South African National Health And Nutrition Examination Survey (SANHANES-1)

Transcription

1 8/6/213 South African National Health And Nutrition Examination Survey (-1) FUNDERS TEAM Purpose The South African National Health And Nutrition Examination Survey () was established as a repeated population health survey in order to address the changing health needs in the country and provide a broader and more comprehensive platform to study the health and nutritional status of the nation on a regular basis. 1

2 8/6/213 Objectives To investigate the: Knowledge, attitudes and behaviour of South Africans with respect to non-communicable and communicable diseases. Nutritional status of South Africans as it relates to food security, dietary intake/behaviour including the consumption of alcohol, and body weight management. Behavioural (smoking, diet, physical inactivity) and social determinants of health and nutrition (demographic, socioeconomic status and geolocation) and relate these to the health and nutritional status of the SA population. General perceptions of health and health care services. METHODS 2

3 8/6/213 Study Design -1 was a cross-sectional survey providing baseline data for repeated surveys and also for future longitudinal (prospective) analysis. A prospective cohort approach will be able to address the relationships between medical, nutritional and behavioural/societal risk factors assessed in the first survey phase (-1) and subsequent morbidity, mortality and changes in risk factors at the national level. Population and Sampling Individuals of all age groups living in SA households, excluding those living in institutions Multi-stage disproportionate, stratified cluster sampling 5 enumeration areas (EA) 2 households per EA All persons in the household were eligible to participate 3

4 8/6/213 Geographic distribution of EAs selected Data collection -1 obtained data through: Interviews based on questionnaires administered by fieldworkers Clinical examination by doctors, nurses and clinic assistants (free-of-charge) in a variety of settings measuring: Physical examinations: blood pressure, step fitness test, anthropometry Laboratory tests: blood samples for biomarker testing (full blood count, HbA1c, cholesterol, triglycerides, C-reactive protein, cotinine, vitamin A, ferritin) 4

5 8/6/213 Data management and analyses Questionnaire data: Children (-14 years), adults (15 years and older) double entered and verified using Census Survey Processing System Clinical Examination data: custom-designed forms Laboratory data: blood samples for biomarker analysis using for serum lipids, ferritin [Roche Modular, Immulite 2, BioRad D1, Abbott Architect]); High Performance Liquid Chromatography (HPLC) (HbA1c, vitamin A, cotinine) Analytical quality control documentation indicated that the coefficient of variation for the analyses ranged from % All data were analysed using SPSS and STATA Data were weighed and benchmarked against the 212 midyear population estimate PATHCARE Laboratories Laboratory tests LANCET Laboratories 5

6 8/6/213 RESULTS Individual level of participation in valid households were realised in the survey and 77.2% agreed to be interviewed individuals were eligible 92.6% completed interviews 43.6% completed a physical examination 878 blood specimens were collected 6

7 8/6/213 Representativity of the sample compared to 212 mid-year estimates Demographics Weighted sample Midyear population 212 n % n % Age Total Race African White Coloured Asian/Indian Total Non-Communicable Diseases 7

8 8/6/213 Rates (%) of self-reported personal history of NCDs by sex and age, SA Males (n=645) 6 Females (n=961) to to to to to to to to to to High blood pressure Heart disease High blood Pressure Heart disease Stroke High blood cholesterol Diabetes Stroke High blood cholesterol Diabetes Clinical Examination: Hypertension 8

9 8/6/ Prevalence of measured prehypertension and hypertension by age, SA 212 (n=73) Prehypertension BP >= /8-89mmHg Hypertension BP>=14/9mmHg Prevalence of measured hypertension by province, SA (n=73)

10 8/6/213 Clinical Examination: Hyperlipidaemia 7 Males (n=197) Prevalence of hyperlipidaemia by sex and age, SA 212 Females (n=3461)

