Findings from Community-Based Screenings for Type 2 Diabetes Mellitus in at Risk Communities in Cape Town, South Africa: A Pilot Study
Abstract
:1. Background
2. Materials and Methods
2.1. Study Design and Population
2.2. Participants Selection
2.3. Diabetes Risk Screening
2.4. Community-Based Diabetes Risk Screening
2.5. Clinic-Based Diabetes Risk Confirmation and Baseline Measurements
2.6. Data Entering and Management
2.7. Statistical Analysis
2.8. Bio-Analysis
3. Results
3.1. Community Screening
3.2. Baseline Evaluation (Clinic Screening)
Socio-Demography
3.3. Health Risks
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Area | Total Population | Level of Education | Average Income | Number of Schools | Number of Health Facilities |
---|---|---|---|---|---|
Khayelitsha SP (informal settlement) Predominantly black community | 11,251 (2357.23/km2) | No info | No info | No info | No info |
Belhar (Ward 12 and 22) Predominantly mixed-ancestry community | 56,234 (6882.25/km2) | No schooling aged 20 + (1.4%). Higher education aged 20 + (9.4%). Matric aged 20 + (29%). | Average household income: No income = 8.3%. R1–R4800 = 1%. R4801–9600 = 1.8%. R9601–R19,600 = 8.9%. R19,601–38,200 = 14.9%. R38,201–76,400 = 20.2%. R76,401–R153,800 = 20.8%. R153,801–R307,600 = 15.3%. R307,601–R614,400 = 6.9%. R614,401–R1,228,800 = 1.4%. | ±20 | 2 (St Vincent clinic and Chestnut CHC) |
Athlone (Ward 49) Predominantly mixed-ancestry community | 8893 (5900/km2) | 71.9% completed grade 9 or higher. 35.6% completed matric or higher. | Average household income: No income = 11.5%. R1–R4800 = 1.7%. R4801–9600 = 3.3%. R9601–R19,600 = 15.5%. R19,601–38,200 = 18.6%. R38,201–76,400 = 18.5%. R76,401–R153,800 = 15%. R153,801–R307,600 = 9.6%. R307,601–R614,400 = 4.7%. R614,401–R1,228,800 = 1.2% .Average annual income = R57,500 | ±20 | 6 (Hood road medical center, Dr. Abdurahman day hospital, Samwumed, Fresenius medical care and Athlone kidney and Dialysis center, Al-nisa maternity home, and Kromboom dental center) |
Bongweni Predominantly black community | 1791 (9420.58 per km2) | No info | No info | ±11 to 15 | 3 (Khayelitsha community health clinic, Clinimed medical and asthetic solutions, and mens clinic international) |
Lavender hill (Ward 68) Predominantly mixed-ancestry community | 26,372 (9335.6/km2) | 62.3% completed grade 9 or higher. 26.7% completed matric or higher. | Average annual income = R57,500 | ±7 | 2 (Lavender hill clinic and Sea wind CHC–TB unit) |
Gugulethu (formal and informal housing) (Ward 40 and 41) Predominantly black community | 98,468 (15,161.70/km2) | 78.2% completed grade 9 or higher. 44.2% completed matric or higher. | Average household income: No income = 19.3%. R1–R4800 = 5.3%. R4801–9600 = 7.1%. R9601–R19,600 = 16.5%. R19,601–38,200 = 23.2%. R38,201–76,400 = 15.4%. R76,401–R153,800 = 8.5%. R153,801–R307,600 = 3.4%. R307,601–R614,400 = 1.1% | ±20 | 2 (Gugulethu medical center and KTC Gugulethu CHC) |
DuNoon (formal and informal housing) (ward 104) Predominantly black community | 29,268 (29,518.5/km2) | 70.7% completed grade 9 or higher. 27% completed matric or higher. | Average monthly income = R2400 Average annual income = R30,000 | 5 | 1 (DuNoon CHC) |
Lotus river (ward 65) Predominantly mixed-ancestry community | 38,143 (7615.72/km2) | 74.8% completed grade 9 or higher. 40.9% completed matric or higher. | Average annual income = R57,500 | ±10–15 | 2 (Lotus river community health clinic and lotus river public clinic) |
