To examine the characteristics of community health workers (CHWs) involved in diabetes prevention programmes (DPPs) and their contributions to expected outcomes.
Electronic databases including ...PubMed-MEDLINE, EBSCOHost, and SCOPUS/EMBASE were searched for studies published between January 2000 and March 2016. All studies that used CHWs to implement DPP in ≥18-year-old participants without diabetes but at high risk for developing the condition, irrespective of the study design, setting or outcomes measured, were included. Results were synthesized narratively.
Forty papers of 30 studies were identified. Studies were mainly community-based and conducted in minority populations in USA. Sample sizes ranged from 20 participants in a single community to 2369 participants in 46 communities. Although CHWs were generally from the local community, their qualifications, work experience and training received differed across studies. Overall the training was culturally sensitive and/or appropriate, covering topics such as the importance of good nutrition and the benefits of increased physical activity, communication and leadership. CHWs delivered a variety of interventions and also screened or recruited participants. The shared culture and language between CHWs and participants likely contributed to better programme implementation and successful outcomes.
The complexity of DPPs and the diverse CHW roles preclude attributing specific outcomes to CHW involvement. Nevertheless, documenting potential CHW roles and the relevant training required may optimise CHW contributions and facilitate their involvement in DPPs in the future.
There is a growing body of research on local retail food environments globally in both urban and rural settings. Despite this, little research has been conducted on adult food choices, local retail ...environments, and healthy food access in resource-poor communities. The purpose of this study is therefore to provide an overview of the evidence on adult food choices (measured as dietary intake) in association with the local retail food environment and food access in resource-poor communities (defined as low-income communities and/or households).
We searched nine databases for studies published from July 2005 to March 2022 and identified 2426 records in the primary and updated search. Observational studies, empirical and theoretical studies, focused on adults ≤ 65 years, published in English peer-reviewed journals, examining local retail food environments and food access, were included. Two independent reviewers screened identified articles using the selection criteria and data extraction form. Study characteristics and findings were summarized for all studies and relevant themes summarized for qualitative and mixed methods studies.
A total of 47 studies were included in this review. Most studies were cross sectional (93.6%) and conducted in the United States of America (70%). Nineteen (40.4%) studies assessed the association between food choice outcomes and local retail food environment exposures, and evidence on these associations are inconclusive. Associations of certain food choice outcomes with healthy food retail environments were positive for healthy foods (in 11 studies) and unhealthy foods (in 3 studies). Associations of certain food choice outcomes with unhealthy retail food environment exposures were positive for unhealthy foods in 1 study and negative for healthy foods in 3 studies. In 9 studies, some of the food choice outcomes were not associated with retail food environment exposures. A healthy food store type and lower food prices were found to be major facilitators for healthy food access in resource-poor communities, while cost and transportation were the main barriers.
More research is needed on the local retail food environment in communities in low- and middle-income countries to develop better interventions to improve food choices and access to healthy foods in resource-poor communities.
In the present global economic crisis and continued rapid urbanization, street food (SF) vending has grown into a practical source of income for people in the developing world. SF are not only ...appreciated for their unique flavours, convenience, and affordability they also contribute to the economy of the country, the perseverance of cultural and social heritage of society, as well as the potential for maintaining and improving the nutritional status of populations. This study aimed to develop a street food vending model (SFVM) that encompasses healthy and safe food options for consumers including hygiene and safety guidelines and viable business and operations for vendors. An evidence-based approach, i.e. "systematically collected proof", was used to inform the development of this model. Phase 1 included two surveys, one of street food vendors (N = 831) and the other of consumers (N = 1047). These surveys obtained data regarding the vendors' operations and food items they sold and the consumers' purchases and their nutrition knowledge. In Phase 2, interviews and focus groups were conducted with government officials. Additionally, regulations and policies regarding street vending were reviewed to determine available regulations and policies for street food vending. In Phase 3, data from the two phases were integrated and participatory action methods involving street food vendors used to validate the findings and inform the development of a SFVM by engaging in focus group discussions with street food vendors (N = 28). The components of the proposed SFVM comprised four parts, namely a food and nutrition component, a hygiene component, a business component and a vending cart. These components serve as a guide and considers various elements of the socioecological framework, namely intrapersonal/individual and interpersonal factors, the physical environment/community as well as the policy environment. The development of this model can serve as an example to countries which have large street food vending components and wish to optimize their value by making them safe and healthy for consumers. Thus, allowing vendors to trade under optimal conditions giving due consideration to regulations and policy.
