The Library

A cross-sectional study of vascular risk factors in a rural South African population : data from the Southern African Stroke Prevention Initiative (SASPI)

Tools

Thorogood, Margaret, Connor, Miles, Tollman, Stephen, Lewando Hundt, Gillian, Fowkes, Gerry and Marsh, Jennifer. (2007) A cross-sectional study of vascular risk factors in a rural South African population : data from the Southern African Stroke Prevention Initiative (SASPI). BMC Public Health, Vol.7 (No.326). ISSN 1471-2458

Preview

PDF
WRAP_Thorogood_1471-2458-7-326.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Download (318Kb)

Official URL: http://dx.doi.org/10.1186/1471-2458-7-326

Abstract

Background: Rural sub-Saharan Africa is at an early stage of economic and health transition. It is predicted that the 21st century will see a serious added economic burden from non-communicable disease including vascular disease in low-income countries as they progress through the transition. The stage of vascular disease in a population is thought to result from the prevalence of vascular risk factors. Already hypertension and stroke are common in adults in sub-Saharan Africa. Using a multidisciplinary approach we aimed to assess the prevalence of several vascular risk factors in Agincourt, a rural demographic surveillance site in South Africa. Methods: We performed a cross sectional random sample survey of adults aged over 35 in Agincourt (population ≈ 70 000). Participants were visited at home by a trained nurse who administered a questionnaire, carried out clinical measurements and took a blood sample. From this we assessed participants' history of vascular risk, blood pressure using an OMRON 705 CP monitor, waist circumference, body mass index (BMI), ankle brachial index (ABI), and total and HDL cholesterol. Results: 402 people (24% men) participated. There was a high prevalence of smoking in men, but the number of cigarettes smoked was small. There was a striking difference in mean BMI between men and women (22.8 kg/m2 versus 27.2 kg/m2), but levels of blood pressure were very similar. 43% of participants had a blood pressure greater than 140/90 or were on anti-hypertensive treatment and 37% of participants identified with measured high blood pressure were on pharmacological treatment. 12% of participants had an ABI of < 0.9, sugesting the presence of sub-clinical atheroma. 25.6% of participants had a total cholesterol level > 5 mmol/l. Conclusion: We found a high prevalence of hypertension, obesity in women, and a suggestion of subclinical atheroma despite relatively favourable cholesterol levels in a rural South African population. South Africa is facing the challenge of an emerging epidemic of vascular disease. Research to establish the social determinates of these risk factors and interventions to reduce both individual and population risk are required.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Social Sciences > School of Health and Social Studies Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Blood-vessels -- Diseases -- South Africa, Peripheral vascular diseases -- South Africa, Hypertension -- South Africa
Journal or Publication Title:	BMC Public Health
Publisher:	BioMed Central Ltd.
ISSN:	1471-2458
Date:	13 November 2007
Volume:	Vol.7
Number:	No.326
Identification Number:	10.1186/1471-2458-7-326
Status:	Peer Reviewed
Access rights to Published version:	Open Access
Funder:	Wellcome Trust (London, England)
Grant number:	ref 0647/Z/01/Z