SADPP Risk Score Calculation | |
---|---|
Regression coefficients of the model | |
Variable | Coefficient |
Age (per 1-year increase) | 0.045 |
Waist Circumference (per cm increase) | 0.048 |
Hypertension (present (1) vs. absent (0)) | 0.649 |
Intercept | −11.012 |
Variable | Components | Measurements Tools/Questions | Reporting in this Paper |
---|---|---|---|
General information | Personal details and contacts for follow up | Not reported | |
Socio-demographic measures | Age, gender, area, community, current marital status, education level, employment, income | Reported | |
Self-reported medical history | General | Not reported | |
Chronic diseases | Diabetes, hypertension, cholesterol, bronchitis/chronic obstructive pulmonary disease, cancer, tuberculosis | Not reported | |
Heart health | Jackson heart medical form [24] | Not reported | |
medication | Chronic prescription medication | Not reported | |
Family medical history | Hypertension, diabetes, heart attack, stroke, cancer | Only familial diabetes history reported | |
Behavioral measures | Tobacco use | WHO STEPS questionnaire [22] | Reported |
Alcohol use | WHO STEPS questionnaire [22] | Reported | |
Sedentary behavior | Time spent in front of a screen | Reported elsewhere [25] | |
Sleep | Time, quality | Reported elsewhere [25] | |
Dietary Measures | 24-hour dietary recall Barriers to healthy eating | Single unquantified dietary recall [26]; food frequency for processed food, barriers to fruit and vegetable consumption [27] | Not reported |
Physical activity measures | Physical activity pattern | WHO STEPS questionnaire: global physical activity questionnaire (GPAQ) [22] | Reported elsewhere [25] |
Barriers to physical activity | Scale adapted from the one designed by Booth et al. [22] | Reported elsewhere [25] | |
Self-efficacy | Scale adapted from the exercise self-efficacy scale (ESES) designed by Schwarzer and Jerusalem [28] | Reported elsewhere [25] | |
Clinical measures | Waist circumference | Measured between the lower border of the lowest rib and upper border of the iliac crest/pelvic bone to the nearest 0.1 cm | Reported |
Weight | Weight measurement with minimal clothing on a digital (SECA) scale, recorded to the nearest 0.1 kg | Reported (BMI) | |
Height | Standing height, minimal clothing, aligning head in a standard anatomical position using a SECA stadiometer | ||
SBP | Electronic M6 COMFORT OMRON device with an integrated cuff | Reported | |
DBP HbA1c | Electronic M6 COMFORT OMRON device with an integrated cuff HbA1c measured using fasting blood and HPLC | Reported | |
Neighborhood indicators | Stores and facilities, access to services and places, roads and walking paths, places for walking/cycling/playing, surroundings, safety from crime and traffic, personal safety, stranger danger | Neighborhood environment walkability scale (NEWS) Africa Questionnaire [23] | Reported elsewhere [25] |
Psychological measures | Chronic stress | Chronic stress scale [29] | Reported elsewhere [25] |
Mood (depression and anxiety) | Patient health questionnaire-9 amended in line with CURES-65 study [30], general anxiety disorder scale [31] | Not reported | |
Support networks | ENRICHD social support scale [32] | Not reported | |
