Quality of care provided to patients with type 2 diabetes mellitus in Tshwane, South Africa.

BACKGROUND:  Type 2 diabetes mellitus (T2D) is a public health challenge, affecting 90% of all patients with diabetes, globally. Compliance to treatment guidelines among healthcare professionals (HCPs) is low, thus resulting in inadequate quality of patient care and poor health outcomes among patients. AIM:  To examine the availability of equipment, guidelines, screening and education offered to patients with T2D and compare between clinics and community health centres (CHCs). SETTING:  Tshwane Metropolitan Municipality, Gauteng Province, South Africa. METHODS:  A cross-sectional descriptive study utilised a self-administered questionnaire to collect data from nurses and doctors responsible for treating patients with T2D, from May to June 2022. About 250 eligible HCPs were recruited during routine morning meetings in 22 clinics and six CHCs. RESULTS:  More than 80% of HCPs reported having basic equipment except for ophthalmoscopes, Snellen charts (67%), tuning forks (64%), electrocardiograms (ECG) (46%) and monofilaments (12%). SEMDSA guidelines were reported by 16% of the participants, Diabetic Foot Care Guidelines were reported by 54% and Dietary Guidelines for Diabetic Patients by 55%. Furthermore, 91%, 71% and 69% of HCPs reported that ECG, microalbumin-creatinine and foot examinations were not always performed, respectively. About 66% and 17% always offered individual educational and group sessions, respectively. CONCLUSION:  Equipment availability and compliance with treatment guidelines, patient education and screening of chronic complications are inadequate.Contribution: The study highlights the poor adherence to treatment guidelines and inadequate equipment in health facilities. These shortcomings could lead to missed opportunities for early diagnosis of complications and ultimately poorer patient outcomes.

Views of Own Body Weight and the Perceived Risks of Developing Obesity and NCDs in South African Adults.

Obesity has become a serious public health problem worldwide and is linked to an increased risk of non-communicable diseases (NCDs). Poor self-perception of body weight is postulated to play a negative role in curbing increased rates of obesity. This study investigated the views of own body weight and perceived risk of developing NCDs in South African adults. This was a community-based quantitative study. Descriptive statistics were used, and logistic regression analysis was conducted on the data. A total of 1050 respondents took part in the study. Of the 161 respondents who perceived themselves to be normal weight, 98.8% (n = 159) misperceived their body weight. The majority of respondents (>90%) who were overweight according to the calculated BMI perceived no risk of developing obesity-related diseases. Most of the respondents, 46% (n = 253), believed that body weight was influenced by heredity. The method used for weight loss by 57% (n = 173) of the respondents was exercising at home. There was a statistically significant association between Body Mass Index (BMI), employment status, risk of developing diabetes, and body weight misperception (p < 0.05). Misperception of body weight was common among the study respondents and may influence weight control intervention strategies. Health promotion targeting personal behaviour, such as body weight self-perception, is crucial in supporting targeted strategies to address obesity in South Africa.

Safe Food Handling Knowledge and Practices of Street Food Vendors in Polokwane Central Business District.

Street food vending is a common business practice in most South African cities. However, street vended foods may be a source of foodborne illnesses if their handling is not well regulated and executed. This study aimed to investigate the knowledge and practices regarding food safety by street food vendors in the Polokwane central business district. This was a quantitative descriptive study where a structured questionnaire was used to collect self-reported data from street food vendors. A checklist was used to collect observed data from the vending site on vendor practices and status of the vending environment. A total of 312 vendors participated in the study, most being young females aged below 40 years (62%), single (51.2%) with less than six years of trade experience (58.3%). Although the level of knowledge was high, safe food handling practices were mostly inadequate. Most vendors operated their businesses in the open air and tents (66.2%). Vending experience significantly correlated with safe food handling practices (p < 0.05). It is significantly riskier to sell cooked rather than uncooked food in the street. Lack of resources like water and a healthy environment negatively affected food handling practices. Health promotion on food safety is recommended for street vendors.

South African rural community understanding of fermented foods preparation and usage.

