3. Electronic Theses and Dissertations (ETDs) - All submissions

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    Biokineticist and physiotherapist attitudes in Gauteng towards overweight and obese individuals
    (2017) Jordaan, Darrin Christopher
    Introduction. Obesity levels have doubled since the 1980s and health professionals have been documented to show weight bias and stigma towards these overweight individuals. Research in South Africa on weight bias has not as yet been conducted. This study aimed to examine bias and prejudice toward overweight and obese individuals in Biokineticists and Physiotherapists Methods. The Fat Phobia Scale (FPS) and The Attitudes Towards Obese Persons (ATOP) questionnaire were used to access bias and prejudice attitudes in the sample of Biokineticists and Physiotherapists. The FPS is a 14-item scale consisting of a five-point semantic differential scale. The ATOP is a 20 point questionnaire that requires a rating of a statement from -3 to +3. Results. A total of 223 Biokineticists and Physiotherapists in the study. Biokineticists were significantly more bias towards overweight and obese patients on both the FPS (p=0.04) and ATOP (p<0.01). Females were also shown to be more prejudice than men (p=0.01), and there was an inverse relationship between the BMI of the healthcare worker, and the fat phobia scale (p=0.02). Lastly, the amount of overweight/obese patients (p=0.56), the age of the healthcare professional (p=0.74) and years of practice did not appear to affect bias and prejudice in this study (p=0.13). Conclusion. These results provide a platform for future research into bias and prejudice for South African health professionals. Future research should include implicit bias and prejudice measures as this study only looked at explicit bias and prejudice.
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    The association between mode of delivery and early adulthood overweight or obesity in an urban South African birth cohort
    (2018) Sogunle, Eniola Olufunmilayo
    Background Obesity is an important public health problem and rates have reached epidemic proportions in many countries. South Africa has one of the highest rates of obesity in Africa, with about 38% of the population (and about 44% of adults) estimated to be overweight or obese in 2013. Caesarean section (CS) as a mode of child delivery has been reported to be associated with a low bacterial richness that predisposes infants to being overweight or obese; this early life deprivation is presumed to persist to adulthood. The aim of this study was to determine if mode of delivery is a predictor of early adulthood overweight or obesity. Methods This was a retrospective analysis of data that was collected from a prospective cohort study (Birth to Twenty Plus) established in 1990. A total of 889 young adults aged 21-24 years were included in the analysis. Pearson’s chi-square and Kruskal-Wallis tests were used to assess associations between covariates and BMI categories, and prevalence of overweight or obesity among young adults, across mode of delivery categories. Multiple logistic regression models were fitted to examine the association between mode of delivery and early adulthood overweight or obesity. Results Of the 889 participants, 793 (89.2%) were delivered vaginally, 24 (2.7%) were delivered by assisted VD, and 72 (8.1%) were delivered through CS. The numbers of overweight and obese young adults were 175 (19.7%) and 106 (11.9%), respectively. Caesarean section was significantly associated with obesity in young adults, after adjusting for potential confounders (OR 1.99, 95% CI 1.00–3.94, p=0.049). However, no significant association was observed for overweight + obese combined. Conclusion Caesarean section was statistically associated with early adulthood obesity but not overweight + obesity combined. Mothers and physicians should, however, reduce the use of CS as a delivery procedure unless entirely required. This is due to the higher odds of obesity in later life, the potential biological link between CS and obesity, and the statistically significant associations reported.
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    Association between social economic status and obesity in a rural South African community
    (2014) Chisi, Songelwayo Lufu
    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.
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    Exploring the role of genetic variation at the leptin and leptin receptor genes (LEP and LEPR) in obesity and hypertension in a black South African cohort
    (2014-04-04) Ngcungcu, Thandiswa
    Obesity and hypertension often occur together and are risk factors for cardio-metabolic disorders. Single nucleotide polymorphisms (SNPs) in the leptin (LEP) and leptin receptor (LEPR) genes have been shown to be associated with obesity and hypertension, but have not been well explored in African populations. The aims of this study were to determine the heritability estimates of anthropometric and blood pressure (BP) measures and leptin levels; to identify additional informative SNPs in and around the LEP and LEPR genes; and to examine the potential relationships between these SNPs and measures of obesity, hypertension and leptin levels in a black South African cohort. Participants from the African Programme on Genes in Hypertension (APOGH) with various anthropometric and BP measurements were genotyped for LEP and LEPR SNPs using the BeadXpress platform. Heritability estimates were determined using Statistical Analysis for Genetic Epidemiology (S.A.G.E.) software and relationships between LEP or LEPR SNPs and obesity, leptin levels and hypertension were assessed using SAS 9.3 and gPLINK vs2.050, taking into account family relationships, various confounders and correcting for multiple testing. The Bonferroni method was used to correct for multiple testing and P≤0.00076 was considered as statistically significant for SNP association tests. Seven-hundred-and-thirteen individuals were successfully genotyped and there were more women (66%) than men. The prevalence of obesity (42%) and hypertension (46%) were high in the sample. Significant heritability (h2 %, P<0.05) was noted for body weight (38%), body mass index (26%), waist (35%) and hip circumference (42%), waist-to-hip ratio (46%), skinfold thickness (44%), systolic (34%), diastolic (27%) and central systolic (33%) BP; but leptin levels were not significantly heritable (h2 %=15%, P=0.228). LEP rs17151914 (P=0.0002) and LEPR rs6690661 (P=0.0007) were significantly associated with leptin levels and diastolic BP, respectively, in women. The LEP rs17151913T-rs6956510G haplotype was associated with an increase in central systolic BP in women (P=0.012 with Bonferroni correction) whereas the LEPR rs2154381C-rs1171261T haplotype was associated with lower systolic BP in men (P=0.0359 with Bonferroni correction). LEP gene variants were significantly correlated with effects on leptin levels in women and the LEPR gene variants were significantly correlated with effects on diastolic BP also in women. These results indicate that further exploration of the role of genetic variation in the LEP and LEPR genes in obesity and hypertension in individuals of African ancestry is warranted.
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