Visceral adiposity index, fitness and clustered cardiovascular disease risk in adolescents.

BACKGROUND:  Clustering of cardiovascular disease (CVD) risk factors have been observed in children and adolescents, but its association with visceral adiposity index (VAI) and cardiorespiratory fitness (CRF) in adolescents has rarely been studied. AIM:  This study determines the independent associations of VAI and CRF with the clustering of cardiovascular disease risk (CVDr) among Nigerian adolescents. SETTING:  Adolescents from specific secondary schools in Kogi East, North Central Nigeria participated in the study. METHODS:  A cross-sectional sample of 403 adolescents (202 boys and 201 girls) aged 11 years - 19 years were evaluated for VAI, CRF and CVDr. Using identified risk factors, a clustered CVDr score was generated. The association between VAI, CRF and clustered CVDr was evaluated using regression models that controlled for age, gender and maturity status. RESULTS:  Fitness was negatively associated with CVDr (ß = -0.268, p  0.001), while VAI was positively correlated with CVDr (ß = 0.379, p  0.001). After CRF or VAI adjustment, the independent association with the dependent variable remained significant. The odds of an adolescent with elevated VAI being at risk of CVD was 4.7 times higher than his peers. Unfit adolescents were 2.1 times more likely to develop CVDr. CONCLUSION:  Both VAI and CRF were independently associated with the clustering of CVDr in Nigerian adolescents. The findings suggest that health promotion efforts focusing on healthy diet and aerobic-type physical activity programmes should be encouraged among the youth to reduce the risk of CVD.Contribution: This study shows that improving visceral adipose tissue and fitness may lower CVD risk factors in adolescents, which is significant for public health.

Coverage of diabetes complications screening in rural Eastern Cape, South Africa: A cross-sectional survey.

BACKGROUND: There is a paucity of data on the coverage of diabetes mellitus (DM) complications screening in primary healthcare facilities in South Africa (SA). This study assesses the extent of screening for DM complications among individuals with type 2 DM attending primary health facilities in rural Eastern Cape (EC), SA. METHODS: The study adopted a descriptive, cross-sectional design and obtained data from 372 individuals with type 2 diabetes attending six selected primary healthcare centres (PHCs) in two EC districts. Demographic and clinical data were obtained through questionnaire-based interviews and reviews of medical records. We assessed the extent of screening for estimated glomerular filtration rate (eGFR), fasting lipogram, eye examination, foot examination and glycated hemoglobin (HbA1c) in the past year. RESULTS: Participants mean age was 62 (standard deviation [s.d.] ± 11) years, and their mean duration of diagnosis was 9 (s.d. ± 8) years. In the past year, HbA1c result was available for 71 (19.1%) of the participants; 60 (16.1%) had eGFR results, while only 33 (8.9%) had documented lipid results. In total, 52 (14.0%) had carried out eye examinations, while only 9 (2.3%) had undergone foot examinations in the past year. About two-thirds of the participants (59.9%) had not undergone any form of complication screening in the past year, and none had undergone the complete screening panel. CONCLUSION: The coverage of screening for DM complications was low across all indicators. Studies to understand barriers to and facilitators of DM complications screening at PHCs are required. Also, interventions to improve diabetes complication screening in the region are needed and should target the primary healthcare providers.

Association of Fitness and Fatness with Clustered Cardiovascular Disease Risk Factors in Nigerian Adolescents.

Purpose: This study examinedthe independent and joint association of fitness and fatness with clustered cardiovascular disease risk (CVDrs) in 11-18 year-old Nigerian adolescents. Methods: A hundred and ninety seven adolescents (100 girls and 97 boys) were evaluated forfitness, fatness and CVDrs. Fitness was evaluated with the progressive aerobic cardiovascular endurance run test while fatness was assessed using body mass index. A clustered CVDrs was computed from the standardized residuals of total cholesterol, high density lipoprotein cholesterol, Low density lipoprotein cholesterol, triglycerides, plasma glucose, systolic blood pressure, and diastolic blood pressure. Regression models controlling for waist circumference assessed the association of fitness and fatness with CVDrs. Results: Prevalence of clustered CVD risk was 7.1% (girls = 3.0%; boys = 4.1%). Based on risk factor abnormalities, 52.8% of participants had one or more CVD risk factor abnormalities with more boys (27.4%) affected. Low fitness was associated with clustered CVDrs in both girls (R2 = 9.8%, ß = -0.287, p = 0.05) and boys (R2 = 17%, ß = -0.406, p < 0.0005). Fatness was not associated with the CVDrs in both sexes. After controlling for all the variables in the model, only fitness (R2 = 10.4%) and abdominal fat (R2 = 19.5%) were associated with CVDrs respectively. Unfit girls were 3.2 (95% CI = 1.31-7.91, p = 0.011) times likely to develop CVD risk abnormality compared to their fit counterparts. The likelihood of unfit boys developing CVD risk abnormality was 3.9 (95% CI = 1.15-10.08, p = 0.005) times compared to their fit peers. Conclusions: Fitness but not fatness was a better predictor of CVDrs in Nigerian boys and girls. The result of this study suggests that any public health strategies aimed at preventing or reversing the increasing trends of CVD risk in adolescents should emphasize promotion of aerobic fitness.

