Burden of chronic conditions and associated risk factors in young women living in urban South Africa: cross-sectional data from the Bukhali trial

Abstract

Background Africa is undergoing rapid urbanisation and demographic ageing. It is hypothesised that multiple risk factors and chronic conditions are presenting at younger ages, yet evidence on early emergence in African populations is limited. The aim was to characterise the disease burden among young women living in urban Soweto (South Africa) by examining the prevalence of multimorbidity and investigating the association of poverty-related and behavioural risk factors with multimorbidity. Methods We conducted a cross-sectional analysis of baseline data from 7735 women aged 18–29 years (mean (SD): 22.6 years (2.8)) enrolled in the Bukhali trial. Participants completed interviewer-conducted surveys, physical measurements and clinical assessments. Multimorbidity was defined as the co-occurrence of ≥2 of six-specified conditions (anaemia, obesity, hypertension, diabetes, HIV infection and depression). Findings Severe food insecurity affected 18.5% (n = 1209) of participants' households, and 91.8% (n = 6829) of young women were unemployed. Hazardous alcohol use was reported by 20% (n = 1539), and 55.5% (n = 4264) reported poor sleep quality. The prevalence of women living with obesity and hypertension was 24.5% (n = 1884) and 8.6% (n = 666) respectively. Depression affected 15.8% (n = 1217), and 22.4% (n = 1700) had multimorbidity. Among poverty-related and modifiable behavioural factors, household food insecurity (RRR 1.21, 95% CI 1.04–1.39) and poor sleep quality (RRR 1.53, 95% CI 1.34–1.76) showed the strongest associations with multimorbidity. Interpretation Young women in Soweto face high anaemia and early cardiometabolic risk, with multimorbidity in their early adulthood. Public health interventions addressing nutrition, sleep, and social factors are needed to curb multimorbidity and improve long-term health. Funding South African Medical Research Council and Canadian Institutes of Health Research (ISA-181192).