By Joanne Lillie

These are the 10 most important health issues facing South African men today – and how you can beat them.

Wading through death notification stats is a grim business. But it pays to know which conditions claim the most lives – especially when there’s a lot you can do to avoid ending up in a body bag. The numbers show there’s a year-by-year increase in the number of deaths due to preventable conditions such as hypertension, respiratory diseases and diabetes, and a drop in the proportion of communicable (infectious) diseases. Over the last few years, the gap between communicable (37%) and non-communicable (53%) diseases has widened; pointing to lifestyle as a massive indicator of your chances of a long and healthy life. The bottom line: sidestep those chips and that extra beer, get active, and keep an eye on your vitals. Your mom can thank us later. These are top 10 killers of people just like you – and how to beat them.

TUBERCULOSIS

If you’ve been coughing for longer than three weeks and spitting up blood despite no bar fights, or if you’re having chest pains even when no chilli burrito has passed your lips, perhaps it’s time to check for TB.

With over nine million new cases and almost 1.5 million deaths each year, TB has overtaken HIV as the world’s leading cause of death. There are twice as many TB deaths than there are for any other cause of death. And in South Africa, significantly more men are affected than women, says internal medicine specialist Dr Phindile Gina, whose research on improving TB tests led to a World Health Organisation endorsment. “Failure to identify and diagnose TB in HIV-positive patients is a key problem, and responsible for a high death rate,” says Gina.

South Africa has the third highest burden of TB in the world (after India and China) with 450,000 cases – a 400% increase in the last 15 years

Symptoms:
1/ A cough that lasts three weeks or longer.
2/ Chest pain.
3/ Coughing up blood
or sputum.
4/ Weakness or fatigue.
5/ Poor appetite and weight loss.
6/ Chills, fever and drenching night sweats.

Beat it:
It’s estimated that about 80% of the population of South Africa has latent (dormant) TB; we are pretty much all infected, but most of us will never develop active disease, thanks to a robust immune system. It’s when your immunity is compromised that you become vulnerable. Here’s how to boost your immunity:

1/ EAT WELL: Get plenty of fresh wholesome food and vitamins.
2/ AVOID DRUGS, EXCESSIVE DRINKING AND SMOKING: That last one can significantly increase the risk of progression from latent to active TB.
3/ MANAGE ANY LONG-TERM ILLNESS that affects your immune system, such as diabetes or HIV.
4/ CERTAIN PRESCRIPTION DRUGS CAN DENT YOUR IMMUNITY: Check in with your doctor if you are unsure.

INFLUENZA & PNEUMONIA

No, not man flu – influenza is a serious infection of the body, while pneumonia involves the inflammation and accumulation of pus and fluid in the lungs. Both are driven in most cases by high rates of HIV due to lowered immunity.

Pneumonia causes those little lung sacs – alveoli – to fill up and swell, which obstructs breathing and can prevent oxygen getting where it needs to be, which is why pneumonia can lead to serious complications and even death. A severe viral or bacterial infection is the most common cause of pneumonia, and it often sets in after the flu, especially if your immunity has taken a dive.

Symptoms:
1/ Fever and a cough that produces green, yellow or bloody mucous
2/ Muscle aches and shaking chills
3/ Shortness of breath; irregular pain when breathing

Beat it:
1/ MANAGE CONDITIONS like HIV/AIDS and diabetes, which can make you susceptible.
2/ QUIT SMOKING as it renders you more vulnerable to lung infections.
3/ SCRUB UP: Hand-washing prevents the easy passage of infections.
4/ HEALTHY EATING, EXERCISE AND AN ANNUAL FLU: JAB before winter sets in can help prevent flu and pneumonia.

HIV

South Africa has the largest anti-retroviral treatment programme in the world, and for good reason: 25% of the world HIV burden sits with South Africa, where 6.3 million people are HIV-positive.

In September last year, the Department of Health launched the most ambitious policy so far, and that is to treat everyone living with HIV irrespective of their CD4 count (the standard measure of immunity status).

“Although HIV prevalence is higher among women, with younger women most affected, men between the ages of 30
and 40 have played a role in this high prevalence,” says HIV researcher Dr Mosa Moshabela, head of the first dedicated Department of Rural Health in South Africa at UKZN.

“Older men have been accused of ‘sugar daddy’ and ‘blesser’ behaviours in transactional sex with younger women – driven largely by poverty and inequalities. For this reason, these men are seen to be responsible for the transmission of HIV.”

Symptoms:
1/ The only way to know is to test. “HIV has shifted from being a symptomatic disease to a non-symptomatic disease in that people are being treated early, without any prior signs,” says Moshabela.

Beat it:
1/ PRACTISE SAFE SEX Every time: Male condoms are still the most effective way of preventing HIV and STIs.
2/ GET CIRCUMCISED: Recent studies show that HIV transmission could be reduced by 60% in men who are circumcised compared to those who aren’t.
3/ GET TESTED: Men generally do not seek HIV testing or care, and often present late. The new self-test kit could sidestep the need to go to
a doctor or clinic. “Everyone in this country should know their HIV status,” says Moshabela.

