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In 2000, an estimated 36,504 deaths (7% of all deaths) in South Africa were attributed to excess body weight [6], and in 2004 non-communicable diseases (NCDs) linked to dietary intake--cardiovascular diseases, diabetes mellitus, cancers--together with respiratory diseases contributed 12% of the overall disease burden [7]. [...]we suggest that the South African government should develop a plan to make healthy foods such as fruit, vegetables, and whole grain cereals more available, affordable, and acceptable, and non-essential, high-calorie, nutrient-poor products, including soft drinks, some packaged foods and snacks, less available, more costly, and less appealing to the South African population.

Built environment attributes have been linked to cardiovascular disease (CVD) risk. Therefore, identifying built environment attributes that are associated with CVD risk is relevant for facilitating effective public health interventions. To conduct a systematic review of literature to examine the influence of built environmental attributes on CVD risks. Multiple database searches including Science direct, CINAHL, Masterfile Premier, EBSCO and manual scan of reference lists were conducted. Studies published in English between 2005 and April 2015 were included if they assessed one or more of the neighborhood environmental attributes in relation with any major CVD outcomes and selected risk factors among adults. Author(s), country/city, sex, age, sample size, study design, tool used to measure neighborhood environment, exposure and outcome assessments and associations were extracted from eligible studies. Eighteen studies met the inclusion criteria. Most studies used both cross-sectional design and Geographic Information System (GIS) to assess the neighborhood environmental attributes. Neighborhood environmental attributes were significantly associated with CVD risk and CVD outcomes in the expected direction. Residential density, safety from traffic, recreation facilities, street connectivity and high walkable environment were associated with physical activity. High walkable environment, fast food restaurants, supermarket/grocery stores were associated with blood pressure, body mass index, diabetes mellitus and metabolic syndrome. High density traffic, road proximity and fast food restaurants were associated with CVDs outcomes. This study confirms the relationship between neighborhood environment attributes and CVDs and risk factors. Prevention programs should account for neighborhood environmental attributes in the communities where people live.

Background Consumption of fruits and vegetables reduces the risk of obesity, diabetes, cancer, cardiovascular mortality and all-cause mortality. The study assessed the pattern of intake and the factors that influence daily intake of commonly available fruits and vegetables in economically disadvantaged South African communities. Methods This is a cross-sectional study nested on an ongoing longitudinal study in South Africa. Two communities (a rural and urban) of low socio-economic status were purposely selected from two of the nine provinces. A sample of 535 participants aged 30–75 years was randomly selected from the longitudinal cohort of 1220; 411 (78%) women. Data were collected using validated food frequency and structured interviewer-administered questionnaires. Descriptive and multivariate regression analysis were undertaken. Results A higher proportion of participants in the urban township compared to their rural community counterparts had purchased fruits (93% vs. 51%) and vegetables (62% vs. 56%) either daily or weekly. Only 37.8% of the participants consumed at least two portions of commonly available fruits and vegetables daily, with no differences in the two communities. Daily/weekly purchase of sugar sweetened beverages (SSBs) was associated with daily intake of fruits and vegetables ( p  = 0.014). Controlling for age and gender, analysis showed that those who spent R1000 (USD71.4) and more on groceries monthly compared to those who spent less, and those who travelled with a personal vehicle to purchase groceries (compared to those who took public transport) were respectively 1.6 times (AOR, 95% CI: 1.05–2.44; p  = 0.030) and 2.1 times (AOR, 95% CI: 1.06–4.09; p  = 0.003) more likely to consume at least two or more portions of fruits and vegetables daily. Those who purchased SSBs daily or weekly were less likely (AOR, 95% CI: 0.54, 0.36–0.81, p  = 0.007) to consume two or more portions of fruits and vegetables daily. The average household monthly income was very low (only 2.6% of households earned R5000 (US$357.1); and education level, attitude towards fruits and vegetables and owning a refrigerator had no significant association with fruits and vegetable daily intake. Conclusion These findings indicate that affordability and frequency of purchase of sugary drinks can influence daily intake of fruits and vegetables in resource-limited communities.

In a large study, cardiac risk-factor burden was correlated with cardiovascular disease and mortality. High-income countries had a high risk burden but low rates of major cardiovascular events, which suggests that contributors other than risk factors influence outcome. Worldwide, 18 million deaths annually are attributed to cardiovascular diseases. 1 From the 1930s to the 1950s, the rate of cardiovascular disease increased in high-income countries, but during this period, the rates were low in middle- and low-income countries. 2 , 3 Since the mid-1970s, the rate of death from cardiovascular diseases has declined markedly in several high-income countries, owing to reductions in risk factors and improved management of cardiovascular disease. 4 By contrast, the incidence of cardiovascular disease has been increasing in some low-income and middle-income countries, 5 , 6 with 80% of the global burden estimated to occur in these countries. 1 It is not . . .

In a large study in 18 countries, sodium and potassium intake were estimated from urine samples and correlated with blood pressure. The correlations were nonlinear and were most pronounced among people with high sodium intake, those with hypertension, and older persons. Hypertension affects 1 billion people and is considered to be a leading cause of death, stroke, myocardial infarction, congestive heart failure, and chronic renal impairment. 1 – 4 Sodium intake is reported to be a modifiable determinant of hypertension. 5 , 6 The International Study of Salt and Blood Pressure (INTERSALT), 7 but not another large study, 8 showed a modest association between higher levels of sodium intake and higher blood pressure. However, INTERSALT was not large enough to determine whether the association varied according to region, participant characteristics, or levels of sodium or potassium intake. Substantially larger studies are needed to assess the shape of . . .

