Urban Africans Research Articles

Fibrinogen concentration and its role in CVD risk in black South Africans – effect of urbanisation

The aim of this study was to investigate correlates of fibrinogen concentration in black South Africans, as well as its association with cardiovascular disease (CVD) risk and whether urbanisation influences this association. A total of 1,006 rural and 1,004 urban black South Africans from the PURE study were cross-sectionally analysed. The association of fibrinogen with CVD risk was determined by investigating the association of fibrinogen with other CVD risk markers as well as with predicted CVD risk using the Reynolds Risk score. The rural group had a significantly higher fibrinogen concentration than the urban group, despite higher levels of risk factors and increased predicted CVD risk in the urban group. Increased levels of CVD risk factors were, however, still associated with increased fibrinogen concentration. Fibrinogen correlated significantly, but weakly, with overall predicted CVD risk. This correlation was stronger in the urban than in the rural group. Multiple regression analysis showed that a smaller percentage of the variance in fibrinogen is explained by the traditional CVD risk factors in the rural than in the urban group. In conclusion, fibrinogen is weakly associated with CVD risk (predicted overall risk as well with individual risk factors) in black South Africans, and is related to the degree of urbanisation. Increased fibrinogen concentration, in black South Africans, especially in rural areas, is largely unexplained, and likely not strongly correlated with traditional CVD-related lifestyle and pathophysiological processes. This does, however, not exclude the possibility that once increased, the fibrinogen concentration contributes to future development of CVD.

Gradients in High-density Lipoprotein Levels in Urban Africans Presenting with Communicable Versus Non-communicable Forms of Heart Disease: The Heart of Soweto Study

Background: The urban enclave of Soweto, South Africa is at the crossroads between communicable (CD) and non-communicable (NCD) forms of heart disease. We hypothesised that patientswithCDwould display low levels of athero-protective high-density lipoprotein (HDL). Methods:Aclinical registry captureddetaileddataonall de novo cases of heart disease presenting to the Cardiology Unit of Soweto’s Baragwanath Hospital during 2006–2008. 1356 patients of African descent (59% female; mean age 58± 14 years) had documented fasting blood levels of HDL, total cholesterol (TCH) and low density lipoprotein (LDL). These lipid profiles were compared according to pre-specified case-coding: NCD (e.g. hypertensive heart disease) versus CD (active or latent infection– e.g. chronic rheumatic heart disease or HIV-related cardiomyopathy). Results: There were significant gradients in HDL ( N b L f w H t ( l

Elevated Resting Heart Rates in Urban Africans Presenting with De Novo Heart Disease

Elevated Resting Heart Rates in Urban Africans Presenting with De Novo Heart Disease

Conventional and behavioral risk factors explain differences in sub-clinical vascular disease between black and Caucasian South Africans: The SABPA study

ObjectivesThere is an emerging burden of cardiovascular disease among urban black Africans in South Africa, which has been largely explained by the transition from traditional African lifestyles to more westernized behavior. We examined the role of health behaviors in explaining the excess burden of sub clinical vascular disease seen in black Africans compared to Caucasians. MethodsThis was a cross-sectional study, comprising of urban African teachers (n=192 black, 206 Caucasian) working for one of the four Kenneth Kaunda Education districts in the North West Province, South Africa. Conventional cardiovascular risk factors, 24h ambulatory blood pressure and objectively measured physical activity (Actical® accelerometers), smoking (confirmed by serum cotinine), and alcohol (serum gamma glutamyl transferase) were assessed. The main outcome was a marker of sub-clinical vascular disease, mean carotid intima media thickness (mCIMT), measured using high resolution ultrasound. ResultsCompared with Caucasians, the black Africans demonstrated higher mCIMT (age and sex adjusted β=0.044, 95% CI, 0.024–0.064mm). The blacks also had higher 24h systolic and diastolic blood pressure, triglycerides, adiposity, and C-reactive protein. In addition, blacks were less physically active (790.0kcal/d vs 947.3kcal/d, p<0.001), more likely to smoke (25% vs 16.3%, p=0.002), and demonstrated higher alcohol abuse (gamma glutamyl transferase, 66.6μ/L vs 27.2μ/L, p<0.001) compared with Caucasians. The difference in mCIMT between blacks and Caucasians was attenuated by 34% when conventional risk factors were added to the model and a further 18% when health behaviors were included. ConclusionThere is an excess burden of sub clinical vascular disease seen in black Africans compared to Caucasians, which can be largely explained by health behaviors and conventional risk factors.

Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics.

In light of increasing access to HAART in sub-Saharan Africa, we conducted a longitudinal study to assess the impact of HAART on sexual risk behaviors among HIV-infected South Africans in urban and rural primary care clinics. Prospective observational cohort. We conducted a cohort study at rural and urban primary care HIV clinics in South Africa consisting of 1544 men and 4719 women enrolled from 2003 to 2010, representing 19703 clinic visits. The primary outcomes were being sexually active, unprotected sex, and more than one sex partner and were evaluated at 6 monthly intervals. Generalized estimated equations assessed the impact of HAART on sexual risk behaviors. Among 6263 HIV-infected men and women, over a third (37.2%) initiated HAART during study follow-up. In comparison to pre-HAART follow-up, visits while receiving HAART were associated with a decrease in those reporting being sexually active [adjusted odds ratio: 0.86 (95% confidence interval: 0.78-0.95)]. Unprotected sex and having more than one sex partner were reduced at visits following HAART initiation compared to pre-HAART visits [adjusted odds ratio: 0.40 (95% confidence interval: 0.34-0.46) and adjusted odds ratio: 0.20 (95% confidence interval: 0.14-0.29), respectively]. Sexual risk behavior significantly decreased following HAART initiation among HIV-infected South African men and women in primary care programs. The further expansion of antiretroviral treatment programs could enhance HIV prevention efforts in Africa.

Predisposing factors and incidence of newly diagnosed atrial fibrillation in an urban African community: insights from the Heart of Soweto Study

BackgroundLittle is known about the incidence and clinical characteristics of newly diagnosed atrial fibrillation/flutter (AF) in urban Africans in epidemiological transition.MethodsThis observational cohort study was carried out in the Chris...

The prevalence and incidence of and risk factors for, micro-albuminuria among urban Africans with type 1 diabetes in South Africa: An inter-ethnic study

BackgroundType 1 diabetes (T1DM) in sub-Saharan Africans is rare and is associated with high mortality from nephropathy. We studied the prevalence and potential risk factors for microalbuminuria (MA) in African and in age-of-onset matched white patients with T1DM. Risk factors for MA were evaluated prospectively in an African cohort. Materials and Methods68 African and 134 white patients, age at diagnosis 10–40 years, duration of diabetes > 2 years, were evaluated for MA; 48 Africans were followed prospectively. ResultsAfricans had shorter duration of diabetes (median, 8 years vs 11 years), higher HbA1c (10.62(SD 2.52)%, vs 9.02(2.44)%, lower cholesterol (4.45(1.04) vs 5.45(1.16)mmol/l), and fewer (23.5% vs 54.5%) had adolescent diabetes onset (p 0.0030 for each); the prevalence of MA was 39.7% and 24.6% respectively (p=0.0155). In multiple regression analysis MA was associated with mean HbA1c (p<0.0001), younger age at diagnosis (p=0.0060), SBP (p=0.0012) and African race (p=0.0287). Prospectively, Africans developing MA (45%) had higher mean HbA1c levels (p=0.0001), were more likely to have had adolescent onset of DM (33.3% vs 8.0%, p=0.0310) and lower BMI (p=0.0340); logistic regression revealed that higher HbA1c and SBP, and lower BMI predicted MA. Nine of 16 African subjects progressed to macroalbuminuria; they were characterised only by extremely poor glycaemic control (mean HbA1c, 13.49(2.00)%). ConclusionsMicroalbuminuria, and severe hyperglycaemia, are common in diabetic Africans with short duration TIDM; MA may rapidly progress to macroalbumiuria. African race may be associated with increased susceptibility to diabetic nephropathy.