11 8/6/213 Prevalence of hypercholesterolaemia (total cholesterol) by race, SA Males (n=1968) Females (n=3478) African Coloured Asian/Indian Total Males Females Clinical Examination: Diabetes (blood sugar) 11

12 8/6/213 Prevalence of impaired glucose homeostasis and diabetes by age, SA (n=475) HbA1c > 6.1% & < 6.5% HbA1c > 6.5% Physical activity 12

13 8/6/ Prevalence of aerobic fitness: percentage aged 18-4 years old unfit by sex and locality, SA Urban Formal Urban Informal Rural Formal Rural Informal Total Males Females Males (n=917) Females (n=1524) Prevalence of aerobic fitness: percentage aged 18-4 years old unfit by sex and race, SA Black African Coloured Total Males Females Males (n=886) Females (n=1496)

14 8/6/213 Tobacco Use Prevalence of tobacco smoking (current smokers), SA 212 (n=15 377) Yes, daily 16.2% Ever smokers (2.8%) Yes, less than daily 2% Yes, but not now 2.6% No, not all 79.2% 14

15 8/6/213 Mean age of tobacco initiation, smoking duration and number of cigarettes smoked per day (current smokers), SA 212 Age of initiation of tobacco smoking (years) Duration of smoking (years) Mean number of cigarettes smoked per day Males Females Total Prevalence of the use of other tobacco products (current smokers), SA 212 (n=14 948) Yes, daily 4.9% Yes, less than daily 1.8% } tobacco Ever users of other products (6.7%) No, not at all 93.3% 15

16 8/6/213 5 of daily exposure to smoking inside the home by province, SA (n=14 569) Prevalence of exposure to tobacco as measured by serum cotinine by sex, SA (n=55) Males Females Total Cotinine < 1 Cotinine > 1 16

17 8/6/213 Prevalence of exposure to tobacco as measured by serum cotinine by locality, SA (n=55) Urban formal Urban informal Rural formal Rural informal Total Cotinine < 1ng/ml Cotinine > 1ng/ml Tobacco cessation by gender, SA (n=2667) Advised to quit smoking Health warning prompted quitting Tried to quit Quiting tobacco smoking Quiting other tobacco products Time elapsed since quitting (years) Males Females Totals 17

18 8/6/213 Household Alcohol Use Perceptions of household alcohol consumption patterns, SA (n = 6 554) Adult men Adult women Teenage boys Teenage girls Nobody Don't know Household members 18

19 8/6/213 Perceived seriousness of problems of alcohol misuse amongst members of the household, SA 212 (n=241) Don't know,.7% Very serious, 8.8% Serious, 8.4% Not a problem, 61.3% Not very serious, 2.8% 1 Extent of snacking while drinking alcohol in households by race, SA (n=2384) African White Coloured Indian Total Race 19

20 8/6/213 Anthropometry (adults) Prevalence of underweight, overweight and obesity by sex and age, SA 212 Males (n=2572) Females (n=4695)

21 8/6/ Waist circumference by sex and age, SA 212 Males (n=2592) 1 Females (n= >=94cm >=12cm >=8cm >=88cm Waist-hip ratio by sex and age, SA Males (n = 2 58) 8 Females (n = 4 685) WHR >= WHR >=.85 21

22 8/6/213 Food security Prevalence of food secure households by locality, SA 212 (n=6115) Urban formal Urban informal Rural formal Rural informal Total Food secure 22

23 8/6/213 7 Prevalence of food insecure households (experiencing hunger) by locality, SA 212 (n=6115) Urban formal Urban informal Rural formal Rural informal Total Experience hunger Prevalence of food insecurity (experiencing hunger) by province, SA 212 (n=6115) Province 23

24 8/6/213 Trends in Food Security status: SA Variable Food Secure At risk of hunger Experienci ng hunger NFCS 1999 NFCS 25 SASAS 28-1, 212 (n = 2735) (n = 2413) (n = 115) (n = 636) % % % % Prevalence of dietary risk factors for NCDs (high fat and sugar intake) by locality, SA (n=15 332) Urban formal Urban informal Rural informal Rural formal Total High fat score (11-2) High sugar score (5-8) 24

