Predictors of metabolic syndrome among teachers in under-resourced schools in South Africa: Baseline findings from the KaziHealth workplace health intervention

Non-communicable diseases (NCDs) account for most of global deaths, with rising prevalence in low-and middle-income countries. Metabolic syndrome (MetS) is a cluster of interrelated NCD risk factors, including obesity, dyslipidaemia, hypertension, and hyperglycaemia, that amplify NCD risk. Four leading modifiable factors driving NCDs are physical inactivity, tobacco and alcohol use, and an unhealthy diet. Teachers in under-resourced schools face significant health challenges, with their wellbeing often overlooked in South Africa. The prevalence and severity of MetS, adherence to physical activity guidelines, and associations with modifiable NCD risk factors were assessed. This study, part of the 'KaziBantu: Healthy Schools for Healthy Communities' project, included 168 teachers (aged 21-72, mean = 47 years) from 8 under-resourced schools in Gqeberha, South Africa. Data collection included MetS markers, device-measured physical activity, tobacco and alcohol use, and total fat, saturated fat, sugar, and sodium intake. Covariates included age, sex, race, education, and household income. MetS was observed in 58% of participants, with central obesity (79%) being the most prevalent component, followed by hypertension (59%). The largest proportion of participants (26%) had 3 MetS components, followed by 4 components (20%), while 12% had all 5 components. Nearly half (44%) of teachers were physically inactive and 53% exceeded total fat intake recommendations. Bayesian multilevel logistic regression revealed key predictors of MetS: age (per year increase; odds ratio[OR]=1.15, 95% credible interval[CrI] [1.07, 1.24]) and high daily total fat intake (OR=3.37, 95%CrI [1.03, 11.96]) were positively associated, while hours spent in moderate-to-vigorous intensity physical activity per week (OR=0.73, 95%CrI [0.55, 0.95]) and higher monthly household income (OR=0.14, 95%CrI [0.02, 0.72]) were protective. Addressing physical inactivity and unhealthy diets through tailored interventions is crucial to reducing MetS prevalence and improving the health of teachers working in low-resourced settings. Effective solutions should empower healthier lifestyles while tackling structural barriers to health equity.