The Public Health Relevance of Contagious Rhythm: Infectious Diseases of 20th Century Musicians

In Contagious Rhythm: Infectious Diseases of 20th Century Musicians,1 Sartin argues that “Musical innovation is...often accompanied by diseases of neglect and overindulgence, particularly infectious illnesses, although risky behavior and associated infectious illnesses tend to decrease as the style matures.”1 Sartin could have added that his narrative shows how the illnesses of musicians, from classical to rock-and-roll, reflect the changing patterns of infectious disease, from the “probable neurosyphilis” that killed Robert Schumann to the HIV/AIDS that killed Freddie Mercury. In a tangential way, the article also charts the changing attitudes toward sexuality over the years. The article does not seek to suggest that all musicians are susceptible to contagious disease or die young. The contributions by Spencer,2 Haaga,3 Herer4 and others suggest that this is a continuing debate. And after all, musicians do not live in isolation. In his study of urban South African music and musicians, Coplan5 argued that it is problematic to “isolate form or process from its total context.” Thus, while apparent that many successful musicians who entertained urban South African blacks in the 1930s, 1940s and 1950s succumbed to alcohol and tuberculosis, statistics show that the prevalence rate for tuberculosis among urban black South Africans was also very high.6 Sartin’s suggestion that ravages to famous musicians from contagious diseases were more likely at the beginning of each wave of innovation, chimes in with the nature of popular (and some classical) music: an initial intense period of adulation by the public, followed by a slow descent into familiarity or, more usually, obscurity. By virtue of their function, creativity and public expectation, musicians may thus come to occupy, by adulation or acclamation, roles in society which give them certain exulted, but more often than not, transient privileges. In Europe this sometimes translated to musicians occupying various entertainment positions at the courts of kings and queens; in the USA, it conferred certain, if limited, advantages on black musicians; and in Africa, musicians have been known to criticize kings, presidents and dictators and get away with it by virtue of their popularity. Successful musicians, as depicted in popular theater and imagination, live lives which ordinary people aspire to, and in living these “aspired-to” lives, musicians may take risks and play with the “fire of the gods.” As the many contributions on the subject show, one can never be sure what exactly makes people take risks.7,8 Some of the risk-taking has roots in socio-economic and personal causes; for example, the Sickle Cell anemia that may have contributed to Miles Davis’ narcotic addiction,9 the mixture of post-independence corruption and social conditions that molded Fela Kuti, or the unique social conditions in 1980s Britain that produced punk musicians. Perhaps as idolized individuals, musicians are exemplars and trendsetters. Yet trendsetters or not, classical or popular, they remain mortal, susceptible to microbes and degeneration.10 Indeed, some find that during their period of fame they are able to exercise their inclinations to be free spirits unconstrained by societal norms. However, these privileges were and are enjoyed by a relatively few musicians; the usual lot of the musician is the frustration of the under-appreciated and under-paid artist. Both the frustrations and privileges have contributed to musicians falling prey to, as Sartin puts it, “risky lifestyles”. It is probably equally true to say that the stresses and demands to be creative and “expand the mind” or relax the nerves provide additional incentives to seek risky release. Sartin’s engaging narrative should not be read as a dry history text or as an exercise in decoding past and current musicians’ individual foibles and illnesses. There is public health and clinical relevance here, whether in the provision of information to aspiring musicians, the use of star musicians in public health campaigns, or the realization, via the suffering of our mortal idols, that infectious disease affects us all.

AN EARLY DECLINE IN INSULIN-LIKE GROWTH FACTOR-1 OF YOUNG AFRICANS PREDISPOSE THEM TO EARLY CARDIOVASCULAR DISEASE ONSET: PP.7.270

Objective: Low serum insulin-like growth factor-1 (IGF-1) is an independent risk factor for cardiovascular disease and diabetes. These noncommunicable diseases are extremely common in urban black South Africans, but their IGF-1 concentration is unknown. We aimed to compare serum IGF-1 concentrations of African and Caucasian people; to investigate their age-related IGF-1 decline and to determine whether IGF-1 could account, at least in part, for the high prevalence of noncommunicable diseases in black Africans. Design and Methods: This cross-sectional study involved 211 African and 316 Caucasian men and women (aged 20–70 yrs). Fasting glucose, insulin, lipids, albumin, creatinine, liver enzymes, cotinine, high-sensitivity C-reactive protein (hsCRP), reactive oxygen species (ROS), IGF-1, blood pressure (BP) and pulse wave velocity (PWV) were determined.Results: IGF-1 was lower in the Africans (P < 0.001), and in both ethnicities IGF-1 declined significantly when comparing age quartiles. But in African men and women IGF-1 declined significantly from age quartile 1 to 2 (r = -0.65, P < 0.001 for both), not seen in young Caucasian men and women (r = -0.08, P = 0.45; r = -0.10, P = 0.34). This was confirmed after adjustment for BP, insulin resistance, hsCRP, cotinine, ã-glutamyl transferase and ROS. Only young Africans showed significant negative correlations of IGF-1 with BP, PWV and HDL-cholesterol. Conclusions: Africans presented lower IGF-1 levels than Caucasians due to an accelerated decline in serum IGF-1 concentration prior to 40 years of age. Strong associations of low serum IGF-1 with arterial stiffness in young Africans suggest that the loss of cardiometabolic protection by IGF-1 could predispose them to earlier disease onset.

THE BURDEN OF CARDIOVASCULAR RISK FACTORS AMONG THE INHABITANTS OF AN URBAN CONGOLESE COMMUNITY: RESULTS OF THE VITARAA STUDY: PP.7.291

Objective: To assess cardiovascular risk profile in an urban Congolese population. Design and Methods: We obtained anthropometric measurements and information on gender, ethnic group, life habits, medical history and use of medication for chronic diseases in a random sample of an urban Congolese community ≥10 years (n = 1823). We recorded blood pressure, pulse rate and determined proteinuria, plasma glucose and lipids. We assessed cardiovascular risk factors by body mass index status and modeled the probability of diabetes and hypertension using logistic regression analysis. Results: In 1287 adults ≥20 years, (727 women; 54.5%) 92.1% had cardiovascular risk factors. The prevalence of risk factors was 30.8% for hypertension, 4.8% for diabetes, 5.5% for smoking, 42.2% for overweight/obesity, 28.0% for abdominal obesity, 4.6% for proteinuria and 18.7% for hypercholesterolemia. Smoking predominated among men, obesity and hypercholesterolemia among women. Rarely isolated condition hypertension clustered with three or more risk factors or co-morbid conditions in 68.8% with no ethnic difference. Overweight/obese participants had higher (P < 0.001) prevalence of hypertension, diabetes, central obesity and hypercholesterolemia. In multivariable-adjusted analysis, the probability of diabetes was increased by overweight/obesity (OR 2.39; 95% CI [1.28–4.45];P = 0.006), hypertension (2.24 [1.25–4.01];P < 0.0001) and hypercholes-terolemia (1.85 [1.01–3.41];P = 0.048); that of hypertension by age (for age≥55 years 6.25 [4.11C9.50];P < 0.001), pulse rate (1.02 [1.003C1.033];P < 0.05), male gender (1.57 [1.13C2.17];P < 0.01), overweight/obesity (1.54 [1.09–2.17];P < 0.05), central obesity (2.41 [1.63C3.57];P < 0.001) and diabetes (1.90 [1.03C3.50];P < 0.05). 47.3% were aware of their hypertension, 18.4% were controlled. The control was better among women and the young patients, it was lower in the overweight/obese. Conclusion: The burden of uncontrolled risk factors in urban Africans emphasizes that control and prevention of cardiovascular disease should deserve more attention on the political agenda in sub-Saharan Africa.

The association between anthropometric parameters, the metabolic syndrome and microalbuminuria in black Africans: the SABPA study.

We aimed to determine which surface anthropometric and metabolic syndrome (MS) markers could be associated with the development of microalbuminuria (MA), and assessed 200 urban Africans (25-60 years) stratified into low (< or = 0.90 and < or = 0.85) and high ( > 0.90 and > 0.85) waist-tohip ratio (WHR) groups from the North-West province. Anthropometric and fasting MS markers, such as systolic and diastolic blood pressure (BP), and glucose, triglyceride (TG) and high-density lipoprotein (HDL) levels, as well as MA markers were measured. Males revealed higher lifestyle risk factors (body mass index, smoking, alcohol consumption, low physical activity), anthropometric and MS markers compared to the females. The same overall trend was seen for high-WHR males but not for high-WHR females compared to their low-WHR counterparts. Both high-WHR groups revealed increased glucose values (males, 6.34 mmol/l; females, 6.13 mmol/l). Multiple linear regression analysis, independent of confounders, showed positive associations between diastolic blood pressure (DBP) (high WHR and all males), TG, waist circumference (WC) and development of MA in all males. In high-WHR females, positive associations existed only between WC and the development of MA, while neck circumference (NC) was associated with MA development in all females. To conclude, vascular BP, TG and WC were associated with risk of renal impairment in males, while in females, NC and WC circumferences were associated with this risk.

HIV neuropathy in South Africans: Frequency, characteristics, and risk factors

The purpose was to estimate the frequency, characteristics, and risk factors of HIV-associated distal sensory polyneuropathy (DSP) among South Africans who attend an urban community-based clinic. In a cross-sectional study, neuropathy status was determined in 598 HIV-infected adults using validated tools (Brief Peripheral Neuropathy Screen and a modified version of the Total Neuropathy Score) to categorize subjects as DSP versus no DSP. Symptomatic DSP (SDSP) required the presence of at least two neuropathic signs together with symptoms. Clinical, anthropometric, and laboratory evaluations were prospectively performed. CD4 counts, antiretroviral therapy (ART), and questionnaires regarding previous tuberculosis (TB) and alcohol exposure were collected retrospectively. Approximately half (49%) of the study population were diagnosed with DSP, and 30% of the study population were diagnosed with SDSP. In multivariate analyses the odds ratio (OR) (95% confidence interval) of DSP were independently associated with ART use (OR 1.7, 1.0-2.9), age (per 10 year increment) (OR 1.7, 1.4-2.2), and prior TB (OR 2.0, 1.3-3.0). Pain or paresthesias were reported as moderately severe by 70% of those with SDSP. Stavudine use was significantly associated with DSP. DSP is a clinically significant problem in urban HIV-infected Africans. Our findings raise the possibility that the incidence of DSP may be reduced with avoidance of stavudine-containing regimens in older subjects, especially with a history of prior TB infection.

A Significant Decline in IGF-I May Predispose Young Africans to Subsequent Cardiometabolic Vulnerability

Low serum IGF-I is an independent risk factor for diabetes and cardiovascular disease. These noncommunicable diseases are extremely common in urban black South Africans, but their IGF-I concentration is unknown. We aimed to compare serum IGF-I concentrations of African and Caucasian people, investigate their age-related IGF-I decline, and determine whether IGF-I could account, at least in part, for the high prevalence of noncommunicable diseases in black Africans. This cross-sectional study involved 211 African and 316 Caucasian men and women (aged 20-70 yr). Fasting glucose, insulin, lipids, albumin, creatinine, liver enzymes, cotinine, high-sensitivity C-reactive protein, reactive oxygen species, IGF-I, blood pressure (BP), and pulse wave velocity were determined. IGF-I was lower in Africans (P < 0.001) and in both ethnicities declined significantly by age quartiles (P < 0.001). In African men and women, IGF-I declined significantly from age quartile 1 to 2 (r = -0.65, P < 0.001), not seen in young Caucasian men and women (r = -0.08, P = 0.45; r = -0.10, P = 0.34). This was confirmed after adjustment for BP, insulin resistance, high-sensitivity C-reactive protein, cotinine, gamma-glutamyl transferase, and reactive oxygen species. Only young Africans showed significant negative correlations of IGF-I with BP, pulse wave velocity, and high-density lipoprotein cholesterol. Africans presented lower IGF-I levels than Caucasians due to an accelerated decline in serum IGF-I concentration prior to 40 yr of age. Strong associations of low serum IGF-I with blood pressure and arterial stiffness in young Africans suggest that the loss of cardiometabolic protection by IGF-I could predispose them to earlier disease onset.