25 8/6/213 Factors influencing grocery shopping by sex, SA 212 Don't do grocery shopping How easy the food item is to prepare Convenience Safety (hygiene) of the food item How well / how long the food item keeps The nutrient content of the food item Health considerations Taste of the food item The price of the food item Females Males Males (n = 6267) Females (n = 8884) Nutritional status of adults 25

26 8/6/213 Prevalence of anaemia by sex, SA Males (n = 1 889) Females (n = 3 299) Total Anaemia Males: 12.2% Total Anaemia Females: 22.% Mild anaemia Moderate anaemia Severe anaemia Males Females Trends in anaemia and iron status: women of reproductive age (16-35 years), SA VARIABLE NFCS-25-1 Anaemia (Hb < 12 g/dl) Iron depletion (Hb 12 g/dl and Ferritin < 15 ng/ml) Iron deficiency anaemia (Hb <12 g/dl and Ferritin < 15 ng/ml) 29.4% 23.1% 7.7% 5.9% 1.5% 9.7% 26

27 8/6/213 Perceived versus actual BMI (15 years and older) by sex, SA Males (n=2499) Females (n=4575) Perceived BMI equals actual BMI Perceived BMI higher than actual BMI Perceived BMI lower than actual BMI Males Females Anthropometry (children) 27

28 8/6/ Prevalence of overweight and obesity of children aged 2-14 years by sex & age, SA 212 Males (n=2123) Females (n=2155) Trends in the prevalence of undernutrition in children aged 1-3 years, SA % NFCS

29 8/6/ Stunting Trends in the prevalence of undernutrition in children aged 4-6 years, SA Severe Stunting Wasting Severe Wasting Underweight Severe Underweight NFCS-25 Child Health and Nutrition Status 29

30 8/6/213 Trends in vitamin A status in children under five years of age, SA VARIABLE SAVACG NFCS-25-1 Mean Vitamin A Vitamin A deficiency (serum retinol <.7 µmol/l).84 µmol/l.62 µmol/l.75 µmol/l 33.3% 63.6% 43.6% Trends in anaemia, and iron status in children under five years of age, SA VARIABLE SAVACG NFCS-25-1 Anaemia (Hb < 11 g/dl) Iron depletion (Hb 11 g/dl and Ferritin < 12 ng/ml) Iron deficiency anaemia (Hb <11 g/dl and Ferritin < 12 ng/ml) 21.4% 28.9% 1.7% 4.8% 7.8% 8.1% 5.% 11.3% 1.9% 3

31 8/6/213 Dietary behaviour of children 1-14 years in relation to eating breakfast, SA % of children do not eat breakfast at home in the morning (n=248) Not hungry in the morning No food in the house to eat for breakfast People at home do not eat breakfast Cannot get up early enough to have breakfast Cannot make their own breakfast Dietary behaviour of children aged 1-14 years in relation to taking lunchboxes, SA % of children do not take a lunchbox to school (n=246) Food at school is enough for the whole day Nothing at home to put in the lunchbox No-one at home to help make a lunchbox Other children will want their food Do not have a nice container to put lunch in 31

32 8/6/ Body image of children aged 1-14 years, SA 212 Happiness with current weight Males (n=1125) Females (n=1192) 3 25 Attempts to gain or lose weight Males (n=1127) Females (n=12) Happy Somewhat happy Unhappy Gain weight Lose weight Males Females Perceived versus actual BMI of children 1-14 years by sex, SA Males (n=2219) Females (n=2235) Perceived BMI equals actual BMI Perceived BMI higher than actual BMI.2.6 Perceived BMI lower than actual BMI Males Females 32

