Browsing by Author "Madlala, Hlengiwe"

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    Correlates of sedentary behaviour among individuals at risk of developing type 2 diabetes mellitus in a low resource setting
    (2023) Africa, Chad; Madlala, Hlengiwe
    Background: There is evidence regarding the adverse effects of prolonged sedentary behaviour (SB) on health outcomes, including the association with non-communicable diseases (NCDs) such as type 2 diabetesmellitus (T2DM). However, there is a scarcity of information regarding the correlates of SB among individuals at risk of developing T2DM in low-income settings such as in South Africa (SA). Therefore, we aimed to identify the prevalence and correlates of SB among adults at riskof developing T2DM in low-income communities in Cape Town, South Africa. Methods: This was secondary analysis of cross-sectional data from the South African Diabetes Prevention Programme (SADPP). The study population consisted of 698 participants from 16 lower socio-economic communities in Cape Town, recruited between August 2017 and March 2018. Participants classified at high-risk completed questionnaires on socio-demographic, behavioural and psychological factors, neighbourhood living conditions and medical history. Self-reported SB was measured using the Global Physical Activity Questionnaire (GPAQ) and a separate questionnaire that recorded minutesof screen time (ST) during a typical working and non- working day. Blood samples were collected forthe determination of fasting glucose, glycated haemoglobin, and lipids. A Kruskal-Wallis or one-way ANOVA was conducted depending on the distribution of the numerical variable. A chi-squared or Fisher's exact test was conducted depending on the expected frequencies of the cells. Robust regression was used to investigate the association between the exposure and outcome variable. Statistical significance was set at p<0.05. Results: Among the 698 participants, the median time (minutes/day) spent in SB and ST was 180.0 and 137.1 minutes/day, respectively. When grouped by SB or ST, most of the participants (66.0% and 77.9%) were classified as having low levels (<4h/day) of SB and ST, respectively. After adjusting for age and gender, SB was associated with type of housing, lower safety, and walking infrastructure scores, excellent self-reported sleep quality and having at least one barrier to physical activity (PA). Conclusion: SB was correlated to factors related to socioeconomic status (SES), as well as barriers to PA and self-reported sleep quality. As such interventions to decrease SB should focus on environmental factors.
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    Open Access
    Determining antenatal medicine exposures in South African women: a comparison of three methods of ascertainment
    (2022-06-03) van der Hoven, Jani; Allen, Elizabeth; Cois, Annibale; de Waal, Renee; Maartens, Gary; Myer, Landon; Malaba, Thokozile; Madlala, Hlengiwe; Nyemba, Dorothy; Phelanyane, Florence; Boulle, Andrew; Mehta, Ushma; Kalk, Emma
    Background In the absence of clinical trials, data on the safety of medicine exposures in pregnancy are dependent on observational studies conducted after the agent has been licensed for use. This requires an accurate history of antenatal medicine use to determine potential risks. Medication use is commonly determined by self-report, clinician records, and electronic pharmacy data; different data sources may be more informative for different types of medication and resources may differ by setting. We compared three methods to determine antenatal medicine use (self-report, clinician records and electronic pharmacy dispensing records [EDR]) in women attending antenatal care at a primary care facility in Cape Town, South Africa in a setting with high HIV prevalence. Methods Structured, interview-administered questionnaires recorded self-reported medicine use. Data were collected from clinician records and EDR on the same participants. We determined agreement between these data sources using Cohen’s kappa and, lacking a gold standard, used Latent Class Analysis to estimate sensitivity, specificity and positive predictive value (PPV) for each data source. Results Between 55% and 89% of 967 women had any medicine use documented depending on the data source (median number of medicines/participant = 5 [IQR 3–6]). Agreement between the datasets was poor regardless of class except for antiretroviral therapy (ART; kappa 0.6–0.71). Overall, agreement was better between the EDR and self-report than with either dataset and the clinician records. Sensitivity and PPV were higher for self-report and the EDR and were similar for the two. Self-report was the best source for over-the-counter, traditional and complementary medicines; clinician records for vaccines and supplements; and EDR for chronic medicines. Conclusions Medicine use in pregnancy was common and no single data source included all the medicines used. ART was the most consistently reported across all three datasets but otherwise agreement between them was poor and dependent on class. Using a single data collection method will under-estimate medicine use in pregnancy and the choice of data source should be guided by the class of the agents being investigated.
