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Xiong S, Jiang W, Wang Y, Hu C, Yang J, Bao M, Hou H, Li F, Liu T, Zhang X, Ma Y, Ye P, Wang Q, Chen Z, Mao L, Peiris D, Tian M. Using routinely collected data to determine care cascades of hypertension and type-2 diabetes management in China: a cross-sectional study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 45:101019. [PMID: 38371948 PMCID: PMC10869296 DOI: 10.1016/j.lanwpc.2024.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/27/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024]
Abstract
Background China's National Essential Public Health Service Package (NEPHSP) aims to promote health for all at the primary health care level and includes a focus on hypertension and type-2 diabetes mellitus (T2DM). However, there are limited contemporary data to quantify the care cascades of hypertension and T2DM in primary health care. Methods This cross-sectional study involved individual level linkage of routinely collected data from the NEPHSP, health insurance claims and hospital electronic health records, from four diverse regions in China, including Xiling District (central China), Wenchuan County (western), Acheng District and Jiao District (northern). We first compared numbers of people aged ≥35 with a recorded diagnosis of hypertension and T2DM against expected numbers derived from epidemiological data. We then constructed care cascades to assess the percentages (1) enrolled in the NEPHSP, (2) adherent to the follow-up care of NEPHSP, (3) receiving medication treatment, and (4) having hypertension and/or T2DM controlled. Findings In the four regions, the total numbers of people aged ≥35 diagnosed of hypertension and T2DM from any data source were 149,176 and 50,828, respectively. This was estimated to be 46.0% (95% confidence interval [CI]: 45.8%-46.2%) and 45.6% (95% CI: 45.3%-45.9%) of the expected totals for hypertension and T2DM, respectively. Among those diagnosed, 65.4% (95% CI: 65.1%-65.6%) with hypertension and 66.1% (95% CI: 65.7%-66.5%) with T2DM were enrolled in the NEPHSP, respectively, in which 54.8% (95% CI: 54.5%-55.2%) with hypertension and 64.7% (95% CI: 64.1%-65.2%) with T2DM were adherent to the required services. Among those enrolled, the overall treatment rates were 70.8% (95% CI: 70.6%-71.1%) for hypertension and 82.2% (95% CI: 81.8%-82.6%) for T2DM. Among those treated, a further 80.9% (95% CI: 80.6%-81.2%) with hypertension and 73.9% (95% CI: 73.3%-74.4%) with T2DM achieved control. These results varied considerably across regions, with the northern sites showing relatively higher enrolment rates while the central site had higher control rates. Interpretation Detection and control rates for hypertension and T2DM are suboptimal in these four regions of China. Further strategies are needed to improve people's enrolment in and adherence to the NEPHSP and strengthen care delivery processes. Of note, our estimations of the diagnosis rates for each region are based on national level large epidemiological data. The interpretation of these data needs caution due to potential bias caused by regional variations. Funding This study is funded by National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases funding (APP1169757), and National Natural Science Foundation of China (72074065).
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Affiliation(s)
- Shangzhi Xiong
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Global Health Research Centre, Duke Kunshan University, Kunshan, China
| | - Wei Jiang
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yongchen Wang
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chi Hu
- Yichang City Centre for Disease Control and Prevention, Yichang, China
| | - Jiajuan Yang
- Yichang City Centre for Disease Control and Prevention, Yichang, China
| | - Mingjia Bao
- Jiamusi City Centre for Disease Control and Prevention, Jiamusi, China
| | - Huinan Hou
- Jiamusi City Centre for Disease Control and Prevention, Jiamusi, China
| | - Fan Li
- Health Bureau of Wenjiang District, Chengdu, China
| | - Tingzhuo Liu
- School of Public Health, Harbin Medical University, Harbin, China
| | - Xinyi Zhang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Yanqiuzi Ma
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Pengpeng Ye
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Qiujun Wang
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhengming Chen
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Limin Mao
- Centre for Social Research in Health, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Maoyi Tian
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
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Orok E, Kabiawu Y, Aderohunmu Z, Obiwulu D. Knowledge, attitude, and perceived risks related to diabetes mellitus among university students in Southwestern Nigeria. Heliyon 2024; 10:e25793. [PMID: 38384547 PMCID: PMC10878925 DOI: 10.1016/j.heliyon.2024.e25793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Diabetes mellitus (DM) has recently shown a demographic shift in epidemiology among adolescents and young adults. Adolescents and young adults are an important demographic of study since studies have shown an increasing prevalence in low-income countries including Nigeria. This study assessed the knowledge, attitude, and perceived risks of DM among university students in selected universities in southwestern Nigeria. Methods This study was a cross-sectional study carried out among university undergraduates in southwestern Nigeria. An online questionnaire was used to collect data via students' WhatsApp groups. The students' knowledge was ranked as good (≥70%), fair (50-69%), and poor (<50%) while attitude was categorized into positive (≥50%), and negative (<50%). The difference in knowledge based on demographics, disease profile, and source of information was analysed using the independent sample t-test and one way analysis of variance for variables with 2 and > 2 groups respectively. Analyses were conducted using SPSS software version 25. Results A total of 349 students consented to participate in the study of whom 55.3% were female. 25.2% had good knowledge while 92.3% of the participants were aware of DM. Positive attitudes and perceived risks were reported among all of the students. Source of information, family history, level of study, and age were significantly associated with knowledge of diabetes. Conclusion A small proportion of the students exhibited good knowledge, while all demonstrated a positive attitude and perceived risks associated with DM. There is a clear need for educational interventions, such as health programs and awareness campaigns, to enhance their knowledge of DM.
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Affiliation(s)
- Edidiong Orok
- Department of Clinical Pharmacy and Public Health, College of Pharmacy, Afe Babalola University, Ado-Ekiti, Ekiti state, Nigeria
| | - Yetunde Kabiawu
- Department of Medicine and Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Zainab Aderohunmu
- Department of Medicine and Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Danielle Obiwulu
- Department of Medicine and Surgery, College of Medicine, University of Lagos, Ikeja, Lagos State, Nigeria
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Kiconco R, Lumumba SA, Bagenda CN, Atwine R, Ndarubweine J, Rugera SP. Insulin therapy among diabetic patients in rural communities of Sub-Saharan Africa: a perspective review. Ther Adv Endocrinol Metab 2024; 15:20420188241232280. [PMID: 38379780 PMCID: PMC10878220 DOI: 10.1177/20420188241232280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Abstract
In this perspective review, we describe a brief background on the status quo of diabetes mellitus-related therapies and glycemic control among patients in rural communities in sub-Saharan Africa. The article discusses insulin therapy as well as the difficulties in obtaining insulin and oral hypoglycemic medications for diabetic patients living in sub-Saharan Africa. We wrap up our discussion with suggestions on solutions and opportunities for future research to tackle this health challenge in these impoverished communities. We conducted a literature search from PubMed and Google Scholar up until August 2023. Key words were used to generate search terms used to retrieve the required information. All types of literature with pertinent information on the current topic were included in the study. Diabetes mellitus is on the rise in sub-Saharan Africa. Several studies have reported poor glycemic control, low screening rates for diabetes mellitus, cigarette smoking, high alcohol consumption, prescription of antidiabetic therapy, and associated costs as contributors to the uptake of antidiabetic treatment. Although there is paucity of data on the extent of insulin therapy uptake and its possible modifiable contributors among the diabetic patients in the region, the anticipated increase in the number of people with diabetes on the continent makes it critical for global leaders to address the research gaps in insulin therapy among rural communities of sub-Saharan Africa, thus reducing the burden of diabetes in these populations.