Socio-demographic and clinical determinants of late presentation among patients newly diagnosed with HIV in the Eastern Cape, South Africa.

South Africa recently implemented the 'test and treat' strategy for all HIV-infected individuals receiving diagnosis at the health facility level. However, the impact of this programme in terms of the prevention of HIV transmission, morbidity and mortality associated with HIV can only be maximized if patients are diagnosed early. This study determines the prevalence of late presentation among newly diagnosed HIV-infected individuals and also examines the socio-demographic and clinical determinants for late presentation in health facilities in the Eastern Cape Province, South Africa.In this cross-sectional study, a total of 335 newly diagnosed patients were recruited consecutively between August 2016 and July 2017. Late presenter for HIV care was defined in accordance with the European Late Presenter Consensus working group as a patient who reports for care when the CD4 count is below 350 cells/µL and/or when there is an established AIDS-defining clinical condition, irrespective of CD4 count. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of late HIV diagnosis.Participants' mean age was 33.6 (SD: 10.6). Almost 96% of the participants believed their route of HIV infection was heterosexual sex. Most newly diagnosed HIV-infected patients (60%) were late presenters (CD4+ count ≤350 cells/µL and/or having an AIDS-defining illness in World Health Organisation (WHO)-defined stage III/IV), with 35% presenting with Acquired Immune Deficiency Syndrome (AIDS)-related complications. In the adjusted model, only male sex (AOR: 2.81; CI: 1.51-5.23), no formal education (AOR: 5.63; CI: 1.68-18.85), and overweight body mass category (AOR: 2.45; CI: 1.04-5.75) were independently associated with late HIV diagnosis.The majority of newly diagnosed HIV-infected individuals were late presenters. To maximize the impact of the 'test and treat' policy aimed at reducing new HIV transmissions and preventing the morbidity and mortality associated with HIV, there is a need for programmes to improve early detection of HIV in the study settings. This programme should target males and individuals with no formal education for maximum impact.

Infant feeding practices among HIV-positive mothers at Tembisa hospital, South Africa.

BACKGROUND: Despite the nutritional, physiological and emotional benefits of breastfeeding, HIV-positive mothers cannot practise exclusive breastfeeding for six months because of a range of influences on their feeding choice - thereby creating a caveat for morbidity in infants. AIM: This study explored factors influencing the infant feeding choice of HIV-positive mothers at a peri-urban hospital in Tembisa, South Africa. METHODS: This study was qualitative and was conducted among 30 purposefully selected postnatal HIV-positive mothers at Tembisa hospital, Gauteng, from May to June 2011. In-depth interviews were conducted mainly in isiZulu and Sepedi which were then transcribed into English. An open coding system of analysis was used for thematic analysis. RESULTS: Nurses significantly influenced the feeding choices of new mothers - sometimes with inconsistent information. The grandmothers of infants also influenced the new mothers' feeding options, in some cases with the new mother coming under duress. Other relatives like the sisters and aunts of mothers appeared to significantly affect feeding choices. The time frames expressed for the initiation of a supplementary diet were as follows: before 1 month, at 1 month and at 4 months. The main reason was the belief that infants required more than breast milk as sustenance during this period. CONCLUSION: In the postnatal hospital setting of this study, the feeding choices of mothers were influenced by nursing personnel. Nursing personnel could marry the influential 'authority' they have with correct and consistent information, in order to change feeding behaviour. Significant 'others' like grandmothers and other relatives also influenced decisions on infant feeding. As such, family dynamics need to be considered when encouraging breastfeeding.

Time spent in sedentary activities in a pediatric population in Pretoria Central, South Africa.

