A Risk Factor Profile for Chronic Lifestyle Diseases in Three Rural Free State Towns

Background: Chronic diseases of lifestyle account for millions of deaths each year globally. These diseases share similar modifiable risk factors; including hypertension; tobacco smoking; diabetes; obesity; hyperlipidaemia and physical inactivity. In South Africa the burden of noncommunicable disease risk factors is high. To reduce or control as many lifestyle risk factors as possible in a population; the distinct risk-factor profile for that specific community must be identified. Therefore; the aim of this study was to assess the health status in three rural Free State communities and to identify a distinct risk-factor profile for chronic lifestyle diseases in these communities. Methods: This study forms part of the baseline phase of the Assuring Health for All in the Free State project. This is a prospective and longitudinal epidemiological study aimed at determining how living in a rural area can either protect or predispose one to developing chronic lifestyle diseases. The communities of three black and coloured; rural Free State areas; namely Trompsburg; Philippolis and Springfontein; were evaluated. The study population consisted of 499 households; and 658 participants (including children) participated in the study. Only results of adult participants between 25 and 64 years will be reported in this article. The study group consisted of 29.4male and 70.6female participants; with a mean age of 49 years. During interviews with trained researchers; household socio-demographic questionnaires; as well as individual questionnaires evaluating diet; risk factors (history of hypertension and/or diabetes) and habits (tobacco smoking and physical activity levels); were completed. All participants underwent anthropometric evaluation; medical examination and blood sampling to determine fasting blood glucose levels.Results: Multiple risk factors for noncommunicable diseases were identified in this study population; including high blood pressure; tobacco smoking; high body mass index (BMI); diabetes and physical inactivity. The reported risk-factor profile was ranked. Increased waist circumference was ranked highest; high blood pressure second; tobacco smoking third; physical inactivity fourth and diabetes fifth. The cumulative risk-factor profile revealed that 35.6 and 21of this study population had two and three risk factors; respectively. Conclusions: The study demonstrated a high prevalence of risk factors for noncommunicable diseases; e.g. large waist circumference; high BMI; raised blood pressure; tobacco smoking and raised blood glucose levels. Serious consideration should be given to this escalating burden of lifestyle diseases in the study population. The development and implementation of relevant health promotion and intervention programmes that will improve the general health and reduce the risk for noncommunicable diseases in this population are advised

Adherence to anti-tuberculosis chemoprophylaxis and treatment in children.

SETTING: Limited data exist on adherence to anti-tuberculosis treatment and chemoprophylaxis in children in high-burden settings. OBJECTIVE: To determine the adherence to anti-tuberculosis chemoprophylaxis and treatment in children evaluated as household contacts of adult pulmonary tuberculosis (PTB) cases. METHODS: A retrospective study, conducted from January 1996 to September 2003, in suburban Cape Town, South Africa, with a high TB incidence. A folder search was done on all children <5 years of age identified as household contacts of adult PTB cases between 1996 and 2003. Data on screening for TB and adherence to prescribed therapy in child contacts were analysed. RESULTS: Three hundred and sixty-one contact episodes with 243 adult PTB cases were identified in 335 children. The median age was 25 months. Adherence to anti-tuberculosis treatment was significantly better than adherence to chemoprophylaxis (82.6% vs. 44.2%; OR 6.83; 95%CI 3.6-12.96). Adherence to a 3-month chemoprophylaxis regimen of isoniazid and rifampicin (3HR) was significantly better than adherence to a 6-month chemoprophylaxis regimen of isoniazid only (69.6% vs. 27.6%; OR 4.97; 95%CI 2.40-10.36). CONCLUSIONS: Although adherence to treatment was good, adherence to unsupervised chemoprophylaxis was poor. We recommend that shorter chemoprophylaxis regimens such as 3HR should be considered to improve adherence, but further studies are required.

Family-based behavioural treatment of obesity: acceptability and effectiveness in the UK.