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Affiliation(s)
- Ritah Kiconco
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Mbarara-Kabale Road, Mbarara 1410, Uganda
- Department of Biochemistry, Sororti University, Soroti, Uganda
| | - Sylvia Achieng Lumumba
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Laboratory Science, Technical University of Mombasa, Mombasa, Kenya
| | - Charles Nkubi Bagenda
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raymond Atwine
- Department of Pathology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Ndarubweine
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Simon Peter Rugera
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
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Prattipati S, Tarimo TG, Kweka GL, Mlangi JJ, Samuel D, Sakita FM, Tupetz A, Bettger JP, Thielman NM, Temu G, Hertz JT. Patient and provider perspectives on barriers to myocardial infarction care among persons with human immunodeficiency virus in Tanzania: A qualitative study. Int J STD AIDS 2024; 35:18-24. [PMID: 37703080 PMCID: PMC11139408 DOI: 10.1177/09564624231199507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION People with HIV (PLWH) have an increased risk myocardial infarction (MI), and evidence suggests that MI is under-diagnosed in Tanzania. However, little is known about barriers to MI care among PLWH in the region. METHODS In this qualitative study grounded in phenomenology, semi-structured interviews were conducted in northern Tanzania. Purposive sampling was used to recruit a diverse group of providers who care for PLWH and patients with HIV and electrocardiographic evidence of prior MI. Emergent themes were identified via inductive thematic analysis. RESULTS 24 physician and patient participants were interviewed. Most participants explained MI as caused by emotional shock and were unaware of the association between HIV and increased MI risk. Providers described poor provider training regarding MI, high out-of-pocket costs, and lack of diagnostic equipment and medications. Patients reported little engagement with and limited knowledge of cardiovascular care, despite high engagement with HIV care. Most provider and patient participants indicated that they would prefer to integrate cardiovascular care with routine HIV care. CONCLUSIONS PLWH face many barriers to MI care in Tanzania. There is a need for multifaceted interventions to educate providers and patients, improve access to MI diagnosis, and increase engagement with cardiovascular care among this population.
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Affiliation(s)
| | | | | | | | | | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet P Bettger
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA, USA
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
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Issaka A, Paradies Y, Cameron AJ, Stevenson C. The association between body weight indices, behavioral factors, and type 2 diabetes mellitus in Africa: A systematic review and meta-analysis of population-based epidemiological studies. Nutr Metab Cardiovasc Dis 2024; 34:1-18. [PMID: 38016892 DOI: 10.1016/j.numecd.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/07/2023] [Accepted: 06/14/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND AIM Type 2 diabetes mellitus (T2DM) is a significant public health concern in Africa. While the associations between modifiable risk factors and T2DM are likely to be Africa-specific, their overall estimations have not been published. This study aimed to use systematic and meta-analytic methods to examine the strength of associations between modifiable risk factors and T2DM in Africa. METHODS AND RESULTS A systematic search of literature published between January 2000 to March 2022 was conducted. The review included only population-based studies and data extracted from 57 studies. Of these, unadjusted data from 50 studies were included in meta-analysis. With considerable heterogeneity between studies, random-effect models were calculated to ascertain the odds ratios (OR) and 95% confidence intervals (CI) for the associations between obesity (OB) and overweight (OV), defined by BMI; central obesity (waist circumference (OB-WC), waist-to-hip-ratio (OB-WHR)), alcohol, fruit and vegetable consumption, smoking, physical activity (PA) and T2DM. Moderator effects of age, African regions, and urban/rural location were assessed. Risk factors associated with T2DM include BMI-OB [OR = 3.05, 95% CI: (2.58, 3.61)], BMI-OV [OR = 2.38, 95% CI: (1.51, 3.75)], and BMI-OV/OB [OR = 2.07, 95% CI: (1.82, 2.34)]; OB-WC [OR = 2.58, 95% CI: (2.09, 3.18)] and OB-WHR [OR = 2.22, 95% CI: (1.69, 2.92)]; PA [OR = 1.85, 95% CI: (1.50, 2.30)]. Significant moderator effects were not observed. CONCLUSION Obesity defined by BMI and central obesity, but not behavioral risk factors were most strongly associated with T2DM in African populations, emphasizing the need for obesity prevention to limit the rise of T2DM. REGISTRATION The PROSPERO registration number is CRD42016043027.
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Affiliation(s)
- Ayuba Issaka
- Global Obesity Centre (GLOBE), School of Health and Social Development, Faculty of Health, Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia; Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; Baker Heart and Diabetes Institute, Non-Communicable Diseases and Implementation Science Unit, VIC, Australia.
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), School of Health and Social Development, Faculty of Health, Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Christopher Stevenson
- Global Obesity Centre (GLOBE), School of Health and Social Development, Faculty of Health, Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
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Joho AA, Sandi F, Yahaya JJ. Determinants of knowledge, attitude, and practice among patients with type 2 diabetes mellitus: A cross-sectional multicenter study in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001351. [PMID: 38039284 PMCID: PMC10691713 DOI: 10.1371/journal.pgph.0001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/31/2023] [Indexed: 12/03/2023]
Abstract
Improvement of primary care for patients with type 2 diabetes mellitus (T2DM) through the promotion of good knowledge, attitude, and practice is of paramount importance for preventing its related complications. This study aimed to assess the levels of knowledge, attitude, and practice and associated factors among patients with T2DM. This was a cross-sectional multicenter hospital-based study that included 979 patients from 8 health facilities in Tanzania. A standardized semi-structured interviewer-administered questionnaire was used to extract the required data. Factor analysis was used to determine the level of knowledge, attitude, and practice. Multivariable analysis under binary logistic regression analysis was used to determine the predictors of knowledge, attitude, and practice. P<0.05 was considered significant. The levels of adequate knowledge, positive attitude, and appropriate practice were 62.1%, 54%, and 30.9%, respectively. Being self-employed (AOR = 1.74, 95% CI = 0.28-0.91, p = 0.040) predicted adequate knowledge. Being male (AOR = 1.46, 95% CI = 1.06-2.01, p = 0.021 and visiting regional hospitals (AOR = 2.17, 95% CI = 1.33-2.51, p = 0.013) were predictors of positive attitude. Residing in rural areas and not having adequate knowledge of diabetes were less likely associated with appropriate practice. This study has shown a significantly low level of appropriate practice among patients with T2DM towards general issues on diabetes, risk factors, and related complications. Therefore, emphasis should be placed on improving good practices that can help prevent related complications.
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Affiliation(s)
- Angelina A. Joho
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Frank Sandi
- Department of Ophthalmology, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania
| | - James J. Yahaya
- Department of Pathology, School of Health Sciences, Soroti University, Soroti, Uganda
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Asmelash D, Mesfin Bambo G, Sahile S, Asmelash Y. Prevalence and associated factors of prediabetes in adult East African population: A systematic review and meta-analysis. Heliyon 2023; 9:e21286. [PMID: 37928032 PMCID: PMC10623273 DOI: 10.1016/j.heliyon.2023.e21286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Diabetes mellitus is a major public health problem with serious consequences, and more than three-fourths of diabetes live in low- and middle-income countries. According to a recent study, people with prediabetes have nearly six times the risk of developing diabetes than those with normal glucose levels. However, due to the inconsistency and absence of representative data, this study aimed to estimate the prevalence of prediabetes and its associated factors in the adult East African population. Methods Databases were systematically searched for articles published between January 1, 2013, and December 30, 2022. All observational community-based studies that reported prediabetes prevalence and/or associated factors in adult East African populations were included in the meta-analyses. Three authors independently extracted all required data using the Excel data extraction format and analyzed using Stata™ Version 11. An I2 test was conducted to determine significant heterogeneity. Finally, a random effects model was used to determine the overall prevalence of prediabetes and its associated factors. The study was registered with Prospero number CRD42023389745. Results The search strategy identified 267 articles. After screening for full-text review, twenty-one articles were included in the final analysis. The overall prevalence of prediabetes was 12.58 % (95 % CI:10.30, 14.86 %) in the adult East African population. Furthermore, the subgroup analysis revealed that prediabetes in the urban population 20 % (95 % CI: 1.60, 38.37) was twice as prevalent as in rural 10.0 % (95 % CI: 5.52, 14.48) populations. The prevalence of prediabetes by the ADA diagnostic criteria was 21.45 % (95 % CI: 15.54, 27.35) three times higher than the WHO 7.20 % (95 % CI: 5.70, 8.69). Moreover, prediabetes was significantly associated with old age (OR = 1.64, 95 %, CI: 1.07, 2.53), hypertension (OR = 2.43, 95 %, CI: 1.02-5.79), obesity and overweight (OR = 1.70, 95 %, CI: 1.09,2.65). Conclusion This study showed a high prevalence of prediabetes, which was significantly associated with old age, hypertension, and high BMI. This study suggests that health policymakers should pay attention to the prevention and control strategies that is targeted at those with obesity, hypertension, and old age.
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Affiliation(s)
- Daniel Asmelash
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Getachew Mesfin Bambo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Samuel Sahile
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Yemane Asmelash
- Department of Statistics, College of Natural and Computational Science, Aksum University, Aksum, Ethiopia
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Issaka A, Stevenson C, Paradies Y, Houehanou YCN, Bosu WK, Kiwallo JB, Wesseh CS, Houinato DS, Nazoum DJP, Cameron AJ. Association between urban-rural location and prevalence of type 2 diabetes and impaired fasting glucose in West Africa: a cross-sectional population-based epidemiological study. BMJ Open 2023; 13:e063318. [PMID: 37734888 PMCID: PMC10514614 DOI: 10.1136/bmjopen-2022-063318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/13/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES We investigated the association between urban/rural location and both type 2 diabetes mellitus (T2DM) and pre-diabetes among populations of five West African countries. DESIGN Cross-sectional studies, using the WHO Stepwise (STEPs) survey data. SETTING National representative data of both urban and rural areas from Benin, Burkina Faso, Ghana, Liberia and Mali. PARTICIPANTS Adults comprising 15 468 participants (6774 men and 8746 women; 7663 urban and 7805 rural residents) aged between 25 and 64 years. RESULTS The age and sex-adjusted prevalence of T2DM was 6.2% for urban areas and 2.5% for rural areas. The prevalence of impaired fasting glucose (IFG) was 6.6% for urban areas, and 3.0% for rural areas. No differences by sex were observed. The crude relative risk (RR) and 95% CI of T2DM and IFG in urban compared with rural areas were 2.69 (1.85 to 3.91) and 2.37 (1.53 to 3.66), respectively. This reduced to RR: 2.03, 95% CI (1.34 to 3.08) and RR: 2.04, 95% CI (1.27 to 3.28), respectively, after adjusting for covariables. CONCLUSION The prevalence of both T2DM and IFG was more than two times as high in urban areas compared with rural areas in West Africa. Behavioural risk factors are common among urban populations, with ongoing urbanisation expected to drive increases in the prevalence of T2DM. These results could guide planning for T2DM screening, preventive strategies and resource allocation in West Africa.
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Affiliation(s)
- Ayuba Issaka
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation (IHT), Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, Geelong, Victoria, Australia
| | - Christopher Stevenson
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation (IHT), Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, Geelong, Victoria, Australia
| | - Yessito Corine N Houehanou
- National School of Senior Technicians Training in Public Health and Epidemiological Surveillance, University of Parakou, Parakou, Borgou, Benin
| | - William K Bosu
- Department of Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Haut-Bassin, Burkina Faso
| | - Jean Baptiste Kiwallo
- Directorate of Population Health Protection (DPSP) of Burkina Faso, Ministry of Health, Ouagadougou, Burkina Faso
| | - Chea Sanford Wesseh
- Republic of Liberia Ministry of Health, Congo Town, Monrovia, Montserrado, Liberia
| | - Dismand Stephan Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases (LEMACEN), Faculty of Health Sciences, University of Abomey Calavi, Cotonou, Benin
| | - Diarra J P Nazoum
- Non-Communicable Diseases and National Directorate of Health, Ministry of Health and Public Hygiene, Bamako, Mali
| | - Adrian J Cameron
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation (IHT), Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Kiryowa HM, Munabi IG, Buwembo W, Rwenyonyi CM, Mwaka ES, Kaddumukasa M. Periodontitis is associated with insulin resistance in adults living with diabetes mellitus in Uganda: a cross- sectional study. BMC Res Notes 2023; 16:217. [PMID: 37710310 PMCID: PMC10503142 DOI: 10.1186/s13104-023-06473-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/23/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Evidence suggests that majority of patients with diabetes mellitus in Uganda have poor glycaemic control as well as periodontal disease. This study set out to determine the association between periodontitis and insulin resistance in adult patients with diabetes mellitus in Uganda using the triglyceride glucose index. METHODS Two hundred and twenty-three adult study participants with confirmed diabetes mellitus were enrolled in a cross-sectional study. Oral examination was carried with the aid of a periodontal probe to determine the periodontal status and findings recorded using the WHO Oral Health Assessment Tool for Adults, 2013. We recorded clinical details for body mass index (BMI in kg/m2) and laboratory parameters including fasting blood sugar (mmol/L), glycated hemoglobin levels (HbA1c, %) and serum triglycerides (mmol/L) using a study questionnaire. Data were analyzed using R version 4.10. The glucose triglyceride index was used as a measure of insulin resistance. Logistic regression analysis carried out to determine the factors associated insulin resistance. RESULTS The majority of the study participants was female (70%) with an average age of 48.5 years (SD+/- 11.1). The mean body mass index was 29.6 kg/m2 (SD+/- 5.82). The mean serum triglyceride index was 9.48 (SD+/- 0.675). Eighty-six-point 1% of the participants had periodontal disease. Bivariate analysis revealed high odds for male sex (OR = 1.31, 95% C.I = 0.44-4.84, p = 0.65) and periodontitis (OR = 3.65, 95% C.I = 0.79-26.15, p = 0.13) but low odds for a high BMI (OR = 0.45. 95% C.I = 0.07-1.67, p = 0.30). Multivariate regression revealed a significant association between insulin resistance and periodontitis. (AOR = 3.52, 95% C.I = 1.19-1.83, p = 0.03). CONCLUSION Insulin resistance is highly prevalent in patients with diabetes mellitus in Uganda and is associated with periodontitis and low body weight.
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Affiliation(s)
- Haruna Muhmood Kiryowa
- Department of Anatomy, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Ian Guyton Munabi
- Department of Anatomy, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - William Buwembo
- Department of Anatomy, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | | | - Erisa Sabakaki Mwaka
- Department of Anatomy, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Bilog NC, Mekoulou Ndongo J, Bika Lele EC, Guessogo WR, Assomo-Ndemba PB, Ahmadou, Etaga NB, Mbama Biloa YJ, Bindi JGBN, Temfemo A, Mandengue SH, Guyot J, Dupré C, Barth N, Bongue B, Etoundi Ngoa LS, Ayina Ayina CN. Prevalence of metabolic syndrome and components in rural, semi-urban and urban areas in the littoral region in Cameroon: impact of physical activity. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:95. [PMID: 37697395 PMCID: PMC10496244 DOI: 10.1186/s41043-023-00415-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/09/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Living areas in developing countries impact seriously lifestyle by modifying energy consumption and energy expenditure. Thus, urbanization is associated with less practice of physical activity (PA), a leading cause of metabolic syndrome (MetS) which prevalence vary in African countries. The present study aimed to assess the effect of PA on MetS according to urbanization level in the littoral region, Cameroon. METHODS A cross-sectional study was conducted in three geographical settings (urban, semi-urban, and rural) in the littoral region in Cameroon. A total of 879 participants were included (urban: 372, semi-urban: 195 and rural: 312). MetS was defined according to the International Federation of Diabetes 2009. The level of PA was assessed using the Global Physical Activity questionnaire. RESULTS Low level of PA was (P < 0.0001) reported in urban (54.5%), semi-urban (28.7%) and rural (16.9%) and high level in rural area (77.9%). The prevalence of MetS was higher in urban areas (37.2%), then rural (36.8%) and finally semi-urban (25.9%). Hyperglycemia (p = 0.0110), low HDL-c (p < 0.0001) and high triglyceridemia (p = 0.0068) were most prevalent in urban residents. Participants with low level of PA were at risk of MetS (OR: 1.751, 95% CI 1.335-2.731, p = 0.001), hyperglycemia (OR: 1.909, 95% CI 1.335-2.731, p = 0.0004) abdominal obesity(OR: 2.007, 95% CI 1.389-2.900, p = 0.0002), low HDL-c (OR: 1.539, 95% CI 1.088-2.179, p = 0.014) and those with moderate level of PA were protected against high blood pressure(OR: 0.452, 95% CI 0.298-0.686, p = 0.0002) and compared to those with high level of PA. Urban dwellers were at the risk of MetS compared to rural residents (OR: 1.708, 95% CI. 1.277-2.285, p = 0.003) and protected against high blood pressure (OR:0.314, 95% CI 0.212-0.466, p < 0.0001), abdominal obesity (OR: 0.570, 95% CI 0.409-0.794, p = 0.0009), and low HDL-c (OR: 0.725, 95% CI 0.534-0.983, p = 0.038) compared to rural residents. CONCLUSIONS MetS was more prevalent in urban dwellers and was associated with a low level of PA.
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Affiliation(s)
- Nadine Carole Bilog
- Department of Biology of Animal Organisms, Faculty of Science, University of Douala, Douala, Cameroun
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Jerson Mekoulou Ndongo
- Department of Biology of Animal Organisms, Faculty of Science, University of Douala, Douala, Cameroun
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Elysée Claude Bika Lele
- Department of Biology of Animal Organisms, Faculty of Science, University of Douala, Douala, Cameroun
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Wiliam Richard Guessogo
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
- National Institute for Youth and Sports Yaounde, University of Yaounde I, Yaounde, Cameroon
| | - Peguy Brice Assomo-Ndemba
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
- Department of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Ahmadou
- Department of Biology of Animal Organisms, Faculty of Science, University of Douala, Douala, Cameroun
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Noel Babayana Etaga
- Department of Biology of Animal Organisms, Faculty of Science, University of Douala, Douala, Cameroun
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | | | - Josiane Gertrude Bwegne Ngasse Bindi
- Department of Biology of Animal Organisms, Faculty of Science, University of Douala, Douala, Cameroun
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Abdou Temfemo
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Samuel Honoré Mandengue
- Department of Biology of Animal Organisms, Faculty of Science, University of Douala, Douala, Cameroun
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Jessica Guyot
- Mines Saint-Etienne, INSERM, SAINBIOSE U1059, 42023, Saint-Étienne, France
| | - Caroline Dupré
- Mines Saint-Etienne, INSERM, SAINBIOSE U1059, 42023, Saint-Étienne, France
| | - Nathalie Barth
- Mines Saint-Etienne, INSERM, SAINBIOSE U1059, 42023, Saint-Étienne, France
| | - Bienvenu Bongue
- Mines Saint-Etienne, INSERM, SAINBIOSE U1059, 42023, Saint-Étienne, France
| | - Laurent Serge Etoundi Ngoa
- Department of Animal Science, Higher Teacher's Training College, University of Yaoundé I, Yaounde, Cameroon
| | - Clarisse Noel Ayina Ayina
- Department of Biology of Animal Organisms, Faculty of Science, University of Douala, Douala, Cameroun.
- Exercise and Sport Physiology Unit, Faculty of Science, University of Douala, Douala, Cameroon.
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Tadege M, Misganaw A, Truneh Z, Tegegne AS. Predictors for the Longevity of People with Diabetes in Buno Bedele and Illubabor Zones, South-west Ethiopia. Diabetes Metab Syndr Obes 2023; 16:1449-1457. [PMID: 37223494 PMCID: PMC10202116 DOI: 10.2147/dmso.s403556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Currently, diabetes is a global health problem and it affects many people, especially in the developing continents. As patients' living conditions improve and the science of medicine advances, the longevity of such patients has increased greatly. Therefore, the purpose of this study was to identify predictors for the association of the longevity of people with diabetes in Buno Bedele and Illubabor Zones, South-west Ethiopia. Methods The study applied a retrospective cohort study design approach. In particular, long rank tests for longevity experience and Cox semi-parametric regression were implemented to compare and investigate the predictors associated with the longevity of patients with diabetes. Results Among all the patients who participated in this study, 56.9% were females and the rest were males. From the Cox regression result, age (AHR = 1.0550, 95% CI: (1.0250, 1.0860), p-value = 0.001), female patients (AHR = 0.2200, 95% CI: (0.0390, 0.5290)), rural patients (AHR = 0.2200, 95% CI: (0.1000, 0.4890), p-value = 0.001), the existence of fasting blood glucose complication (AHR = 1.2040, 95% CI: (1.0930, 1.4460), p-value = 0.001), the existence of blood pressure (AHR = 1.2480, 95% CI: (1.1390, 1.5999), p-value = 0.0180), treatment type, Sulfonylureas (AHR = 4.9970, 95% CI: (1.4140, 17.6550), p-value = 0.0120), treatment type, Sulfonylurea and Metformin (AHR = 5.7200, 95% CI: (1.7780, 18.3990), p-value = 0.0030) were significantly affected the longevity of people with diabetes. Conclusion The findings of the current study showed that the patient's age, sex of patients, residence area, the existence of complications, existence of pressure, and treatment type were major risk factors related to the longevity of people with diabetes. Hence, health-related education should be given to patients who come to take treatment to have better longevity for people with diabetes. More attention should be given to aged patients, male and urban patients, patients under complication treatment, and patients under treatment with single-treatment medication.
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Affiliation(s)
- Melaku Tadege
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia
| | - Azmeraw Misganaw
- Department of Statistics, Mettu University, Mettu, Oromia, Ethiopia
| | - Zemenay Truneh
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia
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Ingenhoff R, Munana R, Weswa I, Gaal J, Sekitoleko I, Mutabazi H, Bodnar BE, Rabin TL, Siddharthan T, Kalyesubula R, Knauf F, Nalwadda CK. Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda. BMC Public Health 2023; 23:881. [PMID: 37173687 PMCID: PMC10176286 DOI: 10.1186/s12889-023-15704-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda. METHODS This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically guided by the framework method. RESULTS Analysis identified elements likely to be required for successful program implementation in this context. Fundamental drivers of CHW programs included structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training. Additional enablers comprised specific CHW characteristics such as confidence, commitment and motivation, as well as social relations and empathy. Lastly, socioemotional aspects such as trust, virtuous behavior, recognition in the community, and the presence of mutual respect were reported to be critical to the success of task shifting programs. CONCLUSION CHWs are perceived as a useful resource when task shifting NCD screening and referral for hypertension and diabetes from facility-based healthcare workers. Before implementation of a task shifting program, it is essential to consider the multiple layers of needs portrayed in this study. This ensures a successful program that overcomes community concerns and may serve as guidance to implement task shifting in similar settings.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Richard Munana
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Julia Gaal
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Hillary Mutabazi
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, USA
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christine K Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
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Luambano C, Mwinuka B, Ibrahim RP, Kacholi G. Knowledge about diabetes mellitus and its associated factors among diabetic outpatients at Muhimbili National Hospital in Tanzania. Pan Afr Med J 2023; 45:3. [PMID: 37346920 PMCID: PMC10280699 DOI: 10.11604/pamj.2023.45.3.33143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/02/2023] [Indexed: 06/23/2023] Open
Abstract
Diabetes mellitus is emerging as one of the major public health threats that contributed to 2% of all deaths in Tanzania in 2016. Although adequate knowledge related to diabetes mellitus is associated with early case detection, prevention, and minimization of health complications and socioeconomic-related consequences, there is less evidence about the adequacy of the community´s knowledge of diabetes in Tanzania. This study aimed to determine knowledge about diabetes mellitus and its associated factors among diabetic outpatients. A cross-sectional study was conducted among 220 diabetic outpatients aged 18 years and above at Muhimbili national hospital in Tanzania between February and April 2017. Data were collected using a structured pretested questionnaire and were entered into Microsoft Excel and exported to SPSS Version 20 for analysis. Bivariate and multivariate logistic regression was used to determine the predictive variables. The significance of independent variables was declared at a 95% confidence level and p-value < 0.05. A total of 137 (64.01%) of the participants had adequate knowledge about diabetes mellitus. The majority (86.9% and 85.1%) reported having adequate knowledge of complications of diabetes and treatment options for diabetes respectively. The least level of knowledge reported was on signs and symptoms (48.6%) and type of diabetes (32.7%). The majority (54%) cited health facilities as the most common sources of information related to diabetes. Both bivariate and multivariate logistic regression analyses showed that there was a statistical association between knowledge related to diabetes and the level of education of study participants. The overall level of knowledge of participants about diabetes mellitus was adequate, with a low level of knowledge related to signs and symptoms of diabetes, and type of diabetes. Health facilities were the most common sources of information related to diabetes. Policy and decision-makers and health care providers should take collective action to improve community knowledge about diabetes. Health education related to diabetes should be integrated into the educational curriculum at all levels in Tanzania, which would massively increase awareness of diabetes.
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Affiliation(s)
- Christine Luambano
- Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania
| | - Bertha Mwinuka
- Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania
- Centre of Excellence in Health Monitoring and Evaluation, Mzumbe University, Morogoro, Tanzania
| | - Rogate Phinias Ibrahim
- Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania
- Centre of Excellence in Health Monitoring and Evaluation, Mzumbe University, Morogoro, Tanzania
| | - Godfrey Kacholi
- Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania
- Centre of Excellence in Health Monitoring and Evaluation, Mzumbe University, Morogoro, Tanzania
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Dehghani A, Korozhdehi H, Hossein Khalilzadeh S, Fallahzadeh H, Rahmanian V. Prevalence of diabetes and its correlates among Iranian adults: Results of the first phase of Shahedieh cohort study. Health Sci Rep 2023; 6:e1170. [PMID: 37021014 PMCID: PMC10069239 DOI: 10.1002/hsr2.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
Background and Aims The diabetes is one of the most common noncommunicable diseases, the prevalence of which is increasing worldwide. This study aimed to determine the prevalence, and correlates the factors of diabetes in the setting of Shahedieh cohort study in Yazd, Iran. Method The present study is a cross‐sectional study conducted on the data of the initial stage of Shahdieh Yazd cohort. This study examined the data of 9747 participants aged from 30 to 73 years. The data included demographic, clinical, and blood test variables. Multivariable logistic regression was used to calculate the adjusted odds ratio (OR), and the risk factors of diabetes were studied. Meanwhile, population attributable risks for diabetes were estimated, and reported. Results The prevalence of diabetes was 17.9% (CI95%: 17.1–18.9); 20.5% in women, and 15.4% in men. Based on the results of multivariable logistic regression showed female sex (OR = 1.4, CI95%: 1.24–1.58), waist‐hip ratio (OR = 1.4, CI95%: 1.24–1.58), high blood pressure (OR = 2.1, CI95%: 1.84–2.4), cardiovascular diseases (CVD) (OR = 1.52, CI95%: 1.28–1.82), stroke (OR = 1.91, CI95%: 1.24–2.94), age (OR = 1.81, CI95%: 1.67–1.96), hypercholesterolemia (OR = 1.79, CI95% triglyceride: 1.59–2.02), and low‐density lipoprotein (LDL) (OR = 1.45, CI95%: 1.4–1.51), as risk factors for diabetes. Among the modifiable risk factors, high blood pressure(52.38%), waist‐to‐hip ratio (48.19%), the history of stroke (47.64%), hypercholesterolemia (44.13%), history of CVD (34.21%), and LDL ≥ 130 (31.03%) had the greatest population‐attributable, respectively. Conclusion The results showed that some of the main determinants of diabetes are the modifiable risk factors. Therefore, implementing early detection, and screening programs for people at risk and preventive measures, such as lifestyle modification programs, and control of risk factors can prevent this disease.
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Affiliation(s)
- Ali Dehghani
- Department of Epidemiology and Biostatistics, School of Public HealthShahid Sadoughi University of Medical Sciences and Health ServicesYazdIran
| | - Hamid Korozhdehi
- Department of Epidemiology and Biostatistics, School of Public HealthShahid Sadoughi University of Medical Sciences and Health ServicesYazdIran
| | | | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, Research Center of Prevention and Epidemiology of Non‑Communicable DiseaseShahid Sadoughi University of Medical SciencesYazdIran
| | - Vahid Rahmanian
- Department of Public HealthTorbat Jam Faculty of Medical SciencesTorbat JamIran
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"A disease that god has given me" patients and caregivers' perspectives on diabetes in southeastern Tanzania. BMC Public Health 2023; 23:213. [PMID: 36721139 PMCID: PMC9890837 DOI: 10.1186/s12889-023-15147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prompt diagnosis and appropriate management of diabetes has the potential of improving survival and patient health outcomes. Yet many diabetes patients present themselves to health facilities at an advanced stage of the disease which complicates its management. Individual perceptions about diseases are known to play a critical role in informing responses and actions including seeking health care and self-care practices. However, little is documented in Tanzania regarding the perspectives of diabetes patients and their caregivers about the disease especially in rural settings. METHODS We conducted 26 in-depth interviews involving 19 diabetes patients and 7 diabetes patient caregivers to explore in detail their perspectives on diabetes as a disease. Data was analyzed using thematic analysis with the help of NVivo9. RESULTS Both patients and caregivers expressed mixed perceptions on diabetes causes. In addition to heredity, and the failure of the pancreas to function well, lifestyle factors including lack of physical activity and eating too many sugary and oily foods were common reported causes. However, none of the participants were clear on the mechanisms between the perceived causes and the actual occurrence of the disease. Perception on susceptibility to diabetes was low even among participants with the disease as they reported not having ever thought of getting the condition before they were diagnosed. Some caregivers expressed worry and fear on their susceptibility to inheriting diabetes from their relatives who had the condition. Diabetes was perceived as a severe and life-threatening condition that can easily cause death if not well managed. Participants indicated uncertainty on its prevention. CONCLUSION This study shows mixed perspectives on the causes, susceptibility, severity and prevention of diabetes which were informed by the participants' limited knowledge and awareness about the disease. Interventions to strengthen responses to diabetes, which include buy-in from the patients and their caregiver's perspectives are essential to improve prevention, early diagnosis and appropriate management in rural settings.
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Gidey G, Hiruy M, Teklu D, Ramanathan K, Amare H. Prevalence of Prediabetes and Related Modifiable Cardiovascular Risk Factors Among Employees of Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia. Diabetes Metab Syndr Obes 2023; 16:643-652. [PMID: 36919104 PMCID: PMC10008371 DOI: 10.2147/dmso.s307823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/22/2021] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Prediabetes is considered an important risk factor for type 2 diabetes and related cardiovascular problems. However, evidence shows that both prediabetes and its associated cardiovascular risk factors could be mitigated through lifestyle modification. This study aims at determining the magnitude of prediabetes and related modifiable cardiovascular risk factors as an initial step towards undertaking such mitigation measures. METHODS A cross-sectional study was conducted on employees of a tertiary care hospital from March to June/2019. Socio-demographic data were collected using a self-administered questionnaire. Anthropometric and blood pressure measurements were performed following WHO guidelines. Biochemical parameters were assayed following standard operating procedures. Categorical variables are summarized using frequencies and percentages. Normality test was performed ahead of describing the numeric data and log transformations were carried out when appropriate. International Diabetes Federation (IDF) and American Diabetes Association (ADA) criteria were used to classify glycemic status. Likewise, IDF and revised National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) were employed for the diagnosis of metabolic syndrome. RESULTS In this study, we engaged a total of 265 employees. About 35.1% were males and 64.9% were females. The median age was 29 (9) years. About 5.7% and 18.1% had prediabetes based on IDF and ADA criteria, respectively. Equally, 3.4% had FBS levels that meet the criteria for overt diabetes on IDF and ADA. Besides, 55.1% had a metabolic risk as implied by the elevated waist-to-height ratio (WhtR), 24.2% had hypertriglyceridemia, 27.9% had above optimal LDL and 57% had low HDL. Overall, 17.9% and 21.9% of the participants had metabolic syndrome according to IDF and revised NCEP ATP III criteria, respectively. CONCLUSION The prevalence of prediabetes and metabolic syndrome observed in hospital employees is comparable with the general population.
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Affiliation(s)
- Gebrekidan Gidey
- Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle, Ethiopia
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mulugeta Hiruy
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Desalegn Teklu
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Kumaresan Ramanathan
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hagos Amare
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Correspondence: Hagos Amare, Tel +251911762294, Email
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Osetinsky B, Mhalu G, Mtenga S, Tediosi F. Care cascades for hypertension and diabetes: Cross-sectional evaluation of rural districts in Tanzania. PLoS Med 2022; 19:e1004140. [PMID: 36469527 PMCID: PMC9762578 DOI: 10.1371/journal.pmed.1004140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/19/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs), especially hypertension and diabetes, are rapidly rising in sub-Saharan Africa, necessitating health systems transformations. In Tanzania, current policies aim to improve control of hypertension and diabetes, but information is still needed to assess the gaps in treatment. METHODS AND FINDINGS We conducted a cross-sectional household survey of 784 adults in two districts in Tanzania from December 2020 to January 2021, capturing the cascade-of-care for hypertension and diabetes. The ages of the respondents ranged from 18 to 89 years. Of those screened positive for these conditions, we measured the proportion in each step of the cascades: awareness, care engagement, treatment, and control. We conducted multivariable logistic regression analyses for all four steps along the hypertension care cascade with the independent variables of social health protection schemes, and prior diagnosis of comorbid diabetes, and demographic information. In our sample, of the 771 who had their blood pressure measured, 41% (95% confidence interval (CI): 38% to 44%) were screened positive for hypertension, and of the 707 who had their blood sugar measured, 6% (95% CI: 4% to 8%) were screened positive for diabetes. Of those with hypertension, 43% (95% CI: 38% to 49%) had a prior diagnosis, 25% (95% CI: 21% to 31%) were engaged in care, 21% (95% CI: 3% to 25%) were on treatment, and 11% (95% CI: 8% to 15%) were controlled. Of the 42 respondents with diabetes, 80% (95% CI: 69% to 93%) had a prior diagnosis. The diabetes care cascade had much less drop-off, so 66% of those with diabetes (95% CI: 52% to 82%) were engaged in care and on treatment, and 48% (95% CI: 32% to 63%) had their diabetes controlled at the point of testing. Healthcare fee exemptions were independently associated with higher odds of being previously diagnosed (OR 5.81; 95% CI [1.98 to 17.10] p < 0.005), engaged in care (OR 4.71; 95% CI [1.59 to 13.90] p 0.005), and retained in treatment (OR 2.93; 95% CI [1.03 to 8.35] p < 0.05). Prior diagnosis of comorbid diabetes was highly associated with higher odds of being engaged in care for hypertension (OR 3.26; 95% CI [1.39 to 7.63] p < 0.005). The two primary limitations of this study were reliance on screening at a single time point only of people available at the village at the time of the sample and dependence on self-report for to inform the three cascade steps of prior diagnosis, healthcare visits for engagement in care, and treatment use. CONCLUSIONS The high burden of hypertension and low levels of control in our study underscores the importance of improving the awareness and treatment of hypertension. The differences in the care cascades for hypertension and diabetes demonstrates that chronic NCD treatment is possible in this setting, but efforts will be needed across the entire care cascade to improve hypertension control.
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Affiliation(s)
- Brianna Osetinsky
- Swiss Tropical and Public Health Institute, Allschwill, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Sally Mtenga
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Allschwill, Switzerland
- University of Basel, Basel, Switzerland
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Kagaruki GB, Mahande MJ, Kreppel KS, Mbata D, Kilale AM, Shayo EH, Mfinanga SG, Bonfoh B. Barriers to the implementation, uptake and scaling up of the healthy plate model among regular street food consumers: a qualitative inquiry in Dar-es-Salaam city, Tanzania. BMC Nutr 2022; 8:110. [PMID: 36203200 PMCID: PMC9541087 DOI: 10.1186/s40795-022-00589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The healthy plate model is considered one of the practical approaches to reduce the average portion of staple food in main meals, consequently reducing the risks associated with diabetes and other Non-communicable Diseases (NCDs). Despite its potential benefits, studies on the implementation of the healthy plate model are limited in Africa. An inquiry explored barriers to implementation, uptake, and scaling up of the healthy plate model among street food vendors and consumers in three districts of Dar-es-Salaam city in Tanzania. Methods A qualitative research design was adopted. Qualitative data collection techniques were employed including; Key Informant Interviews (KIIs) with purposefully selected food and nutrition stakeholders at the National, Regional, District and Ward levels. Focus Group Discussions (FGDs) were conducted with purposefully selected street food consumers and vendors. A total of (13) KIIs were conducted as well as (6) FGDs with street food vendors (2 FGDs) and consumers (4 FGDs). Interview data was managed using Nvivo 12 Software and analyzed thematically. Results Three key themes emerged from participants’ accounts: (i) strategic policy barriers, (ii) food production and preparation environment barriers (producers and vendors), and (iii) individual barriers (consumers and vendors). The strategic policy barriers included absence of guidelines and regulations that focus on NCDs linked to nutrition and lack of education guidance for vendors and consumers. The food production and preparation environment barriers included safety and risks concerns regarding the quality of water used for irrigation and washing fruits and vegetables and the areas where vegetables and fruits are grown and prepared. Individual barriers included low consumer income, knowledge on nutrition, unhealthy eating practices and; low vendors’ knowledge as well as low investment capital. Conclusion Implementation, uptake and scaling up of the healthy plate model for street food consumers in Dar es Salaam City continues to be constrained by barriers in policy, food production and preparation environment, and individual obstacles. Strengthening of food and nutrition policies, ensuring safety of the food production and preparation environment and, consumer and vendor awareness creation and income generation efforts, provide useful entry points for the successful scaling up of a healthy plate model. This could consequently contribute towards prevention of diet related NCDs, including diabetes.
Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00589-6.
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Affiliation(s)
- Gibson B Kagaruki
- Research Programs, National Institute for Medical Research, Tukuyu Medical Research Centre, Tukuyu, Box 538, Mbeya, Tanzania. .,Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania.
| | - Michael J Mahande
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Katharina S Kreppel
- School of Life Science and Bioengineering, the Nelson Mandela African Institution of Science and Technology, Box 447, Arusha, Tanzania.,Department of Public Health, Institute of Tropical Medicine, Antwerp Belgium, Antwerp, Belgium
| | - Doris Mbata
- Research Programs, National Institute for Medical Research, Headquarters, Box 9653, Dar es Salaam, Tanzania
| | - Andrew M Kilale
- Research Programs, National Institute for Medical Research, Muhimbili Centre, Box 3436, Dar es Salaam, Tanzania
| | - Elizabeth H Shayo
- Research Programs, National Institute for Medical Research, Headquarters, Box 9653, Dar es Salaam, Tanzania
| | - Sayoki G Mfinanga
- Research Programs, National Institute for Medical Research, Muhimbili Centre, Box 3436, Dar es Salaam, Tanzania.,Department of Epidemiology & Biostatistics, Public Health Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania
| | - Bassirou Bonfoh
- Departiment of Research and Development, Centre Suisse de Recherches Scientifiques en Côte d'Ivoir, Abidjan, Côte d'Ivoire
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King J, Prabhakar P, Singh N, Sulaiman M, Greco G, Mounier-Jack S, Borghi J. Assessing equity of access and affordability of care among South Sudanese refugees and host communities in two districts in Uganda: a cross-sectional survey. BMC Health Serv Res 2022; 22:1165. [PMID: 36114536 PMCID: PMC9482210 DOI: 10.1186/s12913-022-08547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background The vast majority of refugees are hosted in low and middle income countries (LMICs), which are already struggling to finance and achieve universal health coverage for their own populations. While there is mounting evidence of barriers to health care access facing refugees, there is more limited evidence on equity in access to and affordability of care across refugee and host populations. The objective of this study was to examine equity in terms of health needs, service utilisation, and health care payments both within and between South Sudanese refugees and hosts communities (Ugandan nationals), in two districts of Uganda. Methods Participants were recruited from host and refugee villages from Arua and Kiryandongo districts. Twenty host villages and 20 refugee villages were randomly selected from each district, and 30 households were sampled from each village, with a target sample size of 2400 households. The survey measured condition incidence, health care seeking and health care expenditure outcomes related to acute and chronic illness and maternal care. Equity was assessed descriptively in relation to household consumption expenditure quintiles, and using concentration indices and Kakwani indices (for expenditure outcomes). We also measured the incidence of catastrophic health expenditure- payments for healthcare and impoverishment effects of expenditure across wealth quintiles. Results There was higher health need for acute and chronic conditions in wealthier groups, while maternal care need was greater among poorer groups for refugees and hosts. Service coverage for acute, chronic and antenatal care was similar among hosts and refugee communities. However, lower levels of delivery care access for hosts remain. Although maternal care services are now largely affordable in Uganda among the studied communities, and service access is generally pro-poor, the costs of acute and chronic care can be substantial and regressive and are largely responsible for catastrophic expenditures, with service access benefiting wealthier groups. Conclusions Efforts are needed to enhance access among the poorest for acute and chronic care and reduce associated out-of-pocket payments and their impoverishing effects. Further research examining cost drivers and potential financing arrangements to offset these will be important.
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20
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Muyer MTMC, Botomba S, Poka N, Mpunga D, Sibongwere DK, Peñalvo JL, Sagastume D, Mapatano MA. Diabetes prevalence and risk factors, underestimated without oral glucose tolerance test, in rural Gombe-Matadi Adults, Democratic Republic of Congo, 2019. Sci Rep 2022; 12:15293. [PMID: 36097182 PMCID: PMC9467973 DOI: 10.1038/s41598-022-18658-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022] Open
Abstract
An increase in the diabetes prevalence is reported worldwide. We aimed to determine the diabetes prevalence and its risk factors among adults in a rural area of the Democratic Republic of Congo. A cross-sectional study was conducted in 1531 inhabitants, selected by five stages, in the Health Zone of Gombe-Matadi. Diabetes was defined according to the American Diabetes Association and the International Diabetes Federation. Fasting glycemia and/or an oral glucose tolerance test were collected. We measured body mass index, waist circumference and blood pressure. Mann Whitney's and chi-square tests compared respondents with non-respondents. Multivariable logistic regression measured associations between diabetes and its risk factors. Crude and standardized prevalence of diabetes were 6.7% and 5.3%, respectively. Undiagnosed diabetes accounted for 58.8%. The oral glucose tolerance test alone diagnosed 2.6% of cases. Diabetes was more frequent in males, unemployed, obese and hypertensive (p < 0.05). Risk factors for diabetes were being male, aged ≥ 40 years, general and abdominal obesity associated with elderly, family history of diabetes, and hypertension. Diabetes in rural areas of the Democratic Republic of Congo appears to be underdiagnosed. The oral glucose tolerance test provides an opportunity to screen individuals for diabetes in this setting.
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Affiliation(s)
- Muel Telo Marie-Claire Muyer
- Department of Nutrition, School of Public Health, Epidemiology Center of Diabetes, Kinshasa, Democratic Republic of Congo.