STROKE, HEART ATTACK & HYPERTENSION

Cardiovascular disease is the leading cause of death worldwide, and in South Africa, these conditions comprise three of the top 10 killers. Diseases of the ticker claims more than 10% of the lives lost – around 27 000 men a year.

South Africa has one of the highest rates of hypertension worldwide. This makes us prone to stroke and heart disease. Stats show that about 130 heart attacks and 240 strokes occur every day in South Africa. That means 10 people will have a stroke and five will have a heart attack every hour.

“Cardiovascular disease is on the increase in South Africa, due to the increase in risk factors driven by lifestyle, like hypertension, diabetes, hyperlipidaemia (abnormally high levels of fats in the blood), smoking, obesity and inactivity,” says cardiologist Dr Ntobeko Ntusi. A specialist in cardiovascular imaging, Ntusi sees the effects of poor lifestyle choices first hand. He completed two PhDs partly funded by the Discovery Foundation, one through Oxford University and another through UCT.

“The dominant form of cardiovascular disease in South African men is heart failure. We are seeing a dramatic increase in coronary artery disease (hardening and thickening of artery walls) in younger men. There is also a complex interaction between TB and HIV, and that has expanded the number and type of cardiovascular diseases we see here,” he says.

Symptoms:

STROKE
1/ Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
3/ Sudden confusion, trouble speaking or understanding.
3/ Sudden trouble seeing or blurred vision in one or both eyes.
4/ Sudden trouble walking, dizziness, loss of balance or coordination. A stroke is always an emergency, and if you spot the signs in a mate, colleague or family member, act fast.

HEART ATTACK
1/ Pain in the middle of the chest: some men describe this as pressure, tightness or squeezing.
2/ Lightheadedness, nausea and vomiting.
3/ Pain in the arms, back, neck or jaw.
4/ Shortness of breath.

HYPERTENSION
1/ The majority of people aren’t aware of high BP; the reason it’s called the silent killer.
2/ Some people experience severe headaches, fatigue or confusion, vision problems, chest pain, difficulty breathing, irregular heartbeat, blood in the urine, pounding in your chest, neck or ears.

Beat it:
According to the Heart and Stroke Foundation SA, 80% of these cardiovascular diseases can be prevented.

1/ CUT SALT to less than 5g a day, including salt hiding in bread, boerie, biltong and so on. The Heart and Stroke Foundation reckons that 60% of your dietary intake is hidden. Cutting back by 2g per day reduces cardiovascular events by 20%, studies say.
2/ CHECK YOUR BP AND CHOLESTEROL,
3/ DITCH THE SMOKES, EAT BETTER– AND MOVE MORE.

Deadly risk factors:

1/ Hypertension affects 42.2% of the population, 10.6% suffer from elevated blood glucose, and 34% have high cholesterol. But 80% of cardiovascular events can be prevented with healthy lifestyle changes.

2/ 1 in 4 adults is obese and over half are overweight. Half of all adults are physically inactive.

3/ Contributing to our obesity problem is the increasing consumption of packaged foods high in calories, saturated fats, animal proteins, sugars and salt.

4/ Booze is the third most important risk factor contributing to non-communicable diseases, and it can also accelerate the progression of infectious diseases. Consumption among those who drink amounts to a staggering 27.1 litres per person per year.

CHRONIC LOWER RESPIRATORY DISEASE

This underlying cause of death includes Chronic Obstructive Pulmonary Disease (COPD) and asthma. COPD is the second most common non-infectious disease in the world, and primarily affects men. It’s a chronic, irreversible lung disorder resulting from exposure to noxious particles or gases – mostly smoking. “In Cape Town the estimates for stage two and above COPD are 22% of men – the highest prevalence in the world,” says Professor Richard van Zyl-Smit, head of the Lung Clinical Research Unit at the University of Cape Town Lung Institute. “This is probably due to high smoking rates (more men than women smoke) – but also other risk factors such as TB, HIV infection and exposure to air pollution.”

Symptoms:
1/ Shortness of breath with a cough or wheeze.
2/ Increased mucuos– that’s often worse in the morning.

Beat it:
1/ ONCE THE DAMAGE IS DONE, IT’S PERMANENT: Preventing this lot is key. “There isn’t much that can be done about your genetic make-up or your childhood – but avoiding exposure to any form of air pollution from tobacco, cars and fires is advised.
2/ EAT WELL, EXERCISE AND IF YOU SMOKE, STOP: “If you are worried about emphysema, see your doctor and ask to have your lung function measured – this is a critical step in evaluating any damage from smoking or other exposures,” says Van Zyl-Smit.

26,5% of South African men smoke.

