Situational assessment of determinants of risk factors for cardiovascular diseases in an urban township in South Africa Situational assessment of determinants of risk factors for cardiovascular diseases in an urban township in South Africa Puoane T, Bradley H, Dlangamandla B, Chopra M, Sanders D School of Public Health, University of the Western Cape, Bellville, South Africa. 1Dept of Medicine, University of Cape Town, Cape Town, Tel: 021404 5007. Fax: 021 448 6815 Puoane T, Bradley H, Dlangamandla B, Chopra M, Sanders D 2 School Of Public Health, University of the Western Cape, Bellville, South Africa. 3Zanempilo Trust, Cape Town, South Africa. School of Public Health, University of the Western Cape, Bellville, 4Chronic Diseases of Lifestyle, Medical Research Council, Tygerberg, South Africa.

South Africa. Objective: To identify determinants of risk factors for cardiova scular diseases and to establish priorities for healthy lifestyles in an urban 1Dept of Medicine, University of Cape Town, Cape Town township. 2 Method: Community Health Workers employed by a primary health care non-governmental organization were guided on conducting a School Of Public Health, University of the Western Cape, Bellville, situational assessment of their community. Key informants were interviewed to assess perceptions about diabetes and hypertension and the impact on the community. South Africa. Observations and interviews of street vendors selling food were carried out to obtain information on types of food sold and kno wledge 3 and perceptions of healthy foods. Zanempilo Trust, Cape Town, South Africa. Community mapping was used to investigate environmental determinants.. 4 Chronic Diseases of Lifestyle, Medical Research Council, Tygerberg, Findings: Key informants knew many people with diabetes and hypertension, as well as overweight and obese people in the community. They lacked insight about the impact of diabetes and hypertensio n in the community. There were many sheebens, and meat vendors in South Africa. the community but few stalls selling fruit and vegetables. There were very few green areas and sports fields for promoting relaxation and physical activity.

Conclusion: This assessment shows that knowledge and perceptions of cardiovascular disease is inadequate in this urban population and the environment provides little opportunity for making healthy choices. There is a need for policies that will promote healthy f ood choices and create supportive environments.

Background Background continued

• Studies have shown that black urban • Burden of non-communicable diseases populations consume diets high in fat. have an impact on the individual, family • Those lived in cities for most of their lives and the society consume diet with 30% of calories from • If the environment where people live total fat. promote healthy lifestyles people can • Sedentary lifestyle make healthy choices, thus able to take • Increased level of obesity(BMI >30kg/m2) responsibility for their health

South Africa KHAYELITSHA

1 Background % Informal Dwelling

Khayelitsha is a sub-district of Cape Town 100%

Located 30km from the center of Cape Town 80% Metropolitan Council. 60% The population size estimates ranges from 40% 350000 to 900 000. About 43% of adults are 20% unemployed. Most of employed people fall into types of 0% SPM Plain TOTAL

occupations that are typically unskilled and Central East West Athlone Mitchells Nyanga Tygerberg Tygerberg Helderberg Oostenberg low-paid. Blaauwberg Khayelitsha

% without access to Water % Unemployed 60% 60% 50% 40% 40% 30% 20% 20% 10% 0% 0% SPM SPM Plain TOTAL Central East Athlone West Nyanga Mitchells Plain TOTAL Central East Tygerberg Tygerberg Athlone Nyanga West Mitchells Khayelitsha Blaauwberg Helderberg Oostenberg Tygerberg Tygerberg Helderberg Oostenberg Blaauwberg Khayelitsha

% Households below poverty line Objectives 60% To identify determinants of risk factors 40% for cardiovascular diseases and to establish priorities for healthy lifestyles 20% in an urban township.

0% SPM TOTAL Plain Central Nyanga East West Athlone Mitchells Tygerberg Tygerberg Blaauwberg Helderberg Khayelitsha Oostenberg

2 Mapping Method • Key informants interviews to assess perceptions about diabetes and hypertension and the impact on the community. Observations and interviews of street vendors to obtain information on types of food sold and knowledge and perceptions of healthy foods. Community mapping to investigate environmental determinants

Findings

There were many sheebens, and meat vendors in the community but few stalls selling fruit and vegetables. There were very few green areas and sports fields for promoting relaxation and physical activity. The environment does not promote healthy living Limited choices of fresh vegetables

Environment Environment Street vendor owners lack insight about health consequences of fatty meat

• Environment is unhealthy for exercises

3 Many people in this community are overweight • Lack of entertainment facilities -people become bored and obese

School promoting coke

MAP OF SITE C Area A, B, C, D

Church Fruit Primary & School Year Business Commenced Vege Fire station GARAGE stall Child Welfare

Nutrition centre 1980’s 1990’s 2000’s

Community Hall Church Hall 1985 = 3 1992 = 2 2000 = 4 Library TAXI RANK

Herbalist

School Public telephones Herbalist Day Supermarket Hospital 1986 = 3 1994 = 2 2001 = 4

Fruit, vege & Surgery Supermarket cigarette stall Sheeben Fruit &

Fruit & vege stall Church School 1987 = 3 1995 = 2 2002 = 2 Meat Stand Shop vege

Sheeben t Supermarket Fruit & vege Meat & braai Hair stand Salon

School Pre- school Meat Stand 1998 = 5

Sheeben Meat stand Stadium for Recreation Shop mainly soccer SACLA Health Centre Public telephones

4 For living Conclusion

5% 14% Perceptions of cardiovascular diseases is To supplement inadequate in this urban population salaries The environment provides little opportunity for making healthy choices. Others (package at 81% work, tuition There is a need for policies that will for education) promote healthy food choices and create Slice 4 supportive environments.

Conclusion (continued)

• The community need to be educated about risk factors for CVD and the importance of its prevention

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