Browsing by Author "Madlala, Hlengiwe"

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    An Evaluation of Diagnostic Approaches for Gestational Diabetes Screening in South Africa
    (2024) Mennen, Mathilda; Madlala, Hlengiwe; Myer Benjamin
    Background: Gestational diabetes mellitus (GDM) poses substantial risks to both mothers and their offspring. In South Africa, screening practices vary, and pregnant women are not screened universally due to resource constraints. This study investigates the implications of using point of-care (POC) capillary glucose measures for GDM screening and explores potential strategies to increase screening capacity by eliminating the reliance on central laboratory facilities or reducing the time spent at antenatal facilities for mothers. Objectives: The prevalence of GDM determined by venous blood glucose (VBG) measures obtained during 2-hour oral glucose tolerance tests (OGTTs) was compared to POC capillary glucose (CBG) tests with immediate results. The agreement between VBG and CBG measures was calculated across the whole cohort and in sub-groups, and the clinical and cost implications of each method explored. Methods: A secondary analysis was conducted on data collected from 400 pregnant participants who were enrolled at 24-28 weeks' gestation into a prospective cohort study at an antenatal clinic in Cape Town. Participants were screened for GDM using a gold-standard 75g OGTT and simultaneously underwent POC capillary glucose testing. GDM was diagnosed via each method according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. We calculated the sensitivity and specificity of CBG in detecting VBG-defined GDM at different thresholds and Bland-Altman analyses examined agreement between CBG and VBG. Results: The GDM prevalence was 7% among all participants, resulting from a prevalence of 6% among patients with no risk factors, and 8% among patients with risk factors. Four percent of the cohort was diagnosed with GDM despite having no risk factors. Most cases (96%) were diagnosed on fasting venous measures. Capillary measures overestimated the prevalence of GDM at IADPSG thresholds (25%) and had poor sensitivity (73%). Correlation between venous and capillary measures was lowest in the fasting state (r=0.22, p<0.001). Bland Altman analyses found the average agreement between methods to be lowest in the fasting state. 2 Conclusion: Capillary measures demonstrate poor correlation and agreement with venous measures at 24-28 weeks' gestation, particularly in the fasting state when almost all GDM cases are diagnosed. A fasting plasma glucose, if performed universally as a single measure, outperforms selective risk factor-based OGTT screening and fasting capillary blood glucose in terms of sensitivity and specificity, while reducing the overall number of laboratory-dependent glucose tests performed.
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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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    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.
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    Food intake patterns and associations with postpartum weight retention in women living with and without HIV in Cape Town South Africa
    (2024) Sithole, Siphesihle; Madlala, Hlengiwe; Mukonda Elton
    Background: Maternal nutrition during pregnancy and postpartum may significantly impacts weight outcomes and long-term maternal health. However, dietary habits and weight outcomes during these periods remains poorly understood particularly in obesogenic environments like Gugulethu township (Cape Town, South Africa). In addition, dietary habits among persons living HIV may differ from the general public due to increased nutritional demands. However, there is limited data on food intake and weight outcomes in low-income resource settings. Therefore, the aim of this study was to investigate food intake patterns during pregnancy and postpartum, and associations with gestational weight gain (GWG) and postpartum weight retention (PPWR) among women living with and without HIV. Methods: This Master of Public Health mini-dissertation presents a research protocol (section A) and a journal-formatted manuscript (Section C). This study was a retrospective secondary data analysis study which builds on the Cardiometabolic Risk in Pregnancy (CAMP) a prospective cohort study of 400 pregnant women (n = 200 living with HIV and n = 200 living without HIV) recruited and enrolled from November 2019 to October 2022. Food intake was assessed using the Minimum Dietary Diversity for Women (MDD-W). Food intake was stratified using HIV, GWG and PPWR respectively. Weight assessments in pregnancy and postpartum periods were conducted by a trained study nurse and GWG was categorised as adequate, inadequate, and excessive weight gain according to the Institute of Medicine (IOM) guidelines and PPWR was categorised as weight loss (<0kg), normal weight retention (0-5kg) and excessive weight retention (>5kg). Multinomial regression models examined associations between food intake, GWG and PPWR while controlling for confounders including parity, income marital status as well education level. Results: Overall, 82% of women were multigravida while the overall median age was 30.1 (IQR, 25.4- 34.0). Women living with HIV exhibited higher food intake and dietary diversity during gestation, with significant differences in the consumption of starchy staples (38%) and meats (37%) compared to women without HIV (26% for both). Women living with HIV compared to those living without HIV were more likely to experience inadequate weight gain as opposed to adequate weight gain (OR = 2.24 95% CI 1.12, 4.46). Postpartum, excessive weight retention was associated with milk and milk product consumption, where women consuming milk and milk products compared to those not consuming milk and milk products, were more likely to experience excessive weight retention relative to those who experienced normal weight retention (OR = 2.278 95% CI, 1.10,7.05) while holding all other covariates constant. Conclusion: Our results add valuable insights to the current knowledge by offering detailed perspectives on the complex connections between dietary diversity and its broader consequences on maternal aspects such as GWG and PPWR. Targeted nutritional interventions are needed to promote healthy weight during pregnancy and postpartum periods, particularly among women living with HIV.