References:	1. Pearson TA: Cardiovascular disease in developing countries: Myths, Realities, and Opportunities. Cardiovascular Drugs and Therapy 1999, 13:95-104. 2. Cappuccio F: Epidemiologic transition, migration and cardiovascular disease. International Journal of Epidemiology 2004, 33:387-388. 3. Yusuf S, Reddy S, Stephanie. O, Sonia. A: Global Burden of Cardiovascular Diseases Part I: General Considerations, the Epidemiologic Transisiton, Risk Factors, and the Impact of Urbanization. Circulation 2001, 104:2746 -22753. 4. Leeder S, Raymond S, Greenberg H: A Race against time. New York , Columbian University, New York; 2004. 5. World Health Organisation: The World Health Report 2002. Geneva , World Health Organisation; 2002. 6. Cappuccio FP, Micah FB, Emmett L, Kerry SM, Antwi S, Martin-Peprah R, O. PR, Plange-Rhule J, Eastwood JB: Prevalence, detection, management, and control of hypertension in Ashanti, West Africa. Hypertension 2004, 43(5):1017-1022. 7. Reed DM: The paradox of high risk of stroke in populations with low risk of coronary heart disease. American Journal of Epidemiology 1990, 131:579-588. 8. Walker R: Hypertension and stroke in sub-saharan Africa. Transactions of the Royal Society of Tropical Medicine & Hygiene 1994, 88:609-611. 9. Walker RW, McLarty DG, Kitange HM, Whiting D, Masuki G, Mtasiwa DM, Machibya H, Unwin N, Alberti K, George MM: Stroke mortality in urban and rural Tanzania. The Lancet 2000, 355:1684-1687. 10. Kahn K, Tollman SM, Garenne M, Gear JSS: Who dies from what? Determining cause of death in South Africa's rural northeast. Tropical Medicine and International Health 1999, 4(6):433-441. 11. SASPI Team: Prevalence of stroke survivors in rural South Africa: results from the Southern Africa Stroke Prevention Initiative (SASPI) Agincourt field site. Stroke 2004, 35(3):627-632. 12. SASPI Team: Secondary prevention of stroke - results from the Southern Africa Stroke Prevention Initiative (SASPI) study,Agincourt Field Site. Bulletin of the World Health Organisation 2004, 82(7):503-508. 13. Connor MD, Walker R, Modi G, Warlow C: The burden of stroke in Black populations in sub-Saharan Africa. Lancet Neurology 2007, 6:269-78. 14. Tollman SM, Herbst K, Garenne M: The Agincourt demographic and health study: Phase I. Edited by: Johannesburg, Health Sysems Development Unit. Department of Community health, University of the Witwatersrand; 1995. 15. Kahn K, Tollman SM, Thorogood M, Connor MD, Garenne M, Collinson M, Lewando Hundt G: Health transitions in rural South Africa: New understanding, growing complexity. In Aging in Africa: Current and Future Challenges Edited by: Menken J. Washington , National Academy of Science; 2005. 16. SASPI Team: The social diagnostics of stroke like symptoms: Healers, doctors and prophets in Agincourt, Limpopo Province, South Africa. Journal Biosocial Science 2004, 36:433 -4443. 17. Kahn K, Collinson MA, Hargreaves JR, Clark SJ, Tollman SM: Socioeconomic status and child mortality in a rural sub-district of South Africa. In Measuring Health Equity in Small Areas - Findings from Demographic Surveillance Systems Edited by: de Savigny D, Debpuur C, Mwageni E, Nathan R, Razzaque R, Setel PW. Hants , Ashgate Publishing Ltd; 2005:67-85. 18. Schellenberg JA, Victoria CG, Mushi A, De Savigny D, Schellenberg D, Mshinda H, Bryce J: Inequities among the very poor: health care for children in rural Tanzania. Lancet 2003, 361:561-566. 19. Medical Research Council: South Africa Demographic and Health Survey 1998. Demographic and Health Surveys Macro International Inc; 1998. 20. National Heart Lung and Blood Institute: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Washington , US Department of Health and Social Services; 2004. 21. Lee A, Price JF, Smith FB, Wijk M, Fowkes FGR: Improved prediction of fatal myocardial infarction using the ankle brachial index in addition to conventional risk factors: the Edinburgh Artery Study. Circulation 2004, 110:3075 -30780. 22. International Physical Activity Questionnaire (IPAQ). . 23. StataCorp: Stata Statistical Software: Release 8.0. . 24. Fowkes FGR, Thorogood M, Connor MD, Lewando-Hundt G, Tzoulaki I, Tollman SM: Distribution of a subclinical marker of cardiovascular risk, the ankle brachial index, in a rural African population. European Journal of Cardiovascular Prevention and Rehabilitation 2006, 13:964-969. 