Background: Chronic lifestyle diseases share similar modifiable risk factors, including hypertension, tobacco smoking, diabetes, obesity, hyperlipidaemia and physical inactivity. Metabolic syndrome refers to the cluster of risk factors that increases the risk for developing type 2 diabetes mellitus (DM) and cardiovascular disease. Objectives: The study aimed to assess health status and identify distinct risk-factor profiles for both chronic lifestyle diseases and metabolic syndrome in rural and urban communities in central South Africa.Methods: The investigation formed part of the Assuring Health for All in the Free State (AHAFS) study. During interviews by trained researchers, household socio-demographic and health information, diet, risk factors (i.e. history of hypertension and/or diabetes) and habits (e.g. smoking and inadequate physical activity levels) were determined. Adult participants underwent anthropometric evaluation, medical examination and blood sampling.Results: The risk-factor profile for chronic lifestyle diseases revealed that self-reported hypertension and physical inactivity were ranked the highest risk factor for the rural and urban groups respectively. The cumulative risk-factor profile showed that 40.1% of the rural and 34.4% of the urban study population had three or more risk factors for chronic lifestyle diseases. Furthermore, 52.2% of rural and 39.7% of urban participants had three or more risk factors for metabolic syndrome.Conclusion: This study confirmed that the worldwide increase in the prevalence of chronic lifestyle diseases can be attributed to a more sedentary lifestyle, especially illustrated in the urban study population, and increasing obesity. The rural study population had a higher prevalence of risk factors for metabolic syndrome.

Background: Health professional students frequently use alcohol and narcotics. The potential impact on academic performance and professional behaviour is concerning.Aim: This study aimed to determine self-reported use of alcohol, illicit substances (e.g. cannabis, lysergic acid diethylamide [LSD], magic mushroom, cocaine, crack, ecstasy, methamphetamine and heroin), prescription medication and smoking habits, correlating academic performance.Setting: Faculty of Health Sciences, University of the Free State.Methods: An observational, descriptive, cross-sectional study design was used. Information was obtained using a self-administered questionnaire, capturing demographics, self-reported academic performance, drinking and smoking habits, and substance use. Coded responses were analysed using the Remark Office OMR 8 Software System. Descriptive statistics were calculated for categorical variables.Results: Completed questionnaires comprised 171 students. A total of 78.4% of second year and 82.8% of third year students reported using alcohol. Twenty-two per cent of second year and 24.1% of third year students reported cannabis use. In the second year group, three (2.7%) students reported using magic mushroom, two (1.8%) reported cocaine, two (1.8%) reported ecstasy and one (0.9%) reported using methamphetamine. Only third year students reported using LSD or ‘crack’. Cigarette smoking was common – 31.5% and 35.1% in both groups, respectively. Smokeless tobacco devices were used by 8.5% of second year and 7.1% of third year students. Almost 40% of both groups reported that they had smoked a water pipe. Academic performance achieved was mostly 60% – 69% (38.9%) among second year students and 70% – 79% (46.6%) among third year students.Conclusion: Self-reported use of alcohol and drugs and smoking among medical students is alarming. Additional student support, early identification and referral for management and/or rehabilitation should be a priority at tertiary institutions responsible for training future healthcare professionals.

Background: The global escalating prevalence of lifestyle-related non-communicable diseases places a significant burden on health systems. Chronic diseases of lifestyle (CDL) are a group of diseases that share similar modifiable risk factors that can result in long-term disease processes. Considering the socio-behavioral-metabolic risk profiles of communities and risk factors predictive of the presence of CDL can assist in the development of focused and effective community-based prevention, intervention, and treatment programs for CDL. Aim: To determine the socio-behavioral-metabolic risk profiles and identify associated factors for the following CDL: obesity, cardiovascular disease, hypertension, and type 2 diabetes mellitus in rural and urban communities in central South Africa. Methodology: This cross-sectional study included adults aged 25–65 years in the rural Southern Free State and urban Mangaung. Social determinants, behavioral and metabolic risk factors, and inflammatory biomarkers for CDL were determined. Results: In total, 575 rural (mean age: 42 years; 71% female) and 429 urban (mean age: 44 years; 76% female) participants were included in the study. More than 20% of participants in both communities reported being previously diagnosed with cardiovascular diseases; with reported hypertension and diabetes mellitus more prevalent among rural participants. Insufficient intake of fruit and vegetables, alcohol use, and high blood pressure were among the top five risk factors in both communities. Physical inactivity ranked among the top two risk factors in the urban community; while alcohol and tobacco use was significantly higher in the rural community. Fibrinogen was the most prevalent inflammatory marker in both communities (32.9 rural vs. 48.3% urban). High sensitivity C-reactive protein (Hs-CRP), only available for rural participants, was high with increased levels in more than 80% of participants. In both communities, being female, having high blood pressure and increased fibrinogen levels were associated with obesity. Conclusion: This study illustrated the high prevalence of socio-behavioral-metabolic risk factors for CDL, and identified similarities and distinct differences in the risk profiles of rural and urban communities. Considering the CDL risk profiles of communities can assist in prioritizing health needs and contribute to the development of tailor-made community-based primary health care prevention, intervention, and health promotion programs.

Objectives: Obesity prevalence is increasing worldwide. In South Africa, older and urbanised African women have significantly higher rates of obesity. Limited information is available on the relationship between anthropometric parameters, adipokines and metabolic health status of African women. This study investigated the relationship between obesity, adipokines and the components of metabolic syndrome in urban African women. Methods: This study included 135 urban African women that were 26–63 years of age, identified with metabolic syndrome in the urban leg of the Assuring Health for All in the Free State (AHA-FS) study. To establish anthropometric status, the following measures were taken: body weight, height and waist circumference. Blood was drawn to determine leptin, adiponectin levels and metabolic status. Results: Adiponectin levels in obese women were significantly decreased compared to normal weight women. Leptin levels and leptin:adiponectin ratios (L:A) were increased in the obese group compared to the overweight and normal weight groups. Leptin and L:A showed strong positive correlations with body mass index and waist circumference. Adiponectin levels decreased as the number of components of metabolic syndrome increased. The L:A ratio was significantly lower in women with elevated triglycerides and significantly higher in women with elevated blood glucose levels. Adiponectin levels were significantly lower in women with elevated blood glucose. Conclusion: This study confirms the inverse relationship between adiponectin and leptin with increased body adiposity. Results indicate that waist circumference, fasting blood glucose and triglyceride levels are the metabolic syndrome components most closely associated with altered adiponectin and leptin levels and L:A in urban African women with metabolic syndrome.

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, which 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 individuals (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 29.4% male and 70.6% female 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 21% of 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.

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.