BACKGROUND: The benefits of fermented foods consumption have been demonstrated in a number of research reports. These qualities have been demonstrated, for example, to reduce childhood diseases such as diarrhea and malnutrition. Thus, fermented foods may be recommended for improving the health and nutritional quality of traditional African foods and regular inclusion of fermented foods as part of the daily diet would be desirable. AIMS: Lack of knowledge and understanding toward fermented food preparation may limit their usage. This study explores the South African community's understanding of fermented foods preparation and usage. MATERIALS AND METHODS: This was a qualitative study using focus group interviews to determine the community's understanding and their perception of fermented foods preparation in the rural villages of Odi, in Gauteng Province between May and June 2012. The target population was the caregivers of children under 5 years, attending the hospital's antenatal clinic at the time of study. The information was transcribed, coded, and analyzed using NVivo software. RESULTS: Most caregivers were aware of food fermentation process, and some of them could not clearly differentiate between fermented and unfermented foods. Although most participants knew what fermented foods were, there were misconceptions on how they were made. This was exemplified by the undesirable artifacts, labeled as ingredients, in the fermentation process. CONCLUSION: Caregivers demonstrated a fair knowledge of fermented foods but lack a standard preparation procedure for these foods. There is an urgent need to educate communities and conduct a health promotion campaign on the fermented foods and probiotics.

Caregivers' knowledge and use of fermented foods for infant and young children feeding in a rural community of odi, gauteng province, South Africa.

BACKGROUND: Fermented foods have positive health effects in adults and children if consumed regularly. However, lack of knowledge and perceptions to-wards fermented foods may limit their usage. This study aimed to assess the caregivers' awareness and usage of fermented foods for feeding children in peri-urban/rural communities of Gauteng Province. METHODS: A qualitative exploratory study was conducted in June, 2012, in a peri-urban/rural community to assess the awareness and use of fermented foods by child caregivers attending a local antenatal clinic through focus group discussions. RESULTS: Thirty three caregivers participated in the study; however 29 indicated their demographic profiles. Four major themes that emerged from the analysis included knowledge on fermented foods, perceived benefits of fermentation, varied views about fermentation and feeding practices. Fermented foods that caregivers, their families and community members consume include ting, fat cakes, dumplings, sorghum beer and mageu. Findings also showed that children consumed fermented foods in form of soft ting porridge; and yoghurt, marketed as Activia and Danone commercial brands. Also, caregivers were not comfortable feeding their children with fermented foods, indicating their limited knowledge on the nutri-tional value of these foods. CONCLUSION: It is critical to promote caregivers' knowledge and use of fermented foods for feeding infants and young children in South African rural communities.

Effects of Sutherlandia frutescens extracts on normal T-lymphocytes in vitro.

Sutherlandia frutescens (SF), a popular traditional medicinal plant found in various parts of southern Africa, is used for treatment or management of HIV/AIDS and other diseases including cancer. However, its toxicity profile has not been fully established. The aims of this study were to examine the effects of 70% ethanol (SFE) and deionised water (SFW) extracts on normal isolated human T cells. An experimental study on normal human lymphocytes treated with doses SF extract doses ranging from 0.25 to 2.5 mg/ml. Untreated, vehicle-treated (Ethanol) and camptothecin (CPT) treated normal T cells were used as controls. Induction of cell death, changes in intracellular ATP, caspase-3/-7 activity and nuclear changes were analysed using flow cytometry, luminometry and nuclear staining (Hoechst) respectively. The highest concentration (2.5 mg/ml) of SFE extract induced significant necrosis (95%), depletion of ATP (76%), and inhibition of caspase-3/-7 activity (11%) following a 24 hour incubation period (p< 0.001). The 2.5 mg/ml concentration of SFW showed the same trend but were less effective (necrosis- 26%, ATP- 91%, & caspase-3/-7- 15%). These effects showed a time-dependence over 48 hours of incubation, with high doses of SFE extracts eliminating viable cells by necrosis, depleting ATP levels and decreasing caspase-3/-7 activity (p< 0.001). The activity of SFE extract was independent of ethanol. The SFW extract dilutions were less toxic than the SFE extracts. Significant DNA fragmentation as demonstrated by Hoechst staining was also seen over 48-hour incubation for high doses of both types of SF extracts. These results showed that although high concentrations of SF extracts can be toxic to normal T cells in vitro, SFW fractions were relatively safe for use.

