5 / 48
VOLUME 16 NUMBER 1 • JULY 2019
3
SA JOURNAL OF DIABETES & VASCULAR DISEASE
From the Editor’s Desk
From the Editor’s Desk
Correspondence to: FA Mahomed
Head of Internal Medicine, Madadeni Hospital
Newcastle, KwaZulu-Natal
T
his issue deals with a range of factors related to non-
communicable diseases (NCDs), from risk-factor identification
and management to special groups that may be affected.
Anthony
et al
. (page 4) examined hypertensive disorders
in pregnancy. They outline a clear method of classification,
assessment and management. Other countries in Africa also have
high levels of hypertensive disease in pregnancy; for example, a
study in Botswana showed 22% of pregnancies with hypertensive
disease.
1
Agaba and co-workers (page 11) evaluated NCDs and risk
factors among university employees in Nigeria. They used a
modified version of the World Health Organisation’s STEPwise
programme.
2
This is a programme for surveillance and monitoring
of NCDs, but interestingly, they included aspects of counselling
on lifestyle as part of their study (test and treat). Striking findings
were of high levels of inactivity and a poor diet in the group
of university employees, indicating that further education and
counselling are needed, even in this setting.
Mashiane
et al
., in the Ellisras Longitudinal Study 2017
(page 18), assessed dietary intake and body mass index (BMI).
Important findings include the association between BMI and
high cholesterol intake, female obesity, high dietary carbohydrate
intake and the need for further education and guidance. Female
obesity is a key health problem that needs to be addressed, both
at the causation and consequences level. Studies examining the
impact of obesity on reproductive health and as a risk factor for
NCDs have been carried out, but the management is proving to
be complicated and difficult.
3
Large epidemiological databases,
such as the Ellisras Longitudinal Study 2017, are proving to be
valuable in assessing disease burden, risk-factor identification and
subsequent healthcare policy.
Ngango and Omole (page 22) demonstrate the high clustering of
risk factors for NCDs in the South African primary healthcare setting.
Low socio-economic status and risk for NCDs have been shown to
be an international problem.
4
Mayosi
et al
. expressed this concern
in a concise manner: ‘Concerted action is needed to strengthen
the district-based primary healthcare system, to integrate the care
of chronic diseases and management of risk factors, to develop a
national surveillance system, and to apply interventions of proven
cost-effectiveness in the primary and secondary prevention of such
diseases within populations and health services’.
5
Sebati and co-workers (page 30) showed that in a group of
young people studied in the Ellisras Longitudinal Study 2017,
increased waist circumference was associated with hypertension.
Obesity levels are of concern. Other studies in South Africa confirm
this ‘signal’ of risk factors for NCDs in the youth,
6
and this is an area
that public health officials need to take note of.
Juma and associates (page 35) assessed cardiovascular risk
factors among people living with HIV in Kenya. They found high
levels of pre-hypertension and total cholesterol, especially associated
with nucleoside reverse-transcriptase inhibitor (NRTI)-based ART
regimens. They point out the need to do cardiovascular risk
assessments as part of routine management of HIV. Cardiovascular
disease in HIV takes many forms.
7
As more patients survive with
improved access to and management of HIV treatment, NCDs and
risk of cardiovascular disease take over as the major clinical areas.
8
Ellapen
et al
. (page 40) explain the correct use of exercise in the
management of diabetes. Benefits and risks are outlined.
The insert under Drug Trends reveals new ways of protecting
insulin from temperature fluctuations, which is a key management
aspect to discuss with patients. South African temperatures can
range from –5° to +40°C and with intermittent electricity supply
and harsh working and sporting environments, this topic becomes
a crucial aspect to consider.
References
1.
Johnson KM, Zash R, Haviland MJ, Hacker MR, Luckett R, Diseko M,
et al
.
Hypertensive disease in pregnancy in Botswana: Prevalence and impact on
perinatal outcomes.
Pregnancy Hypertens
2016;
6
(4): 418–422.
2.
STEPS: A framework for surveillance. The WHO STEPwise approach to
surveillance of non-communicable diseases (STEPS). World Health Organisation,
2003.
http://www.who.int/ncd_surveillance3.
Mitchell S, Shaw D. The worldwide epidemic of female obesity.
Best Pract Res Clin
Obstet Gynaeco
l 2015;
29
(3): 289–299.
4.
Di Cesare M, Khang YH, Asaria P, Blakely T, Cowan MJ, Farzadfar F,
et al
.
Inequalities in non-communicable diseases and effective responses.
Lancet
2013;
381
(9866): 585–597.
5.
Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D. The burden of
non-communicable diseases in South Africa.
Lancet
2009;
374
(9693): 934–947.
6.
Negash S, Agyemang C, Matsha TE, Peer N, Erasmus RT, Kengne AP. Differential
prevalence and associations of overweight and obesity by gender and population
group among school learners in South Africa: A cross-sectional study.
BMC Obes
2017;
4
: 29.
7.
Palella FJ, Phair JP. Cardiovascular disease in HIV infection.
Curr Opin HIV AIDS
2011;
6
(4): 266–271.
8.
Triant VA. Cardiovascular disease and HIV infection.
Curr HIV/AIDS Rep
2013;
10
(3): 199–206.