Abstract
BackgroundCountries in Sub-Saharan Africa have recently been experiencing increases in the prevalence of obesity, type 2 diabetes mellitus (T2DM) and other non-communicable diseases in both urban and rural areas. Despite their growing influence on population health in the region, there is a paucity of epidemiological studies on the twin epidemic of obesity and T2DM, particularly in the rural communities in South Africa. We investigated the prevalence and the determinants of overall obesity among patients with T2DM in rural and semi-urban areas surrounding the town of Mthatha, South Africa.MethodsThis hospital-based cross-sectional study was conducted among patients with T2DM attending the outpatient department at Mthatha General Hospital, Eastern Cape Province, South Africa. Data were obtained from 327 participants using standardized questionnaires that included items on sex, age, level of education, type of residence, employment status, smoking status, physical activity, diet and alcohol intake. After taking measurements of height and weight, participants were defined as obese if their body mass index exceeded 30 kg/m2. Univariate and multivariate logistic regression analyses were performed to identify the determinants of obesity in our sample population.ResultsWe found that 60.2% of our sample population were defined as obese. In our univariate analyses, female sex (p < 0.001), age ≥50 years (p = 0.023), rural residence (p < 0.001), excessive alcohol intake (p = 0.002), current cigarette smoking (p < 0.001), level of education (p < 0.001), regular consumption of soft drinks (p < 0.001) and unemployment (p = 0.043) were found to be positively and significantly associated with obesity. In the multivariate logistic regression analysis, female sex (p < 0.001), unemployment (p = 0.012) and level of education (p < 0.001) were found to be independent determinants of obesity.ConclusionWe found that female sex, educational attainment, unemployment and current cigarette smoking were positively associated with obesity among the study participants. Lifestyle changes, poverty reduction and public education are urgently needed to address the growing obesity epidemic in rural areas of South Africa.
Highlights
Countries in Sub-Saharan Africa have recently been experiencing increases in the prevalence of obesity, type 2 diabetes mellitus (T2DM) and other non-communicable diseases in both urban and rural areas
The likelihood of becoming obese was nine-fold for physically inactive patients (80.7%, versus 32.9% among physically active participants), four-fold for those with a higher monthly income (70.1%, versus 35.5%) and double for those residing in rural areas (63.6%)
Our results suggest the presence of a twin epidemic of obesity and T2DM in the rural communities surrounding Mthatha, South Africa
Summary
Countries in Sub-Saharan Africa have recently been experiencing increases in the prevalence of obesity, type 2 diabetes mellitus (T2DM) and other non-communicable diseases in both urban and rural areas. The obesity epidemic was previously thought to be limited to industrialized countries, recent data have emerged showing a substantial increase in prevalence in low and middleincome countries [2,4,11,12,13,14] This trend is mirrored by increases in the prevalence of non-communicable diseases such as diabetes mellitus type 2 (T2DM), hypertension, several types of cancer, gastroesophageal reflux and dyslipidaemia [2,15,16,17,18,19,20,21]. While both obesity and T2DM are associated with an increased risk of mortality due to cardiovascular diseases [13,15,16,17,18,19,21], obesity itself is one of the most significant modifiable risk factors for T2DM [12,21,22,27]
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