Convincing evidence supports the effectiveness of lifestyle interventions in preventing the occurrence of diabetes in high-income countries, however little is known about appropriate interventions ...for use in African countries, where there are higher relative increases in diabetes prevalence. The South African Diabetes Prevention Programme (SA-DPP) was initiated with the aim of preventing or delaying the occurrence of diabetes among South Africans (SAs), through interventions, targeting lifestyle changes related to diet and physical activity. The purpose of the current project is to implement and evaluate the suitability and applicability of the SA-DPP developed and tailored in urban populations in the Western Cape Province, in peri-urban populations in the Eastern Cape Province of SA.
The SA-DPP, which is an cluster randomized control trial, will be implemented in adults aged 30-65 years residing in the OR Tambo district, Eastern Cape, SA. Participants will be recruited using self-selected sampling techniques and 24 clusters across peri-urban communities will be randomly allocated to participate in the lifestyle intervention, facilitated by non-professional health workers (NPHW). The diabetes risk screening will follow a two-staged approach, including the community-based screening, using the African diabetes risk score (ADRS), followed by a clinic-based risk status assessment by an oral glucose tolerance test (OGTT) to exclude unknown diabetes. The lifestyle-change objectives of the current programme relate to, 1) < 30% of total energy intake from fat; 2) < 10% of total energy intake from saturated fat; 3) > 15 g of fibre/1000 kcal; 4) > 4 h/week moderate level of physical activity; and 5) > 2% body mass index (BMI) reduction.
The SA-DPP could represent a successful model for the prevention of diabetes and potentially other lifestyle-related diseases in SA and other countries in the region that are confronted with similar challenges.
PACTR202205591282906.
IntroductionThe local retail food environment influences dietary patterns and food choices, as suggested in the literature. The lack of access to healthy food within this environment may result in ...unhealthy food choices which may lead to obesity and the development of non-communicable diseases. Evidence suggests that resource-poor communities may have unhealthy food environments, therefore, preventing residents from making healthy food choices. A systematic scoping review will be conducted to provide an overview of the evidence on adult food choices in association with the local retail food environment and food access in resource-poor communities.Methods and analysisThis protocol for the scoping review was developed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and the framework process by Arksey and O’Malley. Observational studies, published from July 2005 to January 2021, will be searched and screened. Keywords and medical subject headings (MeSH) terms will be used to search several multidisciplinary databases. Two independent reviewers will screen identified articles using the selection criteria and extract data using the PRISMA-ScR checklist. Descriptive numerical and thematic analysis will be performed to evaluate and categorise quantitative and qualitative data.Ethics and disseminationEthical approval will not be required for the review, as data from published studies will be used. The results of this scoping review will form part of a PhD thesis that will be submitted to the University of the Western Cape, South Africa. The review findings will also be presented at conferences and published in a peer-reviewed journal.Open science framework registration numberhttps://osf.io/shf93.
In South Africa, the nutrition transition has led to unhealthy diets lacking variety, contributing to the rise in overweight, obesity and diet-related noncommunicable diseases. Using baseline ...screening data of the South African Diabetes Prevention Programme (SA-DPP) study, this study aims to determine the relationship of dietary diversity (DD) with nutritional status, cardiometabolic risk factors and food choices of adults at risk of type 2 diabetes in resource-poor communities around Cape Town. Data of 693 adults, 25−65 years old were analysed. This included socio-demographic information, anthropometric measurements, biochemical assessments, food groups consumed the previous day and consumption frequency of certain foods to reflect food choices. The Minimum Dietary Diversity for Women (MDD-W) indicator was calculated; 70.4% of participants had low DD (<5 food groups). Low DD was associated with elevated serum triglycerides AOR: 1.49, 95% CI (1.03, 2.15) p = 0.036. The DD score was positively correlated (although weak) with the unhealthy food score (r = 0.191, p = 0.050) and sugary food score (r = 0.139, p < 0.01). Study participants at risk of diabetes consumed a diet low in DD; however, DD was not associated with nutritional status or cardiometabolic risk factors except for serum triglycerides.
