Complete patient adherence to treatment for diabetic retinopathy (DR) is critical to limit vision loss. There is a dearth of evidence regarding the reasons why South African patients referred for suspected vision-threatening DR stay compliant to or default their treatment. The current study sought to explore factors associated with treatment compliance among patients living with diabetes who have been referred for suspected vision-threatening DR in the Northern/Tygerberg sub-Structure (NTSS) public health care system of Cape Town, South Africa. A qualitative research approach was used where semi-structured in-depth interviews were conducted with 13 adult patients living with DR, and 2 key informants who are primary eye care providers. Thematic data analysis was conducted using taguette.org. Fear of going blind was the most notable patient-related factor associated with compliance. Notable patient-related barriers reported were forgetfulness and a poor state of health. Notable institution-related barriers included suboptimal information received from health care service providers, poor referral management by the organisation delivering retinal screening services, as well as the inaccessibility of the main NTSS hospital via telephone calls. All these factors were confirmed by the key informants of the current study. Finally, all patients and key informants agreed that SARS-CoV-2 negatively affected patients’ adherence to their DR treatment. Hence, scaling up of health care, referral, and appointment setting services could increase the uptake of treatment and retinal screenings among patients attending the Cape Town, NTSS public health care system.

Background: The targeted marketing of unhealthy food and beverages to vulnerable populations, particularly children and adolescents in lower-income communities, is pervasive and coincides with increased noncommunicable disease (NCD) rates. This study examined the extent of food and beverage advertising surrounding schools in three townships in Cape Town, South Africa: Gugulethu, Nyanga, and Kensington. Methodology: Trained fieldworkers used web-based surveys on smartphones to capture all observable outdoor food and beverage advertisements in the three townships. Surveys recorded product brand, type, placement, Global Positioning System (GPS) coordinates, and a digital photograph. Advertisements were categorised as sugar-sweetened beverages (SSBs), unhealthy food (excluding beverages), alcohol, staple food, and miscellaneous food, following the INFORMAS Outdoor Food Advertising Protocol. Advertisements visible within 100mand 400m buffer zones surrounding primary and secondary schools were mapped using the Quantum Geographic Information System (QGIS) software. Descriptive analyses were conducted to determine the extent of outdoor food and beverage advertising surrounding schools. Results: We mapped 26 primary and 7 secondary schools, observing 253 and 1587 food and beverage advertisements within 100m and 400m of schools, respectively. Unhealthy advertisements comprised 69.9% and 68.5% of all observations within 100m- and 400m zones, respectively. There were 117 SSB, 57 unhealthy food, 3 alcohol, 64 staple food, and 12 miscellaneous food advertisements within 100m zones. Nyanga zones contained the most SSB (71, 60.7%) and unhealthy food advertisements (37, 64.9%). Secondary schools had higher SSB advertisement rates than primary schools (p < 0.001). Within 400m zones, there were 623 SSB, 370 unhealthy food, 93 alcohol, 445 staple food, and 56 miscellaneous food advertisements, with Nyanga leading in SSB (335, 53.8%) and unhealthy food advertisements (224, 54.9%). Conclusion: The results highlight a concerning level of exposure to unhealthy food and beverage advertisements around schools, particularly secondary schools in low-income townships. This could have implications for the dietary choices and health of students in these areas. The findings underscore the need for policy interventions and community awareness programs to address and regulate the advertising environment around schools, promoting healthier food and beverage choices for students.

Background: The South African food environment is characterized by pervasive marketing on television and in print media of unhealthy food and beverages. Little is known about the extent of outdoor food and beverage marketing (product, spatial advertising, branding) at transport interchange areas, community food outlets, and schools. Our study aimed to map outdoor food and beverage marketing within the vicinities of these areas in three low-income communities in Cape Town. Methods: Data on food and beverage-related branding, product type, placement, pictures, and Global Positioning System coordinates were captured using a web-based questionnaire. Geographic Information System software was used to delimit the target communities and areas, geospatially map the physical food environment, and perform spatial analysis of the data. Results: Overall, 986 food and beverage advertisement entries were observed. Preliminary results depicted trends of advertisements clustering around retailers. Spatial trends depicted that fast food and sugar-sweetened beverage (SSB) advertisements were likely to collocate around transport interchange areas, while SSB advertisements were more likely to collocate near schools. The spatial trend for alcohol advertisements indicated a clustering near main roads. Spatial trends for product types varied by location. Few advertisements for fruit and vegetables were captured. Further spatial analysis is underway to assess advertisement density and proximity to youth-related areas, food outlets, and transport interchange areas. Conclusions: Low-income communities, commuters, and schoolchildren in South Africa are targeted by advertisements for unhealthy foods and SSBs, indicating the need for policy intervention to regulate food marketing. Key messages: • Geospatial mapping of food and beverage advertisements indicated the promotion of unhealthy products in low-income communities in South Africa. • Food and beverage adverts target school children and commuters using public transport in poorer communities.

Metabolic syndrome (MetS) among adolescents is a growing public health concern globally, yet data from sub-Saharan Africa remain scarce. Variability in diagnostic criteria further complicates surveillance efforts. This study aimed to estimate the prevalence of MetS among adolescents in Cape Town, South Africa, using five diagnostic criteria, to assess the agreement between definitions and explore criteria suitability. We conducted a cross-sectional study among 489 adolescents aged 13-18 years, sampled from coeducational public high schools in Cape Town's Metro South district. Anthropometric, blood pressure, and fasting biochemical measurements were collected. MetS prevalence was assessed using the Cook, Ford, de Ferranti, International Diabetes Federation (IDF), and Agudelo criteria. Agreement between definitions was evaluated using unweighted Kappa statistics. The MetS prevalence with four criteria were similar, ranging from 4.7 % (IDF) to 5.7 % (Ford), while one criterion differed significantly with 17.8 % (de Ferranti). Central obesity and raised blood pressure were the most prevalent MetS components across criteria. Females exhibited higher MetS prevalence than males across the five criteria. Very good agreement was observed between Cook, Ford, and Agudelo definitions (κ > 0.85), while agreement involving IDF and de Ferranti definitions was fair to moderate (κ = 0.33-0.42). Our results underscore the need for locally validated, population-specific MetS criteria and diagnostic thresholds to support early identification of adolescents at risk of cardiometabolic disease (CMD). In the absence of such criteria, the Cook and Ford definitions appear particularly suitable for identifying MetS among South African adolescents, while the Agudelo definition is appropriate when WC measures are unavailable. Finally, our findings reveal a concerning CMD risk profile among adolescents in Cape Town, South Africa, with a particularly high burden observed in females.