Quality of life | The MOS 36-item short-form health survey [33] | Not reported | |
Life satisfaction | How satisfied are you with your life as a whole? | Not reported |
Characteristic | N | % | |
---|---|---|---|
Ethnicity | Black | 432 | 52.9 |
Mixed ancestry | 385 | 47.1 | |
Sex | Males | 189 | 23 |
Females | 648 | 77 | |
Mean age (years) | 47.3 (10.6 SD) | ||
Older than 45 | Yes | 512 | 61.2 |
Township | Athlone ** | 85 | 10.4 |
Belhar ** | 145 | 17.4 | |
Bongweni/Tembani * | 19 | 2.4 | |
Du Noon * | 49 | 5.7 | |
Gugulethu * | 239 | 28.3 | |
Khayelisha SP * | 133 | 15.7 | |
Knole park/Lotus river ** | 75 | 8.9 | |
Lavender hill ** | 86 | 10.2 | |
Body mass index | Underweight | 27 | 3.3 |
Normal weight | 181 | 22.3 | |
Overweight | 208 | 25.6 | |
Obese | 396 | 48.8 | |
Mean waist circumference (cm) | 94 (21.9 SD) | ||
BP ≥ 140/90 mmHg or known hypertension | Yes | 198 | 24.2 |
Family history of diabetes | Yes | 244 | 29.2 |
At risk for diabetes | Yes | 354 | 43.4 |
Socio-Demographic Characteristics (N = 316) | ||||
---|---|---|---|---|
General Population | Black 177 (54.2%) | Mixed-Ancestry 141 (45.7%) | ||
Age, mean (SD) | 51.8 (8.9) | 49 (9.5) | 54 (7.7) ** | |
Gender | N | % | N (%) | |
Male | 60 | 19.0 | 30 (17.5) | 30 (20.8) |
Female | 253 | 80.1 | 141 (82.5) | 114 (79.5) |
NA | 3 | 0.9 | ||
Education | ||||
Never went to school | 2 | 0.6 | 1 (0.6) | 1 (0.7) |
Primary school (grades 1–7) | 76 | 24.1 | 36 (21.4) | 41 (28.3) |
High school (grades 8–12) | 136 | 43.0 | 67 (39.9) | 69 (47.6) * |
Less than grade 12 + FET*/certificate/diploma | 11 | 3.5 | 6 (36.) | 5 (3.4) |
Grade 12 | 36 | 11.5 | 20 (11.9) | 16 (11) |
Tertiary/diploma/degree | 51 | 16.3 | 38 (22.6) | 13 (9) * |
Not Assigned | 5 | 1.6 | ||
Occupation | ||||
Employed (full- or part-time/self-employed) | 93 | 29.4 | 53 (29.9) | 40 (28.6) |
Unemployed | 133 | 42 | 87 (49.1) | 46 (32.8) |
Full-time homemaker | 21 | 6.6 | 2 (1.1) | 19 (13.5) |
Pensioner | 58 | 18.4 | 21 (11.9) | 37 (26.2) |
On a disability grant | 13 | 4.1 | 5 | 8 |
Child grant | 4 | 1.3 | 3 | 1 |
Income | ||||
No income | 32 | 10.2 | 23 (13.7) | 9 (6.2) ** |
R1–R400 | 12 | 3.8 | 12 (7.1) | 0 |
R401–R800 | 27 | 8.6 | 18 (10.7) | 9 (8.6) |
R801–R1600 | 75 | 24 | 41 (24.4) | 34 (23.4) ** |
R1601–R3200 | 95 | 30.4 | 51 (30.4 | 44 (30.3) |
R3201–R6400 | 42 | 13.2 | 16 (9.5) | 26 (17.9) ** |
R6401–R12,800 | 19 | 6.1 | 4 (2.4) | 15 (10.3) ** |
R12,801–R25,600 | 10 | 3.2 | 3 (1.8) | 7(4.8) ** |
R25,601–R51,200 | 1 | 0.3 | 0 | 1 (0.7) |
Risks Factors (N = 316) | ||||
---|---|---|---|---|
General Population | Black | Mixed-Ancestry | ||
Body Mass Index (BMI, kg/m2), mean (SD) | 36 (7.7) | 36.9 (8.3) | 35.1 (6.9) | |
Waist circumference (cm), mean (SD) | 104 (13.2) | 103.9 (13.9) | 104.4 (12.5) | |
BMI | N | % | N (%) | N (%) |
Underweight (<18.5) | X0 | 0 | 0 | 0 |
Normal weight (18.5–24.9) | 12 | 3.8 | (4.1) | (3.6) |
Overweight (25.0 to 29.9) | 67 | 21.2 | (21.6) | (20.1) |
Obese | 233 | 73.7 | (74.3) | (76.3) |
Not documented | 4 | 1.3 | ||
Family medical history | ||||
Having at least one known diabetic close relative | 141 | 44.6 | 70 (40.9) | 71 (49.7) |
Don’t have one known diabetic close relative | 57 | 18.0 | 99 (57.9) | 68 (47.6) |
Don’t know | 114 | 36.1 | 2 (1.2) | 4 (2.8) |
Not documented | 4 | 1.3 | ||
Blood pressure | ||||