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    Diabetes and hypertension in pregnancy: Association with adverse birth outcomes among pregnant women living with and without HIV in Cape Town, South Africa (2017-2019): A retrospective study
    (2023) Lehloa, Amohelang; Madlala, Hlengiwe; Malaba Thokozile
    Background Research suggests that human immunodeficiency virus (HIV) and antiretroviral therapy (ART) increases the likelihood of having hypertension and diabetes. In pregnancy, maternal exposures such as HIV and ART, hypertension, and diabetes are associated with adverse birth outcomes. However, studies tend to explore these factors in isolation. In South Africa, there is a high prevalence of HIV and obesity, thus a high risk of hypertension and diabetes. This study sought to explore the interplay of these non-communicable diseases (NCDs) with HIV in pregnancy and the prevalence of adverse birth outcomes. Methods A retrospective secondary data analysis of data collected from pregnant women where questionnaires, body anthropometrics and birth outcomes were obtained in an urban antenatal facility was conducted. A total of 470 (48%) participants living with HIV and 505 (52%) without HIV were included in this analysis. The prevalence of hypertension and diabetes was reported as overall and stratified by body mass index (BMI) and HIV status in the population. Pregnancy exposures of interest were HIV, hypertension, diabetes, HIV and hypertension, HIV and diabetes, and ART initiated during and pre-pregnancy. Factors associated with hypertension and diabetes were assessed using regression analysis although we could not retrieve the models on diabetes due to sample size restrictions. The adverse birth outcomes of interest were small for gestational age (SGA), large for gestational age (LGA), preterm delivery (PTD), low birthweight (LBW), and high birthweight (HBW). Median and interquartile range, proportions, and regression analysis were used to analyse adverse birth outcomes. Results Overall hypertension was approximately 9% whereas diabetes was 2% in this population. Although we could not achieve statistical significance, obese women living with HIV (WLHIV) had higher hypertension prevalence compared to normal weight WLHIV (14% vs 2%). A unit increase in gravidity, parity and age were significantly associated with increased odds of having hypertension (gravidity OR 1.02; 95% confidence interval (CI): 1.01 – 1.04, parity OR 1.02; 95% CI: 1.01 – 1.04, age OR 95% CI: 1.00 – 1.01). Being obese was significantly associated with increased odds of having hypertension (OR 1.07; 95% CI: 1.02 – 1.13). While there were some associations between increased LBW, PTD and SGA and HIV and ART initiation timing, statistical significance could not be achieved. Hypertension was significantly associated with more LBW and PTD (LBW aOR 2.05; 95% CI: 1.14 – 3.68, PTD aOR 4.67; 95% CI: 2.63 - 8.15). WLHIV and diabetes had a significantly higher prevalence of PTD (26% vs 9%) compared to WLHIV only. There were no appreciable differences in the prevalence of diabetes by HIV status. Stratifying by BMI, total diabetes was significantly higher in the obese group (3%) compared to the normal weight (1%) and overweight group (1%). LBW prevalence was significantly higher in diabetic pregnancies than in non-diabetic pregnancies (30% vs 10%). A higher SGA, LGA, HBW and LBW were recorded for WLHIV and diabetes compared to WLHIV only (SGA: 43% vs 11%, LGA 28% vs 8%: HBW: 14% vs 4%, LBW: 43% vs 11%). Conclusion The findings suggest that a double burden of HIV plus an additional non-communicable disease needs to be closely monitored to prevent increased poor birth outcomes. Extensive dietary and physical activity plans need to be incorporated to mitigate the occurrence of NCDs and poor birth outcomes in this high BMI population especially in WLHIV. The prevalence of diabetes and hypertension in WLHIV needs to be further studied, especially in the HIV-burdened Southern African settings.