School environment, socioeconomic status and weight of children in Bloemfontein, South Africa.

BACKGROUND: The continued existence of undernutrition, associated with a steady increase in the prevalence of overweight and obesity in children and adolescents, necessitates identification of factors contributing to this double burden of disease, in order for effective treatment and prevention programmes to be planned. AIM: To determine the nutritional status of 13-15-year-old children in Bloemfontein and its association with socioeconomic factors. SETTING: Bloemfontein, Free State Province, South Africa (2006). METHODS: This was a cross-sectional analytical study. Randomly selected children (n = 415) completed structured questionnaires on socioeconomic status. The children's weight and height were measured and body mass index-for-age and height-for-age z-scores were computed according to World Health Organization growth standards in order to determine the prevalence of underweight, overweight, obesity and stunting. Waist circumference was measured to classify the children as having a high or very high risk for metabolic disease. RESULTS: Of the 415 children who consented to participate in the study, 14.9% were wasted and 3.4% were severely wasted. Only 6% of the children were overweight/obese. Significantly more boys (23.0%) were wasted than girls (10%) and severe stunting was also significantly higher in boys than in girls (10.3% and 4.2%, respectively). Children whose parents had graduate occupations were significantly more overweight/obese than those with parents working in skilled occupations. Stunting was significantly higher in low (31.4%) and medium (30.4%) socioeconomic groups compared to the high socioeconomic group (18.1%). CONCLUSION: A coexistence of underweight and overweight was found and gender and parental occupation were identified as being predictors of nutritional status.

Household food security and hunger in rural and urban communities in the Free State Province, South Africa.

Household food security impacts heavily on quality of life. We determined factors associated with food insecurity in 886 households in rural and urban Free State Province, South Africa. Significantly more urban than rural households reported current food shortage (81% and 47%, respectively). Predictors of food security included vegetable production in rural areas and keeping food for future use in urban households. Microwave oven ownership was negatively associated with food insecurity in urban households and using a primus or paraffin stove positively associated with food insecurity in rural households. Interventions to improve food availability and access should be emphasized.

Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations.

BACKGROUND: All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. METHODS: We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as 'high' or 'low' risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. RESULTS: Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as 'high' or 'low' risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as 'high CVD risk' (10-year CVD death risk >20%) using the non-laboratory-based score. CONCLUSIONS: We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa.