Urban Africans Research Articles

Determinants of Target Organ Damage in Black Hypertensive Patients Attending Primary Health Care Services in Cape Town: The Hi-Hi Study

In South Africa (SA) cardiovascular disease (CVD) is the second leading cause of death, with hypertension (HTN) being the predominant contributor to morbidity and mortality associated with this disease. We examined the prevalence and determinants of target organ damage (TOD) among urban black hypertensive South Africans attending primary health-care (PHC) services in Cape Town. Patients on HTN treatment, 35-65 years of age, participated in this cross-sectional study. Data relating to sociodemographic factors, medical history, lifestyle patterns, and HTN care regimens were obtained. Blood and urine samples were analyzed and electrocardiographs (ECGs) were recorded. Sokolow-Lyon and Minnesota Code (MC) criteria were used for identifying left ventricular hypertrophy (LVH). Reduced creatinine clearance (Cockroft-Gault), microalbuminuria, proteinuria, and elevated serum creatinine levels were used for identifying "renal impairment by any criteria" (RIC). Ischemic ECG patterns were classified in terms of MC criteria. Multivariate logistic regression analyses were carried out to identify variables independently associated with TOD. The study sample comprised 403 participants. RIC was identified in 26%, LVH in 35%, and ischemic ECG patterns in 49% of the participants. Uncontrolled HTN and an absence of diabetes were associated with LVH as per Sokolow-Lyon criteria. Older age, the presence of diabetes, and the use of beta-blockers were associated with RIC. Ischemic ECG patterns were associated with uncontrolled HTN, older age, male gender, the consumption of less alcohol, and higher levels of low-density lipoprotein cholesterol (LDL-C). TOD is common in this group of black hypertensive patients attending PHC sites. Uncontrolled HTN and older age were most often associated with TOD. Reducing the burden of TOD will require improving the quality of HTN care in PHC settings.

Linolenic acid and folate in wild-growing African dark leafy vegetables (morogo)

Transition from a low-fat vegetable-rich rural diet to a high-fat Westernised diet is considered a factor in the escalating occurrence of vascular-related diseases and type 2 diabetes in urban black South Africans. Consumption of morogo is a distinguishing feature of rural African diets. To determine fatty acid profiles and folate contents of three widely consumed, wild-growing, African dark green leafy vegetables (morogo). GC-MS was applied for analysis of fatty acid composition and a validated microbiological assay conducted to determine folic acid contents of wild-growing morogo sampled from deep rural villages in three different geographical regions of South Africa. Measured fatty acids ranged from 1610.2 to 2941.6 mg/100 g dry mass, with PUFA concentrations 1.4 to 2.8 times those of SFA. Calculated from the relative percentages of linoleic acid (18:2n-6) and linolenic acid (18:3n-3), the ratio of 18:2n-6 to 18:3n-3 PUFA was 1.0:3.4 to 1.0:8.9. The only MUFA was palmitoleic acid (16:1), measured at 34.7 (sd 0.3) to 79.0 (sd 9.3) mg/100 g dry mass, and the predominant SFA was palmitic acid (16:0), measured at 420.6 (sd 83.3) to 662.0 (sd 21.2) mg/100 g dry mass. Folic acid concentration varied from 72 to 217 microg/100 g fresh sample. Morogo is low-fat food item high in folate and with 18:3n-3 in excess of 18:2n-6, the proposed anti-inflammatory effects of which may lower risks of vascular-related chronic diseases and type 2 diabetes.

Erratum: Effects of tobacco smoking on cancer and cardiovascular disease in urban black South Africans

Erratum: Effects of tobacco smoking on cancer and cardiovascular disease in urban black South Africans

Effects of tobacco smoking on cancer and cardiovascular disease in urban black South Africans

Demographic and lifestyle information from 9690 black patients diagnosed with cancer or cardiovascular disease was collected in an ongoing case–control study in Johannesburg, South Africa. Compared to never smokers, the odds ratio (OR) for lung cancer among current smokers was 16.3 (95% confidence interval (CI), 9.6–27.6) for men and 6.4 (95% CI, 4.0–10.4) for women. The corresponding OR for other smoking-related cancers was 4.6 (95% CI, 3.7–5.7) among men and 1.9 (95% CI, 1.6–2.2) among women, and for cardiovascular disease, 3.4 (95% CI, 2.1–5.4) among men and 1.5 (95% CI, 1.1–2.1) among women. Risks were higher among smokers than former smokers, and all risk estimates increased with increasing levels of smoking duration and intensity. Non-electric domestic fuel was associated with approximately 60% increase in the risk of smoking-related cancer, but not cardiovascular disease. Risks for cancers of cervix, oesophagus, oral cavity/pharynx, stomach, larynx, pancreas and anogenital region, as well as squamous cell carcinoma of skin were all significantly higher among current than never-smokers, with ORs ranging from 1.5 for cervix (95% CI, 1.2–1.8) to 14.7 for larynx (95% CI, 7.2–30). The risks of tobacco-related disease reported here are similar to that currently observed in Western countries, even though cigarette consumption is relatively low in this population.

Nutrition and hemostasis: A focus on urbanization in South Africa

South Africa is experiencing a rapid urbanization of its African population characterized by a demographic, nutrition, lifestyle, and health transition. The resultant high prevalence of high cardiovascular disease, in particular of stroke, is of concern. In this narrative review it is suggested that, together with hypertension, changes in the hemostatic system may be one of the major contributors to stroke in this population. It is further suggested that these changes are related to increased fat and animal protein intakes, decreased intakes of total carbohydrate and dietary fiber, as well as persistent suboptimal micronutrient intakes of Africans in transition. The effects of this nutrition transition on plasma fibrinogen, fibrin network structures, plasminogen activator inhibitor 1 activity levels and some other clotting and fibrinolytic factors are discussed. It is concluded that despite indications of present protective mechanisms against the development of coronary heart disease (CHD) in this population the observed changes in diet and hemostatic profiles may eventually lead to a high prevalence of both stroke and CHD in urban black South Africans. It is further suggested that timely nutritional interventions and research of effects thereof on the hemostatic system are urgently needed.

Prevalence of Obesity and Hypertension in Urban and Rural Communities: A Comparison of South African and Australian Risk Factor Prevalence Data

Conclusions: These unique data confirm the importance of HT as a precursor to advanced forms of HD in urban black Africans. doi:10.1016/j.hlc.2008.05.050

Prevalence and risk factors of arternal hypertension among urban Africans workplace: The obsolete role of body mass index

Studies on the prevalence of hypertension among Africans in workplace did not deal with risk factors of hypertension. Thus there is a need to screen urban central Africans at workplace for environmental risk factors of hypertension. A cross-sectional survey was conducted at the Kinshasa National Company of Electricity. A representative sample of 333 employees was screened. Tobacco, alcohol use and level of physical activity measures were obtained. Weight, height, BMI, waist, hip, conicity, blood pressure, pulse pressure and pulse rate were measured. Data were analysed using univariate and multivariate statistics. The prevalence of hypertension was 21.3%. Hypertension was associated with aging, higher professional position, eastern origin, migration, alcohol use, wider pulse pressure >60 mmHg, wider waist >90 cm, wider hip >97 cm, obesity, and left ventricle hypertrophy Independent predictors of hypertension were age, wider waist, wider hip, alcohol intake, and left ventricle hypertrophy. In another logistic regression model, only waist >90 cm (OR = 2.5 C1 95% 1.3-4.9; p < 0.01) and age =55 years were identified as significant predictors of hypertension. There is a need to stop this high prevalence of hypertension significantly predicted by higher waist and age. BMI is inefficient to predict hypertension.

JOHANNESBURG LUNCH-HOUR 1951–1963

Framing the concerns of this paper are two short photographic essays published in Drum, a South African picture magazine modelled on the British Picture Post and the US Life. Both essays take as their subject the activities of black South Africans during a typical lunch-hour in Johannesburg; the first was published (un-credited) in September 1951, the second by Peter Magubane was published in July 1963. I argue that they represent the beginning and the endpoint in the development of, and possibilities for, a particular genre of photography in South Africa: a highpoint for post-war humanist photography. “Johannesburg Lunch-Hour” is the first photographic essay of its kind to be published in Drum, which up until that point had taken a largely paternalistic attitude towards its black audience. This essay signalled a new focus on the lives of “ordinary” urban Africans, and a more creative and vibrant practice of photography. “Lunch-Hour: A Photographic Essay”, although almost identical in theme and style, was published in a period of tightening apartheid legislation and increasingly brutal repression, which impacted on photographic practice and publishing—by April 1965 Drum had ceased publication as an independent monthly magazine. The paper is part of a larger study to research the development of social documentary photography in Drum, to examine its main themes and characteristics, and consider the social vision it projected. The paper is based on archival research and interviews with Drum photographers and editors.

Urban Africa: Changing contours of survival in the city, edited by AbdouMaliq Simone and Abdelghani Abouhani

This edited volume is one of six books published or forthcoming within Codesria's exciting series on ‘Africa in the New Millennium’. Scholars from across the continent produced its 10 chapters. As is often the case with Codesria projects, the book works hard to overcome the major linguistic divide of Africanist social science by bringing together in one volume both Anglophone and Francophone urban studies. Although the book itself is entirely in English, most of its authors come out of Francophone scholarship—which is unsurprising given the generally stronger tradition of African urban studies in French. The organizing framework is one that sees African cities as laboratories of change that embody the ‘determination of urban Africans to find their own way’ (p. 1), with two sections—the first on making urban politics and the second on urban social practices. The volume covers an eclectic combination of cities—some familiar stopping points for African urban studies (i.e. Cairo, Addis Ababa or Cape Town), and some cities rarely subject to wider scholarly analysis, at least in recent literature (such as Zaria, Jos or Kisangani).

Hypertension in Sub-Saharan African Populations

Hypertension in sub-Saharan Africa is a widespread problem of immense economic importance because of its high prevalence in urban areas, its frequent underdiagnosis, and the severity of its complications. We searched PubMed and relevant journals for words in the title of this article. Among the major problems in making headway toward better detection and treatment are the limited resources of many African countries. Relatively recent environmental changes seem to be adverse. Mass migration from rural to periurban and urban areas probably accounts, at least in part, for the high incidence of hypertension in urban black Africans. In the remaining semirural areas, inroads in lifestyle changes associated with "civilization" may explain the apparently rising prevalence of hypertension. Overall, significant segments of the African population are still afflicted by severe poverty, famine, and civil strife, making the overall prevalence of hypertension difficult to determine. Black South Africans have a stroke rate twice as high as that of whites. Two lifestyle changes that are feasible and should help to stem the epidemic of hypertension in Africa are a decreased salt intake and decreased obesity, especially in women. Overall, differences from whites in etiology and therapeutic responses in sub-Saharan African populations are graded and overlapping rather than absolute. Further studies are needed on black Africans, who may (or may not) be genetically and environmentally different from black Americans and from each other in different parts of this vast continent.

Reconstructing ‘Home’ in Apartheid Cape Town: African Women and the Process of Settlement

This article concerns itself with home improvements – both as internalised process and externally visible practice – in African households in Cape Town, South Africa, under apartheid (1948–1994). It is argued that a historical analysis of home improvement provides an important portrayal not only of the structural changes to the homes in which urban Africans lived, but also of the underlying processes of settlement they undertook. The collection of trans-generational oral testimonies from 32 respondents across three generations of African women in selected households is central to the analysis, affording an original and nuanced view of both gendered and generational dynamics. This oral evidence is used in conjunction with written chronologies and schematically-drawn floor plans that detail renovations of predominantly City Council housing. The research indicates that Africans, and notably African women, did indeed ‘grow’ and improve their houses in particular ways, which in turn tended to reflect distinct historical trajectories. For example, ‘first-generation’ African women's choice of renovations in the early years of their residence in these council homes reflected both their need to fashion dwellings along very basic standards of comfort and respectability, and their hesitations over the insecurity of their tenure at the height of coercive state legislation. The ambitious scope of the expansion projects they undertook in the waning years of apartheid attested to a growing affirmation of their rootedness in the city, as homes increasingly became markers of first-generation women's urbanising selves. In contrast, in a radically altered political and social environment, younger generations developed differing notions of housing requirement and housing need. More distanced from community-based networks and more attuned to the benefits afforded by mobility in a broader sense, third-generation women freely contemplated and enthusiastically embraced future movement to other parts of the city or even to other urban areas.

What gestures do: Some communicative functions of quotable gestures in conversations among Black urban South Africans

Using video-recordings of spontaneous conversations among Black urban South Africans, the use of three quotable gestures/emblems is analyzed. Characteristics of their use in relation to speech are established showing that quotable gestures are multifunctional, and fulfill substantive, interactive, and discourse functions simultaneously. Implications for theories on the relationship between gesture and speech and processes of speech–gesture production are discussed. Data presented suggest that the Growth Point model of speech–gesture production has the most explanatory power, but it needs to extend the central notion of context to fully explain the nature of gestural behavior. Questions related to the emergence of quotable gestures in terms of origin, conventionalization, and detachability from speech, the relationship of quotable gestures to other forms of gesture, and the categorization of gestures into gestural typologies are also addressed.

The Importance and Motivational Content of Money Attitudes: South Africans with Living Standards Similar to Those in Industrialised Western Countries

Long neglected in psychological research, money attitudes influence consumer decisionmaking and information processing, and may be active whenever consumers contemplate money situations or exchange relations. This study focused on the money attitudes of 221 urban South Africans whose standards of living are similar to those in industrialised Western countries. A recently developed pan-cultural theory on human values is used to gain insights into the fundamental motivations of money attitudes. The results suggest that money attitudes and value priorities have predictable and theoretically meaningful relations and provide evidence supporting the nomological validity of the revised Money Attitude Scale (MAS). Confirmatory analyses support the five-factor structure of the MAS scale and the hypothesised structure of the Portrait Values Questionnaire. Five new money attitudes are proposed for future research to broaden the scope of the MAS and refine its measurement.

A Repertoire of South African Quotable Gestures

Among black urban South Africans in Gauteng province, quotable gestures are a prominent part of everyday communication. Using observations and video recordings of spontaneous communicative interactions, elicitation interviews, and a decoding test, this study presents the repertoire of quotable gestures in current use. Quotable gestures fall within three main gestural types: lexical, holophrastic, and concept, with lexical gestures constituting the highest proportion. Within each gestural type, gestures vary in their range of meanings, functions, and independence from speech. This variation suggests that sharp distinctions between gestural types and between quotable and speech‐dependent gestures may obscure continuities in meaning, function, and how gestures originate and develop. The article discusses recent work that suggests alternative organizational criteria for the analysis of gestures. It proposes that analysis of gestures begin at the level of interaction, taking into account how social relationships, cultural notions, and identity shape forms of gestural use and behavior.

Some puzzling situations in the onset, occurrence and future of coronary heart disease in developed and developing populations, particularly such in sub-Saharan Africa.

Coronary heart disease (CHD) was rare in developed populations until the early 1900s; this prevailed even among the small segments who were prosperous and who, in measure, had most of the currently recognised risk factors. However, in the 1930s, with improved circumstances from general rises in socio-economic state, there were major increases in the occurrence and mortality rate from the disease, the latter reaching a third of the total mortality in some countries, as in the United Kingdom (UK). Puzzlingly, the inter-population diversity of the increases in CHD has been such that there are as much as five fold differences in CHD mortality rates, as, for example, between Poland and Spain. Within recent years, with appropriate treatments, the mortality rate has halved in some countries, again, as in the UK. However, the incidence rate of the disease has diminished little or hardly at all. Risk factors include a familial component and, nutritionally, over-eating, a high fat intake, relatively low intakes of plant foods, especially of vegetables and fruit and, non-nutritionally, smoking, excessive alcohol consumption and a low level of everyday physical activity. On the one hand, known risk factors, broadly, are considered to be capable of explaining only about half of the variation in the occurrence of the disease. Even at present, known risk factors far from fully explain the epidemiological differences in mortality rates. Yet, on the other hand, there is abundant evidence that in population groups, among whom risk factors are low or have been reduced, CHD incidence and mortality rates are lower. Notwithstanding this knowledge, broadly, there is very little interest in the general public in taking avoiding measures. As to the situation in developing populations, in sub-Saharan Africa, in urban Africans, as in Johannesburg, South Africa, despite considerable westernisation of life style and with rises in risk factors, CHD remains of very low occurrence, the situation thereby resembling, historically, its relatively slow emergence in developed populations. In most eastern countries, mortality rates remain relatively low, as in Russia and Japan. However, in major contrast, in India, rates have risen considerably in urban dwellers. Indeed, in Indian immigrants, as in those in the UK, their rate actually exceeds that in the country's white population. In brief, much remains to be explained in the epidemiology of the disease.

Dueling Bands and Good Girls: Gender, Music, and Nation in Luanda's Musseques, 1961-1974

Luanda is known for its late-night parties (or farras) that trail into the wee hours and include a bowl of muzongue (fish broth with pieces of cassava, fish, and chili peppers eaten in order to counteract the impending exhaustion and hangover). On November 11, 2001, the twenty-sixth anniversary of Angola's independence, I was invited to an event called Caldo de Dipanda (Independence Broth) that was to begin at 7 a.m. at the National Radio Station. It was a special independence day version of a bi-monthly live broadcast event hosted by a Sunday morning radio show (Caldo de Poeira, or Dust Broth) where they invite musicians of the older generation to gather, play music together, eat, and reminisce. My fiance (now husband) and I and a friend, tambourine in hand, arrived half an hour after the scheduled beginning to find some 30 people already gathered. We were directed to a table and served typical Angolan dishes-beans with palm oil, muzongue, boiled cassava and sweet potato-and our choice of beverage. The emcee was already playing a variety of old tunes and inviting various musicians up to the stage to sing their golden oldies. Enthusiastic hugs and hellos abounded in the audience and people were obviously quite pleased to be together. Almost all the guests in attendance were musicians in their 50s or 60s and, with a few exceptions, they were all men. Younger women employees of the radio station were also present, but they were not guests-they served the food and danced with the band for particular songs. Of the eight well-known female singers and dancers' from this generation of artists four are still alive and in Luanda. But where were they? It was a national holiday, the national holiday after all, and this event was meant to celebrate the conjunction between this older generation of artists and independence. The point is not to commit the crime of anachronism, i.e., to draw any conclusions about what happened historically from this recent event. Women singers and dancers certainly existed in the 1960s and 1970s, even if fewer in number than their male counterparts. But the absence of these women artists might easily have overshadowed the male artists very happy to be there and to be together. So while I considered what I knew would be Susan Geiger's question for me (Where are the women?),2 my attention also came to settle on these men not as genderless representatives of the Angolan nation but specifically as Angolanos (Angolan men). What was the relation between masculinity, music, and the nation? How were musical production and the music scene gendered? What was the relationship between this gendered musical production and the nation, given that music from this period was and is deemed typically Angolan? This article explores the relationship between gender and the musical production of the nation in Luanda's musseques (urban shantytowns). Urban Africans took advantage of reforms in colonial policy instituted between 1961 and 1974 to improve their daily lives, carve out new cultural spaces, and create new artistic practices. The production of a local form of urban popular music, called semba, was at the forefront of this process. In the clubs where music was performed, at the parties where it was played, and in the production of the music itself, urban youth rearranged relations not only between themselves and the colonial state but between urban and rural societies, between members of the urban milieu, and between and among men and women. In so doing, they shaped the cultural basis of nation and thus implicated themselves in the political project of nationalism after 1974. I argue that the gendered dynamic of musical production and of the music scene helps account for a shift in the involvement of women as cultural producers and the ascendancy of a masculinist ethic at the moment when music became the salient cultural practice. In the mid- to late 1950s young women were actively involved in the politico-cultural groups that returned to local cultural roots and themes in order to spark political consciousness. …

End-stage renal disease in sub-Saharan and South Africa

The major health problems in Africa are AIDS, tuberculosis, malaria, gastroenteritis and hypertension; hypertension affects about 20% of the adult population. Renal disease, especially glomerular disease, is more prevalent in Africa and seems to be of a more severe form than that found in Western countries. The most common mode of presentation is the nephrotic syndrome, with the age of onset at five to eight years. It is estimated that 2 to 3% of medical admissions in tropical countries are due to renal-related complaints, the majority being the glomerulonephritides. There are no reliable statistics for ESRD in all African countries. Statistics of the South African Dialysis and Transplant Registry (SADTR) reflect the patients selected for renal replacement therapy (RRT) and do not accurately reflect the etiology of chronic renal failure (CRF), where public sector state facilities will offer RRT only to patients who are eligible for a transplant. In 1994, glomerulonephritis was recorded as the cause of ESRD in 1771 (52.1%) and hypertension in 1549 (45.6%) of patients by the SADTR. In a six-year study of 3632 patients with ESRD, based on SADTR statistics, hypertension was reported to be the cause of ESRD in 4.3% of whites, 34.6% of blacks, 20.9% mixed race group and 13.8% of Indians. Malignant hypertension is an important cause of morbidity and mortality among urban black South Africans, with hypertension accounting for 16% of all hospital admissions. In a ten-year study of 368 patients with chronic renal failure in Nigeria, the etiology of renal failure was undetermined in 62%. Of the remaining patients whose etiology was ascertained, hypertension accounted for 61%, diabetes mellitus for 11% and chronic glomerulonephritis for 5.9%. Patients with CRF constituted 10% of all medical admissions in this center. Chronic glomerulonephritis and hypertension are principal causes of CRF in tropical Africa and East Africa, together with diabetes mellitus and obstructive uropathy. The availability of dialysis and transplantation is quite variable in Africa: treatment rates in North Africa are 30 to 186.5 per million population (pmp) in countries with more established programs: Algeria 78.5; Egypt 129.3; Libya 30; Morocco 55.6; Tunisia 186.5 pmp. In South Africa, treatment rates of 99 pmp were reported; Dialysis and transplant programs in the rest of Africa are dependent on the availability of funding and donors. Services are still predominantly urban and therefore generally inaccessible to the poorer, less educated rural patient. There is not enough money for healthcare in the developing world, particularly for expensive and chronic treatment such as RRT. The goal should be to have a circumscribed chronic dialysis program, with as short a time on dialysis as possible, and to increase the availability of transplantation (both living donor and cadaver). Efforts should be made to optimize therapy of renal disease and renal failure globally and particularly in developing countries. Strategies should be developed to screen for and manage conditions such as hypertension and diabetes mellitus at the primary healthcare level in an effort to decrease the incidence of chronic renal failure. Increasingly, health is influenced by social and economic circumstances. Any improvements in health thus demand integrated, comprehensive action against all the determinants of ill health.

O clever ‘He’s streetwise.’ When gestures become quotable

Among urban black South Africans in the province of Gauteng, quotable gestures are a prominent feature of everyday communication. Most notable is a gesture commonly glossed as clever meaning ‘streetwise’ and ‘city slick.’ An analysis of the clever gesture in everyday communicative situations shows that it conveys a variety of meanings and functions related to the core paradigmatic meaning of ‘seeing’ and the core sociointeractional function of acceptance and inclusion. ‘Seeing’ is an important cultural value in black urban society particularly in relation to being clever. ‘Seeing’ is also the central characteristic of modern urban African identity in contrast to the ‘non-seeing’ rural, tribal, and primitive African. The clever gesture is a focused expression of this key social division within South African society. Consideration of the clever gesture in relation to its social role and the gestural repertoire suggests that key cultural concerns determine both quotable status and semantico-grammatical nature.

Psychosocial barriers to HIV-Antibody testing and sexual behaviour among urban Black South Africans

Psychosocial barriers to HIV-Antibody testing and sexual behaviour among urban Black South Africans

On the Worlding of African Cities

How do African urban residents, who are conventionally assumed to operate within parochial, highly localized confines, operate at larger scales? How do they reach a “larger world”? The article looks at some of the overall effects on African cities and their residents of a global process of scalar recomposition and the reconfiguration of social cohesion that ensues. By examining renovations in a traditional Islamic institution, zawiyyah, an example is provided of ways in which urban Africans attempt to act effectively within larger domains.