The immunomodulatory effects of Sutherlandia frutescens extracts in human normal peripheral blood mononuclear cells.

Sutherlandia frutescens (SF) is one of the medicinal plants used as an immune booster in the treatment of chronic ailments such as HIV/AIDS and cancer. Limited data suggest that its efficacy is based on its regulatory effect on cytokines, the critical components of the immune response. In this study, we investigated the in vitro immunomodulatory effects of SF extracts on normal human peripheral blood mononuclear cells (PBMCs). An ELISA-based assay was used to assess the levels of expression of 12 cytokines in treated cells. An adenosine triphosphate (ATP) assay was used to assess cell viability in relation to cytokine secretion. SF ethanol extracts induced changes in cytokine secretion relative to the dose of the extract. Generally cytokine expression and secretion was low in concentration because were not stimulated with any endotoxin. The high SFE dose (2.5 mg/ml) significantly (p<0.001) decreased some cytokines including TNF-α and IL 1ß. Low doses of this extract (0.5 mg/ml) did not change TNF-α and IL 1ß secretion from the baseline (untreated cells). Changes in cytokine secretion of SFE treated cells tracked changes in ATP levels (cell viability). The SFW extract-induced changes in cytokine secretion were independent of cell viability. TNF-α was decreased (p<0.001) by the high dose of SFW extract while IL 1ß and IFNγ were increased (p<0.01) by the same dose. High doses decreased cell viability which was reflected in cytokine secretion. It is evident, from these results, that SF extracts can modulate cytokine secretion in unstimulated normal PBMCs in vitro. Further studies in animal models are recommended to advance understanding of this immunomodulatory activity.

The frequency of cytochrome P450 2E1 polymorphisms in Black South Africans.

Polymorphisms in the promoter region of the Cytochrome P4502E1 (CYP2E1) gene reportedly modify the metabolic activity of CYP2E1 enzyme, and have been associated with increased susceptibility to squamous cell carcinoma (SCC) of the oesophagus in high prevalence areas such as China. To assess the frequency of these polymorphisms in Black South Africans, a population with a high incidence of oesophageal SCC, this study examined genomic DNA from 331 subjects for restriction fragment length polymorphisms in the CYP2E1 (RsaI and PstI digestion). The frequency of the CYP2E1 c1/c1 and c1/c3 genotypes was 95% and 5% respectively. The frequency of the CYP2E1 allele distribution was found to be markedly different between Chinese and South African populations; hence it is important to place racial differences into consideration when proposing allelic variants as genetic markers for cancer.

Reduction of fumonisin B1 and zearalenone by lactic acid bacteria in fermented maize meal.

Fusarium species are fungi that infect maize products worldwide and elaborate mycotoxins, which have been associated with cancer. This study was carried out to investigate the potential of lactic acid bacteria fermentation in reducing mycotoxin concentration and toxicity in maize meal products. Maize meal was spiked separately with fumonisin B1 and zearalenone and then allowed to ferment for 4 days. The potential cytotoxicity of the mycotoxin-spiked fermented extracts was also investigated using the SNO human esophageal carcinoma cell line (the SNO cell line was explanted from a cancer patient, S.N., a 62-year-old Zulu man, in July 1972). A significant decrease (P < 0.05) in the concentration of the two mycotoxins was observed, with a 56 to 67% and a 68 to 75% reduction in the third and fourth days, respectively. The two mycotoxins were not detectable in commercially fermented maize meal (amahewu) samples. After fermentation, mycotoxin-spiked maize meal samples containing lactic acid bacteria culture were comparatively less toxic to SNO cells than were samples without lactic acid bacteria. However, this difference in toxicity was not significant (P > 0.05). These results indicate that lactic acid bacteria fermentation can significantly reduce the concentration of mycotoxins in maize. However, such a reduction may not significantly alter the possible toxic effects of such toxins. The exact mechanism of toxin reduction warrants further investigation.