Emerging evidence suggests that the addition of text messages to standard healthy lifestyle interventions may improve the outcomes of diabetes prevention programs (DPP). This paper describes the ...process of developing text messages targeting behavior change in people at risk of developing diabetes in low-resourced communities as part of the South African DPP (SA-DPP). The development comprised multiple steps led by nutrition and physical activity experts. The steps included the following: (1) text message development based on the existing SA-DPP curriculum and its formative research; (2) text message evaluation for readability/understandability in terms of content, language, and quality, with 75 participants from two low-resourced areas in Cape Town; (3) text message refinement by the expert panel; (4) evaluation of the refined text messages by participants from Step 2; and (5) text bank finalization. Based on the readability survey, 37 of the 67 formulated text messages 24 of the 44 encouraged healthy eating, and 13 of the 23 promoted physical activity were refined. Based on focused discussions with participants, seven more messages were refined to consider alternative terminology. The final text bank includes a total of 67 messages comprising topics related to fruit and vegetable consumption as well as the importance of having variety in the diet (n = 15), limiting fat intake (n = 10), avoiding sugar (n = 11), avoiding salt (n = 5), promoting fiber-rich foods (n = 1), messages promoting physical activity (n = 21), and general check-in messages (n = 4). Most of the text messages were acceptable, understandable, and largely feasible to all participants, with some of the nutrition-related messages being less feasible for participants due to their socioeconomic position. The next step is to assess the text messages in the SA-DPP intervention trial.
To evaluate the viability of leveraging an existing screening programme (the South African Diabetes Prevention Programme (SA-DPP)) to screen for chronic kidney disease (CKD), by assessing the yield ...of CKD cases among those participating in the programme.
Observational study conducted between 2017 and 2019.
16 resource-poor communities in Cape Town, South Africa.
690 participants, aged between 25 and 65 years, identified as at high risk for type 2 diabetes mellitus (T2DM) by the African Diabetes Risk Score.
The prevalence of CKD among those participating in the SA-DPP.
Of the 2173 individuals screened in the community, 690 participants underwent further testing. Of these participants, 9.6% (n=66) and 18.1% (n=125) had screen-detected T2DM and CKD (defined as an estimated glomerular filtration rate (eGFR) of<60 mL/min/1.73 m
and/or albumin-to-creatinine ratio >3 mg/mmol), respectively. Of those with CKD, 73.6% (n=92), 17.6% (n=22) and 8.8% (n=11) presented with stages 1, 2 and 3, respectively. Of the participants with an eGFR <60 mL/min/1.73 m
, 36.4% had no albuminuria and of those with normal kidney function (eGFR ≥90 mL/min/1.73 m
), 10.2% and 3.8% had albuminuria stages 2 and 3, respectively. Of those with T2DM and hypertension, 22.7% and 19.8% had CKD, respectively.
The fact that almost one in five participants identified as high risk for T2DM had CKD underscores the value of including markers of kidney function in an existing screening programme. By using an opportunistic approach to screen high-risk individuals, those with CKD can be identified and appropriately treated to reduce disease progression.
Poor nutrition during the first two years of life has long term consequences, but resource-poor households often do not have the means to access nutrient-dense and diverse diets. Pooled data of 24-h ...dietary recalls (n = 3336) and 2019 retail food prices were analyzed to determine associations of retail cost and energy cost (per 100 kcal) with diet quality indicators for diets of 6–24-month-old South African children who were breastfed (BF-diet) and not breastfed (NBF-diet) during the 24-h recall period. Compared to the BF-diet, retail cost for the NBF-diet was three times higher for age 6–11 months, and double for age 12–17 months. Higher retail cost and energy cost were both associated with higher mean adequacy ratios and dietary diversity scores for BF and NBF diets, except energy cost for the NBF-diet for age 6–11 months. Overall, inclusion of flesh foods, vitamin A-rich fruits and vegetables, and other fruit and vegetables increased from the lowest to the highest retail cost tertile. The higher cost of more nutritious diets highlights the importance of the affordability of diets in interventions aimed at improving diet quality. Possible strategies include: identifying the most-affordable foods within each food group, focusing on foods that provide multiple key micronutrients, and the inclusion of locally available indigenous foods.
One serious concern of health policymakers in South Africa is the fact that there is no national data on the dietary intake of adult South Africans. The only national dietary study was done in ...children in 1999. Hence, it becomes difficult to plan intervention and strategies to combat malnutrition without national data on adults. The current review consequently assessed all dietary studies in adults from 2000 to June 2015 in an attempt to portray typical adult dietary intakes and to assess possible dietary deficiencies. Notable findings were that, in South Africa micronutrient deficiencies are still highly prevalent and energy intakes varied between very low intakes in informal settlements to very high intakes in urban centers. The most commonly deficient food groups observed are fruit and vegetables, and dairy. This has been attributed to high prices and lack of availability of these food groups in poorer urban areas and townships. In rural areas, access to healthy foods also remains a problem. A national nutrition monitoring system is recommended in order to identify dietary deficiencies in specific population groups.
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