RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 10 VOLUME 19 NUMBER 1 • July 2022 Pre-morbid cardiometabolic risks among South Africans living in informal settlements Kebogile Mokwena, Perpetua ModjadjI Correspondence to: Perpetua Modjadji Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa e-mail: Perpetua.modjadji@smu.ac.za Kebogile Mokwena Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa S Afr J Diabetes Vasc Dis 2022; 19: 10–16 Abstract Aim: Numerous studies have been conducted on cardiometabolic risk factors in South Africa. However, not much has been done in informal settlement populations faced with their own set of health risks. This study screened for pre-morbid cardiometabolic risks and associated factors among adults living in informal settlements in South Africa. Methods: A cross-sectional study used the WHO STEPwise questionnaire to collect data on demography, anthropometry, blood pressure, and glucose and cholesterol levels (n = 329). Cardiometabolic risks were based on the criteria considered by the International Diabetes Federation and the National Cholesterol Education Program Adult Treatment Panel III. Data were analysed using STATA 14. Results: The median age was 35 (25–42) years. Cardiometabolic risk factors in the study subjects were hypertension (66%), overweight/obesity (45%), abdominal obesity (46%), and elevated cholesterol (15%) and glucose levels (7%). The metabolic syndrome was found in 17% of the subjects, with a high prevalence observed among participants aged 35–59 years (28%) and ≥ 60 years (40%). The metabolic syndrome was significantly associated with gender [males, adjusted odds ratio (AOR) = 0.4, 95% CI: 0.20–0.90] and age, 35–59 years (AOR = 5.07, 95% CI: 2.24– 11.23) and ≥ 60 years (AOR = 6.57, 95% CI; 1.57–27.54). Conclusion: Prevalent cardiometabolic risk factors in informal settlements indicate the need for routine screening for all the components of the metabolic syndrome at the primary healthcare level. Keywords: cardiometabolic risks, metabolic syndrome, informal settlements, South Africa Introduction South Africa has experienced steady urbanisation over the last two decades.1 One of the most prominent major consequences of urbanisation in developing countries is the persistence of and rise in informal settlements, including slums.2,3 The United Nations defines informal settlements as unplanned residential areas where housing, shelter and services have been constructed on land that the occupants occupy illegally.4 The steady increase in the number of informal settlements in South Africa comes with poverty and resultant ill health.5 The health literature concentrates more on communicable diseases, yet low-income urban residents also suffer from noncommunicable diseases (NCDs), which are increasingly creating a double burden in these households.6 The largest burden of NCDs is now occurring in resource-limited countries undergoing demographic and epidemiological transitions.7 These transitions are attributed to changes in lifestyle, such as sedentariness,8 smoking9 and consumption of a high-fat diet.10 NCDs and associated cardiometabolic risk factors pose health challenges in populations.11 Cardiometabolic risk factors increase the likelihood of vascular events or of developing diabetes, and encompass hypertension, dyslipidaemia, abdominal obesity and ethnicity.12,13 South Africa is experiencing alarming rates of hypertension (54–77%),14-16 overweight/obesity (56–68%)17 and abdominal obesity (56.4–65.2%).18,19 In addition, the prevalence of dyslipidaemia in community-level assessments has been reported to be between 14 and 69%.20-22 Furthermore, the prevalence of diabetes is rapidly increasing and has been reported to be between 5.5 and 9% among adults in the country.23,24 Cardiometabolic risks are particularly prevalent in people diagnosed with the metabolic syndrome (MetS), a complex disorder of interconnected risk factors, including hypertension, dyslipidaemia, obesity and high blood glucose levels.25-28 The prevalence of the MetS in South Africa varies from five to 62%,18,2933 and is attributable to factors such as age, gender, lifestyle, socioeconomic variables and ethnicity.34 People with the MetS have a three-fold risk of heart attack or stroke, a two-fold risk of cardiovascular diseases (CVDs) or of dying from such events, and a five-fold risk of developing type 2 diabetes mellitus, compared to people without the MetS.35 However, the MetS has been investigated in the context of high-income and urban settings in South Africa,36,37 while only a few studies are reported in low-income rural settings.30,32 The literature documents that the mushrooming of informal settlements in South Africa drives cardiometabolic diseases, such as CVDs and related risks.38,39 However, there is very little research directly addressing cardiometabolic risk in informal settlements known to be occupied by vulnerable populations.5,40 In light of this, the aim of the study was to screen for cardiometabolic risk factors among South African adults living in informal settlements and determine their association with selected demographic and lifestyle variables. Getting screening tests is one of the most important disease-prevention strategies used in public health in general, and health promotion in particular.41 Methods A cross-sectional study was conducted to screen for cardiometabolic risk factors and determine their association with selected
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