OBJECTIVE: To assess the acceptability and impact of family-based behavioural treatment (FBBT) for childhood obesity in a clinical setting in the UK. DESIGN: Pre- and post-treatment assessment for four consecutive treatment groups. SETTING: Treatment groups took place at Great Ormond Street Hospital, London. PATIENTS: Participants were 33 families with obese (BMI >or=98th centile for age and sex) children aged 8-13 years. INTERVENTION: FBBT was delivered over 12 sessions. MAIN OUTCOME MEASURES: Overweight (percentage BMI), self-esteem, mood and eating attitudes were assessed before and after treatment; overweight was re-assessed at 3-month follow-up for those who completed treatment. RESULTS: The FBBT programme materials translated easily to the UK setting and the programme was well-liked by participants. Twenty-seven out of 33 families (82%) completed the sessions. Children lost 8.4% BMI over the time of treatment, and this was maintained at 3-month follow-up. Self-esteem and depression improved significantly and there was no change in food pre-occupation, anorexia or bulimia on the ChEAT. CONCLUSIONS: These results establish that FBBT is feasible and acceptable in a clinical setting in Britain. They indicate that significant loss of overweight can be achieved using the programme without adverse psychological consequences.

Effect of customization of master gutta-percha cone on apical control of root filling using different techniques: an ex vivo study.

AIMS: (i) To compare the prevalence of extrusion of root filling material when placed using different root filling techniques, with or without customization of the master gutta-percha (GP) cone; and (ii) to investigate the effects of some factors influencing root filling extrusion and presence of voids. METHODOLOGY: A total of 180 roots were selected, prepared and randomly allocated to three groups. Five general dental practitioners performed the root fillings; each filled one group of roots (n = 60) using each of three techniques; 'cold lateral compaction' (n = 20), 'warm vertical compaction' (n = 20) and 'continuous-wave' (n = 20) techniques. For each obturation technique, the master GP cone was customized using chloroform in 10 samples. Two groups of the roots were recycled to allow all five operators to fulfill their remit. Two observers, blind to operator and obturation technique, examined the radiographs (master apical file, post-obturation) to determine the presence of root filling extrusion and voids within the apical 5 mm, independently. Root filling extrusion was also confirmed by direct inspection of the root apex after obturation. The data were analysed using logistic regression models. RESULTS: A total of 300 root fillings were performed; nine were excluded from the analysis. Most of the root fillings (80%, n = 233) were placed within 0.5 mm of the working length; only 20% (n = 58) were placed >0.5 mm beyond the working length. The odds of prevalence of extrusion (>0.5 mm) were significantly reduced by about 50% when cold lateral compaction or customization of GP were used. One operator produced 2.5 times more extruded root fillings than others. Curvature & length of root canal, apical size of prepared canal, as well as operator's preferred obturation technique had no significant influence on the prevalence of extrusion. Customization of GP was the sole factor to significantly reduce the prevalence of voids within the apical 5 mm of working length. CONCLUSIONS: Root filling extrusion was significantly influenced by 'operator' and was reduced by cold lateral compaction and customization of the master cone. Customization of master cone was the only factor that reduced voids apically.

A prospective evaluation of children under the age of 5 years living in the same household as adults with recently diagnosed pulmonary tuberculosis.

SETTING: A South African suburb with a high tuberculosis incidence (> 800/100,000). OBJECTIVE: To determine the prevalence of tuberculosis infection and disease in children less than 5 years of age who were in close household contact with adults with pulmonary tuberculosis. DESIGN: Prospective clinical study. SUBJECTS: Children under 5 years of age (of whom > 98% had been BCG vaccinated in the neonatal period) in household contact with an adult with tuberculosis. INVESTIGATION: Clinical investigation, Mantoux skin testing, chest radiography, gastric aspirate culture for Mycobacterium tuberculosis. RESULTS: Of 155 children younger than 5 years in contact with 80 index cases (83% smear positive), 14% were infected and 34% diseased. Children aged under 2 years had more severe disease (endobronchial tuberculosis and bronchial compression). Of 154 household members aged over 5 years who were assessed, 17 had culture proven pulmonary tuberculosis (13 smear positive) and a further 16 were placed an antituberculosis treatment on the basis of radiological evidence. CONCLUSION: In a high tuberculosis incidence area evaluation of and chemoprophylaxis for childhood contacts of adults with pulmonary tuberculosis is a rewarding procedure. The detection of culture and smear positive pulmonary tuberculosis amongst adolescent and adult household contacts emphasizes the role of contact tracing in the detection of infectious cases of pulmonary tuberculosis and the prevention of the spread of tuberculosis.

TB or not TB? An evaluation of children with an incorrect initial diagnosis of pulmonary tuberculosis.