Optimal/normal (<120/120–129 mmHg/<80/80–84 mmHg) | 129 | 40.8 | (35.7) | (47.5) * |
High normal (130–139 mmHg/85–89 mmHg) | 71 | 22.5 | (25.7) | (19.4) * |
Hypertension (≥140 mmHg/90 mmHg) | 93 | 29.4 | (33.3) | (25.9) * |
Isolated systolic hypertension (≥140 mmHg/<90 mmHg) | 19 | 6.0 | (5.3) | (7.2) * |
Not documented | 4 | 1.3 | ||
Glycosylated hemoglobin (HbA1c) | ||||
≥5.7 mmol/L | 208 | 67.9 | 104 (62.3) | 104 (74.3) * |
Not documented | 11 | 3.5 | ||
Glycemia | ||||
Impaired fasting glucose (>6.1–7 mmol/L) | 18 | 5.8 | 10 (5.9) | 8 (5.8) |
Impaired glucose tolerance (≥7.8–11.1 mmol/L) | 41 | 13.2 | 22 (12.9) | 19 (13.7) |
Diabetic (IFG >7 mmol/L and IGT >11.1 mmol/L) | 31 | 10 | 15 (8.8) | 16 (11.3) |
Cholesterol | ||||
Total cholesterol (>5 mmol/L) | 150 | 48.2 | 68 (40) | 82 (58.2) ** |
HDL cholesterol (<1.2 mmol/L) | 166 | 52.9 | 79 (47) | 85 (60.3) * |
LDL cholesterol (>3 mmol/L) | 179 | 57.7 | 78 (47.6) | 99 (70.2) ** |
Triglycerides (>1.5 mmol/L) | 113 | 35.8 | 47 (27.6) | 63 (44.7) ** |
Alcohol consumption | ||||
Abstainer | 174 | 54.8 | 78 (45.3) | 98 (65.8) ** |
Less than once a month | 51 | 15.9 | 32 (18.6) | 19 (12.8) ** |
1–3 days per month | 45 | 14 | 30 (17.4) | 15 (10.1) ** |
Several times per week | 42 | 13.1 | 31 (18.0) | 11 (7.4) ** |
Not documented | 7 | 2.2 | ||
Tobacco status | ||||
Non-smoker | 191 | 59.95 | 125 (72.7) | 66 (44.3) ** |
Current smoker (daily or occasionally) | 109 | 34 | 36 (20.9) | 73 (49) ** |
Ex-smoker | 14 | 4.4 | 10 (5.8) | 4 (2.7) ** |
Not documented | 7 | 2.2 |
Glycemic Status | Normoglycemia (n = 239) | Dysglycemia (n = 41) | Diabetic (n = 31) | p-Value |
---|---|---|---|---|
(IFG < 6 and IGT < 7.8) | (IFG > 6.1–7 mmol/L and IGT ≥ 7.8–11.1 mmol/L) | (IFG > 7 mmol/L and IGT > 11.1 mmol/L) | ||
HbA1c (≥5.7 mmol/L) | 142 (59.4) | 32 (78) | 31 (100) | <0.0001 |
Total cholesterol (>5 mmol/L) | 116 (48.5) | 16 (39) | 15 (46.8) | 0.525 |
HDL cholesterol (<1.2 mmol/L) | 84 (35) | 19 (46.3) | 15 (46.8) | 0.159 |
LDL cholesterol (>3 mmol/L) | 122 (51) | 19 (46.3) | 19 (59.4) | 0.544 |
Triglycerides (>1.5 mmol/L) | 77 (32.2) | 16 (39) | 15 (46.8) | 0.169 |
BMI (overweight and obese) (>25 kg/m2) | 229 (95.8) | 39 (95.1) | 30 (93.8) | 0.484 |
Hypertension (≥140 mmHg/90 mmHg) | 80 (33.5) | 16 (39) | 13 (40.6) | 0.524 |
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Hill, J.; Peer, N.; Jonathan, D.; Mayige, M.; Sobngwi, E.; Kengne, A.P. Findings from Community-Based Screenings for Type 2 Diabetes Mellitus in at Risk Communities in Cape Town, South Africa: A Pilot Study. Int. J. Environ. Res. Public Health 2020, 17, 2876. https://doi.org/10.3390/ijerph17082876
Hill J, Peer N, Jonathan D, Mayige M, Sobngwi E, Kengne AP. Findings from Community-Based Screenings for Type 2 Diabetes Mellitus in at Risk Communities in Cape Town, South Africa: A Pilot Study. International Journal of Environmental Research and Public Health. 2020; 17(8):2876. https://doi.org/10.3390/ijerph17082876
Chicago/Turabian StyleHill, Jillian, Nasheeta Peer, Deborah Jonathan, Mary Mayige, Eugene Sobngwi, and Andre Pascal Kengne. 2020. "Findings from Community-Based Screenings for Type 2 Diabetes Mellitus in at Risk Communities in Cape Town, South Africa: A Pilot Study" International Journal of Environmental Research and Public Health 17, no. 8: 2876. https://doi.org/10.3390/ijerph17082876