CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 AFRICA 27 gender, age and setting in South Africa have been reported.14,16,60 Elevated levels of cholesterol (14%) and glucose (7%) in this study were similar to those of other studies.29,61 The presence of any of the three cardiometabolic risk factors found in this study contributes to the MetS.54 Challenges exist with regard to comparison of the presence of the MetS across studies, due to the various definitions of the MetS in the literature.62 In South Africa, not much is known about the MetS among vulnerable communities.18 However, the prevalence of the MetS (17%) was low in this study compared to the 42% reported in Soweto (Gauteng province)36 and the 55.4 to 62% reported in the urban Western Cape province.29 Higher prevalence of the MetS was observed among middle-aged (28%) to older (40%) participants and females (30%), similar to other studies.19,30 The prevalence of the MetS in the current study setting may be driven by the presence of obesity, hypertension and dyslipidaemia, similar to previous studies,30,36 and explained by the urbanisation and epidemiological transition currently occurring in South Africa.19 Factors such as age and gender (multivariate analysis), marital status, and alcohol and tobacco use (bivariate analysis) were associated with individual cardiometabolic risk and the MetS in this study, similar to other studies.16,18-20,63-65 The literature documents that females are more prone to abdominal obesity and overweight/obesity than males58 because of the hormonal regulation of body fat distribution in females.66 Furthermore, older age was associated with hypertension and the MetS in this study, similar to other studies.16,19 Owolabi et al.19 summarised that ageing is often associated with a higher tendency towards cardiometabolic risk factors such as obesity, hypertension and dyslipidaemia. It should be noted that this study has several limitations and strengths. This study serves as a baseline for pre-morbid cardiometabolic risks among adults living in informal settlements, in the absence of screening studies. The study adhered to standardised methods and sheds light on the presence of cardiometabolic risk factors and the MetS, as well as their associated factors among South Africans living in informal settlements. In terms of limitations, the study may not necessarily represent the entire informal settlement population, due to the low participation experienced during the screening campaign. The results of this study cannot be generalised to rural and other urban areas in South Africa, except for other informal settlements in the Gauteng province. Data on all variables were not obtained from all participants due to resistance to participation. Future research should endeavour to study cardiometabolic risks in detail and use venous blood and, if necessary, repeated tests to confirm dyslipidaemia and diabetes. Larger studies are needed to determine the associations of demographic and lifestyle factors with the MetS, mediated by the informal settlement environment. Conclusion Our study confirms that, similar to other communities in South Africa, informal settlements in South Africa have entered the epidemic of the MetS. This is confirmed by the evidence of prevalent cardiometabolic risk factors, such as hypertension, overweight/obesity, abdominal obesity and elevated cholesterol levels. Population-based strategies to reduce the impact of cardiometabolic risks need to include contextual and diversified public health and health-promotion programmes to benefit the community in informal settlements. It is also imperative to emphasise routine screening for all the components of the MetS at the primary healthcare level. 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