BACKGROUND: Scant information exist on screen time behavior of South Africa children and whether they do not meet the recommendation of American Association of Pediatrics (AAP) concerning screen time activity for children is only speculative. Therefore, the purpose of this study was to examine the time spent in sedentary activities, especially screen time of South African children with regard to gender. METHODS: This cross-sectional study involved a random sample of 1136 school children (548 boys; 588 girls) aged 9-13 years attending public schools in Central Pretoria, South Africa. Questionnaire was used to collect data on the participants' sedentary behaviors. The prevalence estimates for sedentary time activity was based on the guidelines (i.e., <2 or ≥2 hours per day) of AAP. RESULTS: The mean age of the children was 11.1±1.4 years. Sedentary activity data were collected from 548 boys (48.2%) and 588 (51.8%) girls. The majority of children spent more than two hours per day (exceeding the AAP recommendation for sedentary activity) watching TV (3.0%), worked or played on the computer (25.4%), read (1.0%), played music (27.9%), played board games (14.7%), washing clothes (8.0%), floor sweeping (10.5%), art work (18.2%), and spent time on other unspecified activities (28.6%). Boys spent more time (2 hours, 3-4 hours) watching TV (38.3%; P=0.001), playing computer (31.8 %; P=0.024) and board games (17.4%; P=0.012) than girls. The corresponding figures for girls were 35.7%, 19.2% and 12.5% for TV, computer and board games, respectively. However, the proportion of those who spent more time playing music was higher among girls (32.7%) than boys (22.4%) (P=0.002). Overall, the time spent exceeding AAP recommendation (≥ 2 hours) was not statistically (P=0.427) different between boys and girls. CONCLUSIONS: The time spent in sedentary activities, particularly in screen time activity among urban primary school children in Pretoria Central is excessively higher than the recommendation (i.e., ≥2 hours per day) set for children. Also, gender differences exist in the sedentary activities of the children, with boys having higher screen time and other sedentary activities than girls. Children's screen time activity needs to be monitored to reduce the time children spend in front of the TV, computer gaming, video watching and other sedentary activities.

Anthropometrically determined nutritional status of urban primary schoolchildren in Makurdi, Nigeria.

BACKGROUND: No information exists on the nutritional status of primary school children residing in Makurdi, Nigeria. It is envisaged that the data could serve as baseline data for future studies, as well as inform public health policy. The aim of this study was to assess the prevalence of malnutrition among urban school children in Makurdi, Nigeria. METHODS: Height and weight of 2015 (979 boys and 1036 girls), aged 9-12 years, attending public primary school in Makurdi were measured and the body mass index (BMI) calculated. Anthropometric indices of weight-for-age (WA) and height-for-age (HA) were used to estimate the children's nutritional status. The BMI thinness classification was also calculated. RESULTS: Underweight (WAZ < -2) and stunting (HAZ < -2) occurred in 43.4% and 52.7%, respectively. WAZ and HAZ mean scores of the children were -0.91(SD = 0.43) and -0.83 (SD = 0.54), respectively. Boys were more underweight (48.8%) than girls (38.5%), and the difference was statistically significant (p = 0.024; p < 0.05). Conversely, girls tend to be more stunted (56.8%) compared to boys (48.4%) (p = 0.004; p < 0.05). Normal WAZ and HAZ occurred in 54.6% and 44.2% of the children, respectively. Using the 2007 World Health Organisation BMI thinness classification, majority of the children exhibited Grade 1 thinness (77.3%), which was predominant at all ages (9-12 years) in both boys and girls. Gender wise, 79.8% boys and 75.0% girls fall within the Grade I thinness category. Based on the WHO classification, severe malnutrition occurred in 31.3% of the children. CONCLUSIONS: There is severe malnutrition among the school children living in Makurdi. Most of the children are underweight, stunted and thinned. As such, providing community education on environmental sanitation and personal hygienic practices, proper child rearing, breast-feeding and weaning practices would possibly reverse the trends.

Growth status and menarcheal age among adolescent school girls in Wannune, Benue State, Nigeria.

BACKGROUND: Menarcheal age is a sensitive indicator of environmental conditions during childhood. The aim of study is to determine the age at menarche and growth status in adolescents in a rural area of Tarka, Wannune, Nigeria. METHODS: Data on 722 female students (aged 12-18 years) were collected in February 2009. Height and weight were measured. Body mass index (BMI; kg m-2) was used as an index of relative weight. RESULTS: Mean and median menarcheal age calculated by probit analysis were 13.02 (SD 3.0) (95% CI: 13.02-13.07), and age 13.00 (SD 2.8) (95% CI: 12.98-13.04), respectively. Girls who reach menarche are significantly heavier and taller with higher BMIs than those of their pre-menarcheal peers. CONCLUSION: The age of menarche is probably still declining in Nigeria. Although BMI is an important factor in the onset of menstruation, some other unmeasured environmental variables may be implicated in this population.