title: Female sex, poverty and globalization as determinants of obesity among rural South African type 2 diabetics: a cross-sectional study.
abstract: BACKGROUND
  Countries in Sub-Saharan Africa have recently been experiencing increases in the prevalence of obesity, type 2 diabetes mellitus (T2DM) and other non-communicable diseases in both urban and rural areas. Despite their growing influence on population health in the region, there is a paucity of epidemiological studies on the twin epidemic of obesity and T2DM, particularly in the rural communities in South Africa. We investigated the prevalence and the determinants of overall obesity among patients with T2DM in rural and semi-urban areas surrounding the town of Mthatha, South Africa.
  
  
  METHODS
  This hospital-based cross-sectional study was conducted among patients with T2DM attending the outpatient department at Mthatha General Hospital, Eastern Cape Province, South Africa. Data were obtained from 327 participants using standardized questionnaires that included items on sex, age, level of education, type of residence, employment status, smoking status, physical activity, diet and alcohol intake. After taking measurements of height and weight, participants were defined as obese if their body mass index exceeded 30 kg/m(2). Univariate and multivariate logistic regression analyses were performed to identify the determinants of obesity in our sample population.
  
  
  RESULTS
  We found that 60.2% of our sample population were defined as obese. In our univariate analyses, female sex (p < 0.001), age ≥50 years (p = 0.023), rural residence (p < 0.001), excessive alcohol intake (p = 0.002), current cigarette smoking (p < 0.001), level of education (p < 0.001), regular consumption of soft drinks (p < 0.001) and unemployment (p = 0.043) were found to be positively and significantly associated with obesity. In the multivariate logistic regression analysis, female sex (p < 0.001), unemployment (p = 0.012) and level of education (p < 0.001) were found to be independent determinants of obesity.
  
  
  CONCLUSIONS
  We found that female sex, educational attainment, unemployment and current cigarette smoking were positively associated with obesity among the study participants. Lifestyle changes, poverty reduction and public education are urgently needed to address the growing obesity epidemic in rural areas of South Africa.
authors.affiliation: Department of Family Medicine, Senior Specialist, Faculty of Health Sciences, Walter Sisulu University, Cecilia Makiwane Hospital, East London Hospital Complex, Private Bag X 9047, Mdantsane, East London, South Africa, 5200. vincoladele@gmail.com.
authors.forename: Oladele Vincent
authors.initials: OV
authors.lastname: Adeniyi
authors.affiliation: Department of Community Medicine, Research Champion Professor, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha, South Africa, 5117. longombenza@gmail.com.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Longo-Mbenza
authors.affiliation: Department of Nursing Science, Senior Researcher, School of Health Sciences, University of Fort Hare, Private Bag X9083, East London, South Africa, 5201. daniel.goon2013@yahoo.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ter Goon
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D038622:Internationality; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011203:Poverty; D015995:Prevalence; D012423:Rural Health; D012737:Sex Factors; D013019:South Africa / Q000453:epidemiology; D018881:Suburban Health; D011795:Surveys and Questionnaires