The current epidemic of obesity and its co-morbidities reflect an urgent need to reform our modern eating patterns. This commentary proposes the reclamation of our traditional diets of the precolonial, preindustrial era, which are argued to be more sustainable, in terms of health, economics, and ecology, than the low-carbohydrate or Palaeolithic diet. It is also argued that, via the reclamation of traditional diets, a more successful uptake of the current Food Based Dietary Guideline for increasing intake of pulses could be achieved.

WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability. We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry. Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24 776), 33% of lower middle-income countries (13 253 of 40 023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16 874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 0·16, 95% CI 0·04–0·57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (0·16, 0·04–0·55). Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines. Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHO's targets of 50% use of key medicines by 2025. Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.

Globally the number of people with Type 2 diabetes mellitus (T2DM) has risen significantly over the last few decades. Aligned to this is a growing use of community health workers (CHWs) to deliver T2DM self-management support with good clinical outcomes especially in High Income Countries (HIC). Evidence and lessons from these interventions can be useful for Low- and Middle-Income countries (LMICs) such as South Africa that are experiencing a marked increase in T2DM prevalence. This study aimed to examine how CHW have been utilized to support T2DM self-management globally, their preparation for and supervision to perform their functions. The review was guided by a stepwise approach outlined in the framework for scoping reviews developed by Arksey and O'Malley. Peer reviewed scientific and grey literature was searched using a string of keywords, selecting English full-text articles published between 2000 and 2015. Articles were selected using inclusion criteria, charted and content analyzed. 1008 studies were identified of which 54 full text articles were selected. Most (53) of the selected studies were in HIC and targeted mostly minority populations in low resource settings. CHWs were mostly deployed to provide education, support, and advocacy. Structured curriculum based education was the most frequently reported service provided by CHWs to support T2DM self-management. Support services included informational, emotional, appraisal and instrumental support. Models of CHW care included facility linked nurse-led CHW coordination, facility-linked CHW led coordination and standalone CHW interventions without facility interaction. CHWs play several roles in T2DM self-management, including structured education, ongoing support and health system advocacy. Preparing and coordinating CHWs for these roles is crucial and needs further research and strengthening.

Household air pollution (HAP) from solid fuel use for cooking affects 2.5 billion individuals globally and may contribute substantially to disease burden. However, few prospective studies have assessed the impact of HAP on mortality and cardiorespiratory disease. Our goal was to evaluate associations between HAP and mortality, cardiovascular disease (CVD), and respiratory disease in the prospective urban and rural epidemiology (PURE) study. We studied 91,350 adults 35–70 y of age from 467 urban and rural communities in 11 countries (Bangladesh, Brazil, Chile, China, Colombia, India, Pakistan, Philippines, South Africa, Tanzania, and Zimbabwe). After a median follow-up period of 9.1 y, we recorded 6,595 deaths, 5,472 incident cases of CVD (CVD death or nonfatal myocardial infarction, stroke, or heart failure), and 2,436 incident cases of respiratory disease (respiratory death or nonfatal chronic obstructive pulmonary disease, pulmonary tuberculosis, pneumonia, or lung cancer). We used Cox proportional hazards models adjusted for individual, household, and community-level characteristics to compare events for individuals living in households that used solid fuels for cooking to those using electricity or gas. We found that 41.8% of participants lived in households using solid fuels as their primary cooking fuel. Compared with electricity or gas, solid fuel use was associated with fully adjusted hazard ratios of 1.12 (95% CI: 1.04, 1.21) for all-cause mortality, 1.08 (95% CI: 0.99, 1.17) for fatal or nonfatal CVD, 1.14 (95% CI: 1.00, 1.30) for fatal or nonfatal respiratory disease, and 1.12 (95% CI: 1.06, 1.19) for mortality from any cause or the first incidence of a nonfatal cardiorespiratory outcome. Associations persisted in extensive sensitivity analyses, but small differences were observed across study regions and across individual and household characteristics. Use of solid fuels for cooking is a risk factor for mortality and cardiorespiratory disease. Continued efforts to replace solid fuels with cleaner alternatives are needed to reduce premature mortality and morbidity in developing countries. https://doi.org/10.1289/EHP3915.

Background The obesity epidemic is associated with rising rates of cardiovascular disease (CVD) among adults, particularly in countries undergoing rapid urbanisation and nutrition transition. This study explored the perceptions of body size, obesity risk awareness, and the willingness to lose weight among adults in a resource-limited urban community to inform appropriate community-based interventions for the prevention of obesity. Method This is a descriptive qualitative study. Semi-structured focus group discussions were conducted with purposively selected black men and women aged 35–70 years living in an urban South African township. Weight and height measurements were taken, and the participants were classified into optimal weight, overweight and obese groups based on their body mass index (Kg/m 2 ). Participants were asked to discuss on perceived obesity threat and risk of cardiovascular disease. Information on body image perceptions and the willingness to lose excess body weight were also discussed. Discussions were conducted in the local language (isiXhosa), transcribed and translated into English. Data was analysed using the thematic analysis approach. Results Participants generally believed that obesity could lead to health conditions such as heart attack, stroke, diabetes, and hypertension. However, severity of obesity was perceived differently in the groups. Men in all groups and women in the obese and optimal weight groups perceived obesity to be a serious threat to their health, whereas the overweight women did not. Obese participants who had experienced chronic disease conditions indicated strong perceptions of risk of obesity and cardiovascular disease. Obese participants, particularly men, expressed willingness to lose weight, compared to the men and women who were overweight. The belief that overweight is ‘normal’ and not a disease, subjective norms, and inaccessibility to physical activity facilities, negatively influenced participants’ readiness to lose weight. Conclusion Low perception of threat of obesity to health particularly among overweight women in this community indicates a considerable challenge to obesity control. Community health education and promotion programmes that increase awareness about the risk associated with overweight, and improve the motivation for physical activity and maintenance of optimal body weight are needed.