OBJECT: The aim of the study was to identify diagnoses that are confused with pulmonary tuberculosis in children. DESIGN: Prospective, investigative clinical study. SETTING: Tertiary care teaching hospital and an urban tuberculosis clinic in an area with a very high incidence of pulmonary tuberculosis (> 800 new cases/100,000/year). PATIENTS: Children suspected of having tuberculosis, children followed up for pulmonary infiltrates with eosinophilia and children with congenital pulmonary anomalies were investigated. INTERVENTION(s). None. OUTCOME MEASURE: Pulmonary tuberculosis was diagnosed using modified World Health Organisation criteria and the diagnoses of those children not suffering from pulmonary tuberculosis were analysed. RESULTS: Of the 354 children initially suspected of suffering from tuberculosis 71 (20%) were found to be suffering from other pulmonary disease, viz. pneumonia or bronchopneumonia (29%), bronchopneumonia with wheezing (18%), and asthma with lobar or segmental collapse (12%). Of 14 children suffering from pulmonary infiltrates with peripheral eosinophilia 6 (43%) were initially incorrectly diagnosed and treated for tuberculosis. Of 54 children with congenital pulmonary anomalies, 8 (15%) were treated for tuberculosis before the correct diagnosis was made. Congenital anomalies most often confused with tuberculosis were unilateral lung hypoplasia, bronchogenic cyst and tracheal bronchus with an anomalous lobe. CONCLUSIONS: The criteria for diagnosing tuberculosis in children is complicated in areas with a high incidence of tuberculosis and poor socio-economic circumstances where many children presenting with conditions other than tuberculosis will be in contact with an adult case of pulmonary tuberculosis. The commonest conditions confused with tuberculosis are pneumonia, bronchopneumonia and asthma. Pulmonary infiltrates with peripheral eosinophilia and congenital lung abnormalities should be considered especially if the children have an atypical clinical picture or do not respond to tuberculosis treatment.

Delay in the diagnosis, notification and initiation of treatment and compliance in children with tuberculosis.

SETTING: The mortality and morbidity from childhood tuberculosis may be influenced by the delay from the time of first symptoms until the start of and compliance with treatment. OBJECTIVE: This study investigated these delay periods and the compliance with therapy in children with tuberculosis. DESIGN: During the study period there were 49 children with probable and 123 with confirmed pulmonary tuberculosis (WHO criteria). The mean period from first symptoms until presentation was 4.3 weeks, from presentation until notification 5 weeks and from notification until therapy 0.9 weeks. 16% of children notified as having tuberculosis never received therapy. Significantly fewer children in the urban squatter communities received therapy than in urban settled (P = 0.02), rural agricultural (P = 0.0001) and rural settled (P = 0.09) communities. 12% of children did not complete their therapy. CONCLUSION: The delay in presentation ('patient delay') was shorter than the delay in diagnosis ('doctor delay'). Failure to trace children and to complete therapy was particularly likely to occur in urban squatter communities. Easier access to health care facilities may shorten the 'patient delay' while greater awareness of tuberculosis and proper investigation of children may shorten the 'doctor delay'.

Value of the lateral chest radiograph in tuberculosis in children.

The value of the lateral chest radiograph, often considered a useful adjunct in the detection of hilar adenopathy, was evaluated in a prospective study of 449 children assessed for tuberculosis. Of these children 298 presented to the hospital with signs and symptoms suggestive of tuberculosis, while 151 were investigated in a regional clinic solely because they were in close contact with an adult household member on treatment for tuberculosis. Tuberculosis was confirmed by culture in 176 of the 449 children (39%). In 40 of these (23%) hilar adenopathy was visible on frontal and lateral view, in 19 of the 176 confirmed cases (11%) only on a frontal view and in 22 (13%) on a lateral view only. Probable tuberculosis was diagnosed in a further 140 of the 449 children (31%), and hilar adenopathy was visible on frontal and lateral views in 39 of these children (28%), on the frontal view only in 8 (6%) and on the lateral view only in 27 (19%). In the symptomatic children investigated in the hospital, and the asymptomatic children investigated in the clinic, hilar adenopathy was detected on the lateral chest radiograph only in 36 (12%) and 14 (9%) cases respectively. Lateral chest radiographs will considerably improve the accuracy of the diagnosis of childhood tuberculosis.