25. Berger GMB, Marais AD: Diagnosis, management and prevention of the common Dyslipidaemias in South Africa-Clinical Guideline 2000. South Afrcian Medical Association and LASSA working group 2000. 26. Gillum RF: The Epidemiology of Cardiovascular Disease in Black Americans. N Engl J Med 1996, 335:1597-1599. 27. Thorogood M, Connor MD, Lewando-Hundt G, Tollman S: Understanding and managing hypertension in an African sub-district: A multidisciplinary approach. Scandinavian Journal of Public Health 2007, 35(suppl 69):52-9. 28. Edginton ME, Hodkinson J, Seftel HC: Disease Patterns in a Sout hAfrican Rural Bantu Population. South African Medical Journal 1972, 46:968-976. 29. Cooper R, Rotimi C, Ataman S, McGee D, Osotimehin B, Kadiri S, Muna W, Kingue S, Fraser H, Forrester T, Bennett F, Wilks R: The prevalence of hypertension in seven populations of west African origin. Am J Public Health 1997, 87(2):160-168. 30. Mbanya JC, Minkoulou EM, Salah JN, Balkau B: The Prevalence of hypertension in rural and urban Cameroon. Internal Journal of Epidemiology 1998, 27:181-185. 31. Edwards R, Unwin N, Mugasi F, Whiting D, Rashid S, Kissima J, Aspray TJ, Alberti KGMM: Hypertension prevalence and care in an urban and rural area of Tanzania. Journal of Hypertension 2000, 18:145-152. 32. Oosthuizen W, Voster HH, Kruger A, Venger CS, Druger HS, de Ridder JH: Impact of urbanisation on serum lipid profiles - the THUSA survey. South African Medical Journal 2002, 92(9):723-728. 33. Swai ABM, McLarty DG, Kitange HM, Kilima PM, Tatalla S, Keen N, Chuwa LM, Alberti KGMM: Low prevalence of risk factors for coronary heart disease in rural Tanzania. International Journal of Epidemiology 1993, 22(4):651-659. 34. Mollentze WF: Epidemiological Aspects in South Africa. South African Journal of Diabetes and Vascular Disease 2004, 1:55-56. 35. Kruger HS, Venter CS, Vorster HH: Obesity in African women in the North West Province, South Africa is associated with an increased risk of non-communicable diseases: the THUSA study. British Journal of Nutrition 2001, 86:733-740. 36. Steyn K, Jooste PL, Bourne L, Jean. F, Badenhorst CJ, D.E. B: Risk factors for coronary heart disease in the black population of the Cape Peninsula. The BRISK study. S Afr Med J 1991, 79(8):480-485. 37. Puoane T, Steyn K, Bradshaw D, Laubscher R, Fourie J, Lambert V, Mbananga N: Obesity in South Africa: The South African Demographic and Health Survey. Obesity Research 2002, 10(10):1038-1048. 38. Monteiro C A., Moura EC, Conde WL, Popkin BM: Socioeconomic status and obesity in adult populations of developing countries: a review. Bulletin of the WHO 2004, 82(12):940-946. 39. Kaufman JS, Asuzu MC, Mufunda J, Forrester T, Wilks R, Luke A, Long AE, Cooper RS: Relationship between blood pressure and body mass index in lean populations. Hypertension 1997, 30:1511 -11516. 40. Bunker C, Ukoli FA, Matthews KA, Kriska AM, Huston SL, Kuller LH: Weight threshold and blood pressure in a lean black population. Hypertension 1995, 26:616 -6623. 41. Kerry S, Emmett L, Micah FB, Martin-Peprah R, Antwi S, Phillips RO, Plange-Rhule J, Eastwood JB, P. CF: Rural and semi-urban difference in salt intake, and its dietray sources, in Ashanti. West Africa. Ethnicity & Disease 2005, 15:33-39. 42. Kahn K: Dying to make a fresh start. Mortality and health transition in a new South Africa. In Public Health and Clinical Medicine Volume PhD. Umeå , Umeå University; 2006. 43. Kahn K, Tollman SM: Stroke in rural South Africa - contributing to the little known about a big problem. South African Medical Journal 1999, 89(1):63-65. 44. Murray CJL, Lauer JA, Hutubessy RCW, Niessen L, Tomijima N, Anthony. R, M.M. LC, B. ED: Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovasculardisease risk. The Lancet 2003, 361:717-725. 45. World Health Organisation: Preventing chronic disease: a vital investment: WHO global report. Geneva , World Health Organisation; 2005.
URI:	http://wrap.warwick.ac.uk/id/eprint/253