33 8/6/213 General Health Perception: Physical health Self-rated health status of adults 15 years and older by sex, SA Males (n=6287) Females (n=898) Very good Good Moderate Bad & very bad Levels of Health Males Females Total

34 8/6/213 Self-rated difficulty with work or household activities in the last 3 days in adults 15 years and older by locality, SA (n=15 121) Urban formal Urban informal Rural informal Rural formal Total Self-reported prevalence of impaired hearing in adults 15 years and older by locality and race, SA 212 (n=14 527) (n=14 479) Urban formal Urban Informal Rural formal Rual Informal Total 34

35 8/6/ Self-Reported prevalence of impaired vision (15 years and older) by locality and race, SA 212 (n=15 35) 5 (n=15 61) Urban formal Urban Informal Rural formal Rual Informal Total General Health Perception: Mental Health 35

36 8/6/ Prevalence of psychological distress in adults 15 years and older by sex and age, SA 212 Males (n=6242) Females (n=8819) Males Females 25 Experience of traumatic events by locality and type of trauma, SA 212 (n=15 196) Urban formal Urban informal Rural formal Rural informal Total Personal assault Family-related Other 36

37 8/6/213 Prevalence of symptoms and diagnosis of post traumatic stress disorder, SA (n=1644) PTSD Symptoms PTSD Diagnosis No significant differences for both symptoms and diagnosis by sex, age, province and race Quality of Health Care Services 37

38 8/6/213 Satisfaction at outpatient health care facilities, SA 212 Factor Public Private Very good and good Very bad and bad Very good and good Very bad and bad Treated respectfully 8.4% 6.4% 95.5%.6% Clarity of explanations 8.9% 5.6% 95.1% 1.1% Involvement in decision making 77.6% 6.9% 92.6% 2.1% Privacy 83.7% 4.8% 95.4% 1.2% Choice of health care provider 79.5% 5.5% 92.4%.5% Cleanliness 85.2% 3.7% 95.2%.2% Availability of medication 77.6% 9.4% 96.%.5% Availability of tests 76.2% 8.1% 95.9%.4% Waiting times 59.5% 24.4% 87.7% 4.5% Satisfaction at in-patient health care facilities, SA 212 Factor Public Private Very good and good Very bad and bad Very good and good Very bad and bad Treated respectfully 84.9% 4.6% 97.6%.7% Clarity of explanations 85.% 6.4% 96.8% 1.6% Involvement in decision making 81.5% 9.% 94.4% 2.8% Privacy 81.6% 5.6% 97.4%.6% Choice of health care provider 82.9% 4.2% 96.9% 1.6% Cleanliness 84.9% 3.4% 97.9% 1.4% Availability of medication 85.% 3.9% 97.3%.5% Availability of tests 84.5% 5.2% 98.8%.1% Waiting times 72.4% 13.4% 93.% 3.1% 38

39 8/6/213 Tuberculosis: Social Determinants Perception of seriousness of TB by race, SA (n=14 693) Coloured African White Asian/Indian Total Very serious Somewhat serious 39

40 8/6/213 Knowledge of TB being curable by province, SA 212 n= Expression of concern for TB presence in HIV positive people, by province, SA 212 (n=14 67)

41 8/6/213 Prevalence of stigma associated with TB (avoidance of people with TB) by province, SA (n=14 95) SUMMARY 41

42 8/6/213 Summary The successfully completed -1: Is representative of the population Provides baseline values and informs policy in a number of heath and nutrition domains Provides evidence on the impact of current interventions, and Creates the basis on which the population s health and nutritional status can be monitored longitudinally Overall Summary South Africa indeed has a huge burden of disease that is fuelled by a multiplicity of risk factors requiring multisectoral action and healthy public policies The underlying socio-economic, cultural, behavioural and environmental determinants of health are significant Self-reported levels of morbidity are high 42

43 8/6/213 THANK YOU THANK YOU 43