Review Article
Indirect and direct effects of factors associated with diabetes amongst the rural black population in the Dikgale Health and Demographic Surveillance System, South Africa
Submitted: 22 October 2020 | Published: 15 July 2021
About the author(s)
Peter M. Mphekgwana, Department of Research Administration and Development, University of Limpopo, Polokwane, South AfricaLinneth N. Mabila, Department of Pharmacy, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
Eric Maimela, Department of Medical Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa; and, Public Health and Health Promotion, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
Abstract
Background: Diabetes is an enormous, growing clinical and public health problem, which together with hypertension contributes significantly to the high risk of cardiovascular diseases (CVDs) globally.
Aim: To examine the indirect and direct effects of risk factors simultaneously as a network of multiple pathways leading to diabetes in the rurally based adult population (aged 15+) using a household survey.
Methods: This investigation was based on a predictive model using a cross-sectional community-based study to identify the direct and indirect effects of diabetes risk factors in the Dikgale Health and Demographic Surveillance System (HDSS) consisting of 15 villages, with 7200 households and a total population of approximately 36 000. Fasting blood glucose and total cholesterol were measured using ILAB 300 with the following cut-off values: high fasting blood glucose 7 mmol/L and triglycerides 1.70 mmol/L.
Results: A total of 1407 individuals were interviewed, of whom 1281 had their blood pressure (BP) measured. The conceptual model was validated by the goodness-of-fit indexes (comparative fit index [CFI] = 1.00, Tucker Lewis index [TLI] = 1.041, root mean square error of approximation [RMSEA] = 0.001). Hypertension had the strongest direct effect of 0.0918 on diabetes, followed by age (0.0039) and high waist circumference (−0.0023). Hypertension also mediates the effects that high waist circumference (0.0005) and triglycerides (0.0060) have on diabetes status.
Conclusion: The results in this study confirm the conceptual model considered in the risk factors for diabetes and suggest that hypertension, age and high waist circumference are the key variables directly affecting the diabetes status in the South African rural black population. The direct effect of triglycerides on diabetes suggests mediation by some measured factor(s).
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Crossref Citations
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Peter M. Mphekgwana, Musa E. Sono-Setati, Tania V. Mokgophi, Yehenew G. Kifle, Sphiwe Madiba, Perpetua Modjadji
International Journal of Environmental Research and Public Health vol: 20 issue: 10 first page: 5799 year: 2023
doi: 10.3390/ijerph20105799