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    Prevalence of pregnancy and postpartum hypertension in obese women living with HIV In Cape Town, South Africa
    (2024) Phohlo, Nthabiseng; Madlala, Hlengiwe
    Background: In accordance with global hypertension practice guidelines, hypertension is defined as having systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg in an office or clinic setting following repeated examination. Hypertension is one of the leading causes of morbidity and mortality in the world and it is a risk factor for many non-communicable diseases, particularly cardiovascular disease. In South Africa, management of hypertension remains suboptimal due to insufficient healthcare utilities. Roughly 8.22 million adult South Africans who do not have private insurance have hypertension and the direct healthcare costs associated with hypertension were projected to be around 10.1 billion. Consequently, proactive interventions need to be reinforced in order to combat this growing epidemic and factors associated with it need to be well defined. Coupled with escalating trends of obesity and high prevalence of HIV, hypertension poses more thread to South African health system. Globally, obesity has increased since 1975 to 2016 from 3% to 11% among men, from 6% to 15% among women and from less than 1% to 8% in children. Conversely in South Africa, prevalence of obesity in adult men and women was 9% and 27% in 2003. Additionally, about 21.7% of women of child bearing age are living with HIV. More research is therefore required in order to inform relevant stakeholders to incorporate effective measures that can control and prevent this disease. Methods: A retrospective cohort study that used secondary data from previous studies was carried out. This data was for pregnant WLHIV, who presented themselves at Gugulethu community health facility from 2013 to 2018. The data was merged for analysis of hypertensive disorders of pregnancy (HDP) in association with body mass Index (BMI) and antiretroviral therapy (ART) initiation time. Women who were included in the study were those who were on ART before pregnancy (preconception) and those who initiated ART during pregnancy (post conception). Other risk factors associated with PIH and PPH were also determined. Hypertension was classified according to American hypertension guidelines. Descriptive analysis of the whole sample included 1859 WLHIV, 752 WLHIV of these were included in the sub-analysis of PPH. Analytical analysis was done by multinomial ordinal proportional logistic regression because the outcome had four ordered levels (normal, high-normal, grade1 and grade2). This analysis was done using R programming version 4.2.2. Ethical statement: Ethics approval was obtained from Human Research Ethics committee, Faculty of Health Sciences, University of Cape Town. Informed consent for parent studies, where data was collected from was obtained from the participants. In this study, no informed consent from the participants was required as these were already obtained from the parent studies. Results: Overall PIH prevalence was 67.7 cases per 1000 population. Prevalence of PIH was 67.7 cases per 1000 population stratified by ART initiation timing (42% preconception and 58% post-conception) and 67.9 cases per 1000 population stratified by BMI (a proportion of obese women was 67%). Conversely, PIH prevalence in obese women was 43 cases per 1000 population in the overall sample. Association between PIH and ART initiation timing (preconception) was OR; 0.76, 95% CI; 0.59 to 0.97, with p-value of 0.03. Association between PIH and BMI in obese women was; OR; 3.49, 95% CI; 2.42 to 5.15, p-values; <0.001. Overall PPH prevalence was 155 cases per 1000 population. PPH prevalence was 155 cases per 1000 population stratified by ART initiation timing (44% preconception and 56% post-conception) and 158.6 cases per 1000 population stratified by BMI (a proportion of 64% was obese women). Overall PPH prevalence in obese women was 101 cases per 1000 population. ART initiation timing (preconception) and PPH association was (OR; 0.67, 95% CI; 0.47 to 0.95), p-value; 0.03. BMI and PPH association in obese women was; (OR; 2.41, 95% CI; 1.51 to 3.96), p-value; < 0.001. Obesity, old age (≥35) and late booking at antenatal clinic were risk factors that showed a positive association with hypertension, with ORs; 3.49, 2.21 and 1.56 respectively. Conclusions: There is significantly high prevalence of PIH and PPH in women living with HIV in Cape Town. Obesity is the major risk factor for PIH and PPH. ART initiation timing (preconception) was negatively associated with PIH and PPH. Effective measures to manage and prevent hypertension in pregnant WLHIV need to be implemented to prevent PIH and PPH. Pregnant WLHIV need to be monitored for hypertension, particularly those above 35 years and those who are obese. Early booking at antenatal care should be encouraged to facilitate early monitoring of PIH.