NON-NATURAL CAUSES: VIOLENCE, INJURIES AND SUICIDE

Men are three times more likely to die of unnatural causes than women. For men, the most common non-natural cause of death in 2014 was assault (12.9%), followed by transport accidents (12.1%). Alcohol is a prominent factor in violence and injuries, including interpersonal violence, domestic violence, sexual assault and road traffic injuries. Suicide accounts for approximately 10% of all non-natural deaths in SA, according to the MRC National Injury Mortality Surveillance (NIMSS).

Rates here are “inordinately high”, says Professor Lourens Schlebusch, an international expert on stress and suicide and the author of Suicidal Behaviour in South Africa and Mind Shift: Stress Management and Your Health (University of Kwa-Zulu Natal Press). Most of the 8 000 South Africans who die by suicide each year are young men: studies have shown that 83% of suicide victims are men, and the majority of victims were under age 44. Young men are at greatest risk of dying from unnatural causes, with as many as 55% of male deaths in this age group registered as unnatural.
Source: Stats SA 2014, statssa.gov.za/publications/P030932014.pdf

40% of deaths in South African men are deemed premature (before the age of 60).


OTHER VIRAL DISEASE

It’s probably fair to say that viruses are not incredibly well understood, and a “mysterious” virus is sometimes blamed for deaths where there is no clear cause. “Viral infections are common, but the commonly occurring viruses (except HIV) rarely cause death, and the “deadly” viruses – such as hemorrhagic fever viruses – are rare,” says Dr Raveen Parboosing, a virologist at Inkosi Albert Luthuli Central Hospital in Durban. “Microbe Hunter” Parboosing spent his PhD engineering nanoparticles to mimic and block HIV viruses.

Some of the more prevalent viral diseases are hepatitis B and C – and infection is more common among people who are HIV-positive. “As many as 1 in 10 or 20 adults are chronically infected with hepatitis B,” says Parboosing.

Symptoms:
1/ Fever
2/ Jaundice
3/ Loss of appetite
4/ Vomiting
5/ Complications include cirrhosis, liver cancer and end-stage liver disease

“The prevalence of hepatitis C is not as high, and many patients are asymptomatic or have non-specific symptoms (such as abdominal pain).”

Beat it:
1/ BOOST YOUR IMMUNITY and manage other chronic conditions that compromise your immune system.
2/ PRACTICE SAFE SEX: Every time, no exceptions – ever.

INTESTINAL INFECTIOUS DISEASE

Diarrhoea is a symptom of infections caused by various bacteria, viruses and parasites, mostly a result of contaminated food and water.

Previously common only in children, rates of diarrhoea have increased in the adult population in SA. The most severe threat posed by diarrhoea is dehydration, which can be fatal.

Although unlikely in your average urban setting, an upset belly is all too common when traveling through Africa, in places where clean water supply is limited. If you find yourself in a rural setting, it’s best to drink bottled water and avoid any unusual foods, or produce washed in water. If you’re afflicted, drink plenty of clean water to prevent dehydration.

Symptoms:
1/ Nausea and vomiting
2/ Loose, watery stool
3/ Cramping

Beat it:
1/ GET VACCINATED: shots can vary widely depending on where exactly you plan to travel, but they are never negotiable. Some can take time to become effective, so speak to your doctor or visit a travel clinic four to six weeks before you leave for your trip.
2/ AVOID BITES by investing in a safe, good quality insect repellant, and sleep only in screened-off areas.
3/ DRINK CLEAN WATER: Sip from canned or unopened bottles, and when in doubt, boil it.

DIABETES

More than 24 South African men die from diabetes every day. There has been a year-on-year increase in deaths due to diabetes over the last decade, mostly as a result of poor eating habits and lack of exercise.

The driver of type-2 diabetes? One in 3 South African men is overweight or obese. “The lifestyle of the stereotypical South African male leads to a high risk for the metabolic syndrome – sedentary behaviour, along with a diet of carbs, meat and beer can lead to elevated blood pressure and cholesterol, increased waist circumference and abnormal glucose metabolism,” says Dr Joel Dave, an endocrinologist based at Groote Schuur Hospital and UCT Private Academic Hospital. “That guy is at great risk of developing diabetes,” he says.

Symptoms:
1/ Excessive thirst
2/ Frequent or increased urination, especially at night
3/ Excessive hunger
4/ Fatigue
5/ Blurry vision
6/ Sores or cuts that won’t heal

Beat it:
MAKE HEALTHY FOOD CHOICES: Nutrition scientists recommend meals cooked at home – with whole, fresh, plant-based foods – eliminating over-processed foods and limiting processed carbs, red meat, salt and sugar.
MAINTAIN A HEALTHY WEIGHT: Studies show that people who are at high risk for diabetes can prevent or delay onset by losing weight. “For every kilo you lose, you may see positive health changes,” says Dave. “Some patients with type-2 diabetes are diabetic because of their weight. If they lose a significant amount of it, they can cure their diabetes.”
MOVE EVERY DAY: Aim for least 30 minutes of moderate to vigorous activity, five days a week.
CONTROL BLOOD PRESSURE AND CHOLESTEROL: to reduce risk factors associated with diabetes.