Comparison between surrogate indices of insulin sensitivity and resistance, and the hyperinsulinaemic euglycaemic glucose clamp in urban South African blacks with and without coronary artery disease

Coronary artery disease (CAD) and diabetes mellitus (DM) are increasing in urban black South Africans during their transition from a rural to a western lifestyle. Insulin resistance is associated with CAD and DM. Fasting-based indices [homeostasis model assessment of insulin resistance (HOMA IR), log HOMA IR, and quantitative insulin sensitivity check index (QUICKI)] were calculated and their correlations with the glucose disposal rate (M) obtained from the hyperinsulinaemic euglycaemic glucose clamp were compared in 40 patients with CAD and 20 patients without CAD. Normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and DM were categorised using the oral glucose tolerance test. M and QUICKI were lower in patients with CAD (p<0.0001 and p<0.02); HOMA IR and log HOMA IR were higher (p<0.02). M and QUICKI decreased and HOMA IR and log HOMA IR increased progressively across the NGT, IGT and DM categories in patients with and without CAD. Glucose concentrations increased across the glucose tolerance categories in patients with CAD (p<0.001) and without CAD (p<0.01). Linear regression analysis revealed significant correlations between M and log HOMA IR (r=-0.3412; p<0.02) and QUICKI (r=0.4078; p<0.003), and between waist circumference (WC) and log HOMA IR (r=0.4637) and QUICKI (r=-0.4680) both p<0.001. We concluded that patients with CAD were more insulin resistant than patients without CAD. As glucose tolerance declined, insulin resistance worsened. Log HOMA IR and QUICKI were comparable to the hyperinsulinaemic euglycaemic glucose clamp and these surrogate indices provided a valid method to estimate insulin sensitivity/resistance in our patients.

The clinical consequences and challenges of hypertension in urban-dwelling black Africans: Insights from the Heart of Soweto Study

There is a paucity of data to describe advanced forms of cardiovascular disease (CVD) in urban black Africans with hypertension (HT). Chris Hani Baragwanath Hospital services the black African community of 1.1 million people in Soweto, South Africa. We prospectively collected detailed demographic and clinical data from all de novo presentations to the hospital's Cardiology Unit in 2006. Overall, 761 black African patients (56% of de novo cases) presented with a diagnosis of HT with more women (63%, aged 58.5±14.9 years) than men (aged 58.0±15.6 years). On presentation, 396 women (82%) versus 187 men (67%) had dizziness, palpitations and/or chest pain (OR 1.23, 95% 1.12-1.34: p<0.0001). HT was the primary diagnosis in 266 cases (35%). In the rest (n=495), non-ischaemic forms of heart failure were common (54% of total) while only 6.2% had coronary artery disease. Concurrent left ventricular hypertrophy, renal dysfunction and anaemia were present in 39%, 24% and 11% of cases, respectively, with a similar age-adjusted pattern of co-morbidity according to sex. However, men were more likely to present with impaired systolic function (OR 2.13, 95% CI 1.50 to 3.00; p<0.0001). In the absence of effective primary and secondary prevention strategies, these unique data highlight the potentially devastating impact of advanced forms of hypertensive heart disease in urban black African communities with more women than men affected.

Leptin, Adiponectin, and High-Sensitivity C-Reactive Protein in Relation to the Metabolic Syndrome in Urban South African Blacks With and Without Coronary Artery Disease

Metabolic syndrome and coronary artery disease (CAD) are increasing in urban black South Africans during their transition from a rural to a western lifestyle. Inflammation is frequently associated with metabolic syndrome and CAD. This study evaluated markers of inflammation in black CAD patients, some of whom had metabolic syndrome. Metabolic syndrome was defined according to International Diabetes Federation criteria. Inflammatory markers leptin, adiponectin, and high-sensitivity C-reactive protein (hs-CRP) were measured in 40 patients and 20 control subjects. Metabolic syndrome was present in 23 patients and absent in 17 patients. Leptin was the only significantly higher marker in patients with metabolic syndrome compared to patients without metabolic syndrome (P < 0.01). Leptin was higher in women than men (P < 0.01) and higher in both genders with metabolic syndrome (P < 0.03 and P < 0.04, respectively). Leptin levels rose significantly with increasing metabolic syndrome criteria (P < 0.05). hs-CRP concentrations were elevated in both patient groups. Positive correlations were found between leptin and body mass index (BMI) (r = 0.7107; P < 0.0001), waist circumference (WC) (r = 0.4981; P <0.002), and hs-CRP (r = 0.3886; P < 0.02). Leptin differentiated between CAD patients with and without metabolic syndrome and determined metabolic syndrome status in women and men. Leptin was the only marker that increased with additional metabolic syndrome criteria. Elevated hs-CRP concentrations may indicate a low-grade inflammatory state in CAD patients. Association of leptin with BMI, WC, and hs-CRP revealed a close link with metabolic syndrome, obesity, and inflammation in urban black South African CAD patients.

Local Politics and the Dynamics of Property in Africa, Christian Lund

Reviewed by: Local Politics and the Dynamics of Property in Africa Dawn M. Whitehead Lund, Christian. 2008. Local Politics and the Dynamics of Property in Africa. New York: Cambridge University Press. 200 pp. Christian Lund’s book, Local Politics and the Dynamics of Property in Africa, makes a significant contribution to the fertile field of the anthropology of politics on the African continent, particularly in Ghana, a stable West African country. With access to a rich array of research sources, Lund has used multiple microhistories of conflict to offer a lucid discussion of land and indigenous politics in the northeastern (or Upper-East) part of Ghana. This publication, an original study of property disputes in general, offers its users information on politics and the state in that area of Ghana, which well deserves the exposure being provided. [End Page 126] Dr. Lund is a member of the Social Science Research Council in Denmark and the Director of Roskilde University’s Graduate School in International Development Studies. He shows in this book how access to land is vital to the livelihoods of rural and urban Africans. As he points out, individuals have recourse to a variety of political, administrative, and legal institutions to exert energy and imagination to getting their land claims recognized as rights. This study provides researchers, students, and general readers with detailed discussion of how public authority and the state are formed in the context of debates and struggles over property. It explores how the 1979 state divestiture of land encouraged competition between customary authorities and other institutions, including what is known as the earth-priest. As Lund concludes, such processes are the key to understanding the notion of property in Africa. For a meaningful articulation of the nuances of property in this part of Ghana, Lund provides his readers nine useful chapters, beginning with an introduction that begins with a quote from Samuel Beckett: “Any fool can turn the blind eye. But who knows what the ostrich sees in the sand?” (p. 1). Lund begins with an account of a petition for compensation for the taking of farmlands at Pabaga-Damweo Residential Area of the Ghanaian Upper-East. He shows that the land on which the local police station was built was seized, but “not legally acquired by the government” (p. 1). Citizens, to express anger for what they saw as theft, claimed the land back by cultivating the grounds of the police station—a bold act, which led to a compromise with the National Bureau of National Investigation (BNI), to the effect that “the local population can grow only low crops, enabling the police to have a clear view from the buildings” (p. 2). Lund, in detail, looks at several aspects of the land issues in lively and sophisticated discussions, which touch on the incongruities of the situation, coupled with the history of land policies in the area (chapter 2); the ownership of the major city of Bolgatanga (chapter 3); chieftaincy, land, and local administration (chapter 4); land conflicts and their settlement (chapter 5); Bawku and its volatility (chapter 6); rent and access to forest resources (chapter 7); small dams and fluid tenure (chapter 8); and the conclusion, in which Lund discusses structural patterns, processual patterns, organization, and technology (chapter 9). This book is basically about property disputes in their sociohistorical contexts, but Lund goes further to provide information on how interest in African land tenure has reemerged, with several international organizations, including the World Bank, as the principal actors. Toward these ends, he points out how property and public authority are mutually constitutive and contingent: “Where land tenure is fluid and the range of public authorities considerable, landed property as well as political institutions become highly negotiable and the object of local politics” (p. 174). For readers to appreciate unfamiliar terminologies, Lund explains in minute detail how patterns are not restricted to structural outcomes, but [End Page 127] “can equally be identified in the processual dynamics of property” (p. 178). This, in fact, is a book that will benefit academics (including researchers), students, and general readers. Dawn M. Whitehead Indiana University–Purdue University Indianapolis (IUPUI) Copyright © 2009 Indiana University Press

Postprandial Hyperglycemia in Urban South African Blacks with and without Coronary Artery Disease

