Research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science (MSc) in Epidemiology in the field of Epidemiology and Biostatistics / Obesity is an emerging problem in South Africa, particularly in women for whom prevalence rates well above 40% have been reported. Parallel to this health problem, South Africa continues to experience relatively high poverty levels of 10.5% to 48.0%. The aim of this study was to estimate the prevalence of obesity and low social economic status (SES) levels at Agincourt Health and Socio-Demographic Surveillance System site (AHDSS). The study also sought to investigate the association between low SES and obesity at AHDSS. Materials and methods This was a secondary data analysis of the original Na Nakekela HIV/Non communicable disease (NCD) study conducted at AHDSS from August 2010 to May 2011. Included in the study presented in this report were residents of AHDSS aged 15 years or older during this time period. Data from 4 502 individuals (2 683 females and 1 819 males) were analysed. Age-specific prevalences of obesity (body mass index ≥ 30kg/m2), and central obesity (waist hip ratio ≥1.0 and ≥0.85 in men and women, respectively), stratified by sex and SES, were calculated. SES was assessed by ascertaining the household assets of AHDSS residents and assigning a weighted score to the household assets, using multiple correspondence analysis (MCA). The household score was then computed and used to classify the population into SES categories. The relative ranks of households, using this score, were then used as a measure of SES. The association between SES and obesity (BMI ≥ 30) was assessed by means of chi-square tests and logistic regression. Results The overall prevalence of obesity at the AHDSS in the study period was 20.4%. Overall, sex -specific prevalences of obesity were 29.3% and 7.4% in females and males, respectively. Females aged 50-59 years and males aged 45-49 years had the highest age-specific prevalence of obesity, at 40.1% and 18.3%, respectively. The overall prevalence of central obesity was 31.1%. Sex-specific prevalence of central obesity in females was 51.1%, while in males it was 4.9%. The highest age-specific prevalence of central obesity in both sexes was for those 70 years and older: 74.3% in females and 11.1% in males. Around 50% of individuals at the AHDSS were classified as belonging to lower SES categories, with females constituting 56.6% of these individuals. The highest prevalence of individuals in the high SES category was females aged 60-69 (14.5%) and males aged 70 (16.4%) years and older. After adjusting for other variables, being in a lower SES category was inversely associated with obesity as measured by BMI, as was being male and being HIV positive. The only positive predictor of high BMI was older age. No association between central obesity and lower SES was found after adjusting for confounders and other explanatory variables. However, older age was a predictor of central obesity. Being male, HIV positive and the male head of the household were factors that were inversely associated with central obesity. Discussion The high prevalence of individuals in the lower SES group (50.5%) reported in this study is similar to the Mpumalanga provincial poverty estimate of 51%.The ratio of obese females to males was at least 2.2 in every age group. The prevalence of central obesity in females of 51.1% in the AHDSS was higher than the national estimate of 47.1% for females, while the male estimate of 4.9% was lower than the 6.8% national estimate for males. In contrast to other studies, no associations between lower SES and obesity as measured by central obesity were observed. Conclusion and Recommendations Specific interventions to reduce obesity in females should be undertaken, including the provision of educational talks. This would empower them to make better informed decisions about food and lifestyle choices. These recommendations should be integrated into already existing HIV prevention programmes because HIV prevention is currently the main focus of policy makers in South Africa. Measures to reduce the number of individuals in the lower SES group, which this study reported to be very high (especially among women), e.g. through job creation, should be considered.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

A prospective longitudinal study was carried out to establish the relationship between growth, development and social milieu in Coloured pre-school children in Cape Town. This population was selected because, on the basis of previous studies, a wide range of nutritional status as well as a spectrum of socio-economic conditions were known to exist. A pilot study was conducted to establish the feasibility of obtaining information about factors to be included in the study as well as to determine the most suitable sampling methods. A cohort of 1 000 consecutive Coloured infants born in the Cape Town municipal area and notified to the Cape Town City Council was identified. A random sample of 187 was selected from the cohort for long-term study. Anthropometric data were documented from birth until 5 years and compared to the NCHS reference values. Developmental data consisted of milestones recorded during infancy, language assessment on the Reynell Language Scale at 2½ years carried out by the Logopaedics Department, University of Cape Town, and at 5 years, a specially constructed developmental assessment designed to assess gross motor function, fine motor development including visuo-motor skills and language, both comprehension and expression as well as basic colour and number concepts. Social data were collected during home visits by two experienced, full-time research social workers, who were both integrally involved in the planning of the study. At birth infants were relatively light and short for gestational age. Size at birth correlated with social class. A rapid post-natal weight gain rendered them relatively overweight between 3 and 6 months. Thereafter they again became lighter and shorter than the NCHS reference values and this persisted during the pre-school period. Mother's weight was related to weight at birth, 12 months and 30 months. The genetic influence on growth was reflected in a correlation between parental height and child's length from 12 months onwards. Environmental influences as assessed by social class by occupational grading of the breadwinner, income and family stability were also correlated with growth from 12 months onwards. Infant development as indicated by milestones was very similar to internationally reported studies. Motor development was not associated with social class by occupational grading of the breadwinner but with father's education, mother's personality and family stability. It was also highly correlated with growth during infancy. Early language milestones were associated with the child's micro-environment as indicated by marital status, family unit, setting and stability. Language development at 30 months reflected a general lag in verbal skills and was correlated with parental education and family stability. At five years there was a good correlation between growth, development and social milieu, although the social variables accounted for far more of the variation in development than did growth. Social class by occupation grading of the breadwinner and income reflected the general socio-economic status and there was a good cross-correlation between the social variables. Approximately one third of the families lived in a middle cl ass environment. However, poor maternal education, low incomes and over-crowding were prevalent and must constitute risk factors in child rearing. Sixty five percent of the mothers were not educated further than primary school level and over half of the families were living below an effective minimum level of income. Similarly, over half the families lived in grossly overcrowded conditions. In conclusion, therefore, during infancy developmental milestones were similar to those reported in the literature. Later, however, there was a fall-off in development and this coincided with a greater association with social circumstances. Just prior to school entry social factors far outweighed growth indices as predictors of developmental variation. Social stability of the family a composite evaluation based on a number of social characteristics, was most consistently associated with development. The implications for intervention are that this would need to be broad based and aimed at improving incomes, housing, family cohesion and child centredness and eliminating social pathology. Such intervention would require a concerted effort from a variety of sources which should include administrators, community workers and health professionals.

This dissertation reports on an evaluation of the home visiting programme of the SACLA Rehabilitation Worker project against the background of the socio-economic context of the community and the history of the project. The evaluation had two aims. Firstly, it aimed to highlight the programme's strengths and weaknesses so that the work could become both more efficient and more effective. Secondly, it aimed to establish whether the SACLA rehabilitation project is an effective model of a community based rehabilitation project on which other local projects could be based. Quantitative data was collected by interviewing the caregivers of disabled children who were involved in the project. In-depth interviews with the rehabilitation workers provided qualitative data which was used to confirm the validity of some of the quantitative data. The foremost findings were that the mothers were very positive about the support received from the RWs. The majority of the caregivers remembered the activities that they had been taught by the RWs and performed them well. Poor communication with the caregivers and a lack of skills on the part of the RWs gave rise to a number of problems. A number of changes highlighted by the evaluation were suggested. In conclusion, the project was found to be an effective model of local community based rehabilitation on which other projects could be based.