Coronary artery disease (CAD) is increasing in urban black South Africans during their transition from a rural to a western lifestyle. This study assessed postprandial hyperglycemia, which a risk factor for CAD, in blacks with and without CAD. Fasting lipid levels and postprandial glucometabolic profiles were measured in 40 patients and 20 controls. Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM) were categorized according to American Diabetes Association criteria. Postprandial hyperglycemia was assessed by the oral glucose tolerance test (OGTT) and area under curve (AUC) analysis. Insulin resistance was evaluated by hyperinsulinemic euglycemic clamp (insulin-mediated glucose disposal, M-value). Glucose AUC was higher in patients than controls (p < 0.0001). Highest correlations were between AUC and 0-minute glucose (r = 0.7847; p < 0.0001), and 120-minute glucose (r = 0.9187; p < 0.0001). Patients had higher fasting and postprandial glucose responses (p < 0.05). Glucose concentrations increased among NGT, IGT, and DM categories in patients (p < 0.001) and controls (p < 0.01). Abnormal glucose tolerance was more prevalent in patients (50%) than controls (40%). M-values were lower in patients (p < 0.0001) and decreased between categories, significantly in DM patients (p < 0.02). More patients (70%) than controls (13%) had low M-values (p < 0.001). Postprandial hyperglycemia was common in black CAD patients and glucose concentrations at 0 minute and 120 minutes were the strongest determinants. As glucose tolerance declined, glycemic control deteriorated and insulin resistance worsened. Abnormal glucose tolerance and insulin resistance were more prevalent in patients with CAD.

Male–female differences in the genetic regulation of t-PA and PAI-1 levels in a Ghanaian population

Tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) directly influence thrombus formation and degradation, and have been identified as risk factors for thromboembolic disease. Prior studies investigated determinants of t-PA and PAI-1 expression, but mainly in Caucasian subjects. The aim of this study was to identify the contributions of genetic and other factors to inter-individual variation in plasma levels of t-PA and PAI-1 in a large-scale population-based sample from urban West Africa. t-PA, PAI-1 and several demographic, anthropometric, and metabolic parameters were measured in 992 residents of Sunyani, the capital of the Brong-Ahafo region of Ghana. In addition, nine gene polymorphisms associated with components of the renin-angiotensin and fibrinolytic systems were determined. We found that BMI, systolic and diastolic blood pressure, total cholesterol, glucose, and triglycerides were all significant predictors of t-PA and PAI-1 in both females and males. In addition, a significant relationship was found between the PAI-1 4G/5G (rs1799768) polymorphism on PAI-1 levels in females, the TPA I/D (rs4646972) polymorphism on t-PA and PAI-1 in males, the renin (rs3730103) polymorphism on t-PA and PAI-1 in males, the ethanolamine kinase 2 (rs1917542) polymorphism on PAI-1 in males, and the renin (rs1464816) polymorphism on t-PA in females and on PAI-1 in males. This study of urban West Africans shows that t-PA and PAI-1 levels are determined by both genetic loci of the fibrinolytic and renin-angiotensin systems and other factors often associated with cardiovascular disease, and that genetic factors differ between males and females.

Coping with urbanization: A cardiometabolic risk?: The THUSA study

An assessment of specific coping styles in rural–urban Africans is done to evaluate its contribution as cardiometabolic risk factor. In total, 608 apparently healthy Africans were included in a cross-sectional comparative study from the North-West Province in South Africa. The adapted and translated COPE Questionnaire classified participants according to their responses into active (AC) or passive (PC) copers. Fasting resting metabolic syndrome (MS) indicators using the WHO definition (glucose, high density lipoproteins, waist/hip ratio, hypertension prevalence, and triglyceride) and associated MS values, i.e. fibrinogen were obtained. The Finapres recorded resting blood pressure continuously. Co-variates for all statistical analyses included age, body mass index (BMI) and lifestyle factors (alcohol consumption, smoking habits and physical activity). The only MS values prevalent in urbanized participants were higher hypertension prevalence rates and fibrinogen (women only) compared to their rural counterparts. Adding coping styles, it was mainly the urbanized AC participants that indicated higher MS values (hypertension prevalence, glucose and fibrinogen) when compared to their rural and PC counterparts. In conclusion, urbanization is associated with enhanced blood pressure and fibrinogen (women) values only. Coping as cardiometabolic risk is accentuated in the urbanized AC group, especially the men. The urbanized AC group with their higher blood pressure values and more MS indicators appears to have behaviorally an AC style but physiologically a dissociated AC style.