| | - Steve Botomba
- Department of Nutrition, School of Public Health, Epidemiology Center of Diabetes, Kinshasa, Democratic Republic of Congo
| | - Nickson Poka
- Education Center of Diabetes and Health, Epidemiology Center of Diabetes, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Mpunga
- Department of Community Health, School of Public Health, Kinshasa, Democratic Republic of Congo.,Department of Nutrition, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Deogratias Katsuva Sibongwere
- Non-Communicable Diseases Unit, Department of Public Health, Institute of Tropical Medicine of Antwerp, Sint-Rochusstraat 43, 2000, Antwerp, Belgium.,Education Department, Institute of Tropical Medicine of Antwerp, Sint-Rochusstraat 43, 2000, Antwerp, Belgium
| | - José Luis Peñalvo
- Non-Communicable Diseases Unit, Department of Public Health, Institute of Tropical Medicine of Antwerp, Sint-Rochusstraat 43, 2000, Antwerp, Belgium
| | - Diana Sagastume
- Non-Communicable Diseases Unit, Department of Public Health, Institute of Tropical Medicine of Antwerp, Sint-Rochusstraat 43, 2000, Antwerp, Belgium
| | - Mala Ali Mapatano
- Department of Nutrition, School of Public Health, Epidemiology Center of Diabetes, Kinshasa, Democratic Republic of Congo
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21
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Manisha AM, Shangali AR, Mfinanga SG, Mbugi EV. Prevalence and factors associated with latent autoimmune diabetes in adults (LADA): a cross-sectional study. BMC Endocr Disord 2022; 22:175. [PMID: 35804315 PMCID: PMC9270809 DOI: 10.1186/s12902-022-01089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Latent Autoimmune Diabetes in Adults (LADA) is a slowly progressive Type 1 diabetes subgroup with onset during middle age. Studies report that about 10% of adults initially diagnosed with clinical Type 2 diabetes (T2D) have LADA. Inappropriate diagnosis and mismanagement of the LADA can increase the risk of diabetic complications, which affect the quality of life and is the cause of increased mortality. In low-income countries setting, data regarding the magnitude of LADA is limited. We carried out this study to estimate the burden of misdiagnosed LADA among T2D patients in selected health facilities in Dar es Salaam and to bring awareness to the use of Glutamic Acid Decarboxylase (GAD) autoantibody in screening for LADA. METHODOLOGY We enrolled 186 phenotypically T2D patients in this cross-sectional study, through a standardized data collection tool we obtained participants' demographic and clinical information. For testing GAD levels, we used a double-antibody Enzyme-Linked Immunosorbent Assay (ELISA). The Fisher's Exact and student t-tests were used to test the significance of the statistical associations of the glycaemic control and diabetes complications between T2D and LADA. RESULTS Out of 186 patients, 156 gave conclusive GAD Ab ELISA reading with LADA accounting for 5.1% (95% CI: 2.5 - 10.0). The mean age of subjects was 54.3 years (Range: 33-85 years). The parameters such as mean age, family history of diabetes mellitus status, Fasting Blood Glucose, clinical characteristics, and complications did not show significant statistical differences between patients with LADA and Type 2 diabetes. However, all LADA- Human Immunodeficiency Virus (HIV) comorbid patients had retinopathy, which was statistically insignificant in 20 (87%) T2D-HIV comorbid patients (p = 0.669). Neither neuropathy, nephropathy, nor Diabetic Mellitus (D.M.) foot syndrome was observed among LADA-HIV comorbid patients. Nevertheless, 22 (95.7%), 3 (13%), and 2 (8.7%) of T2D-HIV comorbidity had neuropathy, nephropathy, or D.M. foot syndrome, respectively. CONCLUSIONS The study established a LADA prevalence of 5.1% among T2D patients and has shown the role of GAD autoantibody in the screening for LADA. The study calls for a well- designed larger longitudinal study to generate strong evidence on the association of risk factors and complications associated with the LADA. This will develop robust evidence on the association of risk factors and complications associated with the LADA and T2D.
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Affiliation(s)
- Anselmo M. Manisha
- Department Biochemistry, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
- Department of Biochemistry and Physiology, Mwanza University, P.O. Box 1719, Mwanza, Tanzania
| | - Aminiel R. Shangali
- Department of Biochemistry and Physiology, Mwanza University, P.O. Box 1719, Mwanza, Tanzania
- Department of Parasitology, Microbiology and Immunology, Mwanza University, P.O. Box 1719, Mwanza, Tanzania
| | - Sayoki G. Mfinanga
- National Institute for Medical Research, P.O. Box 3436, Dar es salaam, Tanzania
- Department of Epidemiology and Statistics, School of Public Health, Muhimbili University of Health, and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Erasto V. Mbugi
- Department Biochemistry, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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22
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Ghaemmaghami Z, Eftekhar E, Shahbazi R, Nejatizadeh A, Shahmoradi M, Kheirandish M. Pre-diabetes, Diabetes Mellitus and Related Cardio-metabolic Risk Factors in the Southern Coastal Region of Iran Middle-aged and Elderly Population; Bandare-Kong Cohort Study. ARCHIVES OF IRANIAN MEDICINE 2022; 25:409-416. [DOI: 10.34172/aim.2022.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/09/2022] [Indexed: 11/06/2022]
Abstract
Background: To evaluate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), and its cardio-metabolic risk factors in the southern Iranian adult population. Methods: This is a population-based cross-sectional survey on 3944 middle-aged and elderly adults (35–70 years) from Bandare-Kong. The participants were recruited from 2016 to 2018 and the first phase data of the Bandare-Kong Cohort as a part of the PERSIAN Cohort were used for analysis. Results: Among the 3944 included adults, the age-adjusted prevalence of T2DM and IFG was 17.40% and 20.61%, respectively. Mean FPG was higher among those older than 55 years, females, rural residents, current cigarette smokers, hypertriglyceridemia, hypercholesterolemia, unemployed and low educational level in subjects with diabetes and pre-diabetes. T2DM and IFG were more prevalent in women and men, respectively. Also, those with higher waist circumference (WC), higher body mass index (BMI), lower educational levels, rural residents, former cigarette smokers, hypertension (HTN), hypercholesterolemia, hypertriglyceridemia and age older 45 years, had a higher T2DM and IFG prevalence. Multivariable regression analysis showed that older age, higher WC, HTN and hypertriglyceridemia and living in rural regions were statistically significant predictors of T2DM and pre-diabetes while BMI≥25 kg/m2 was the only significant risk factor for IFG. Conclusion: The current study illustrated that T2DM and IFG have a high prevalence among the middle-aged and elderly adult Iranian population, particularly in rural dwellers. Hence, prevention strategies should be implemented to reduce diabetes and pre-diabetes, especially in rural areas.
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Affiliation(s)
- Zahra Ghaemmaghami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Eftekhar
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Roghayeh Shahbazi
- Cellular and Molecular Medicine Department, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Azim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Shahmoradi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Kheirandish
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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23
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Nigussie KA, Shegena EA, Stephen OP, Namugambe JS, Yadesa TM. Prevalence and factors associated with inappropriate anti- diabetic medication therapy among type 2 diabetes mellitus patients at the medical and surgical wards of Mbarara Regional Referral Hospital, Uganda. PLoS One 2022; 17:e0270108. [PMID: 35767589 PMCID: PMC9242490 DOI: 10.1371/journal.pone.0270108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Inappropriate Anti-diabetic Medication Therapy (IADT) refers to a drug-related problem and includes ‘ineffective drug therapy’, ‘unnecessary drug therapy’, ‘dosage too high’, and ‘dosage too low’. This study aimed to determine the prevalence and factors associated with IADT among T2DM patients at Mbarara Regional Referral Hospital, Uganda (MRRH). Method A prospective cross-sectional study was conducted at the medical and surgical wards of MRRH from November 2021 to January 2022. One hundred and thirty-eight adult patients aged 18 years and above, with T2DM, were recruited using consecutive sampling. Patient file reviews and interviewer-administered questionnaire was used for data collection. The data were entered into and analyzed using SPSS version 25. Descriptive analysis was employed to describe the population and determine the prevalence of IADT. Types of IADTs were identified using Cipolle’s DRP classification tool. A univariate and multivariate logistic regression analysis was used to identify factors significantly associated with IADT. The P-value of < 0.05 was considered statistically significant at 95% confidence interval. Results A total of 138 hospitalized T2DM patients were studied. Eighty (58.0%) were females, and 70 (50.7%) were ≥ 60 years of age. Out of a total of 138 participants, 97 experienced at least one IADT, with an estimated prevalence of 70.3%. ‘Dosage too high’ (29.2%) and ‘dosage too low’ (27.9%) were the most common type of IADTs. Age ≥ 60 years (AOR, 8.44; 95% CI, 2.09–10.90; P-value = 0.003), T2DM duration of < 1 year (AOR, 0.37; 95% CI, 0.11–0.35; P-value = 0.019), and HbA1c of < 7% (AOR, 9.97; 95% CI, 2.34–13.57; P-value = 0.002) were found to be factors significantly associated with the occurrence of IADTs. Conclusion The overall prevalence of inappropriate anti-diabetic medication therapy among T2DM patients admitted to medical and surgical wards of MRRH was 70.3%. The most common type of IADT in this study was ‘dosage too high’, accounting for almost one-third followed by ‘dosage too low’ accounting for a quarter of total IADTs. Age greater or equal to 60 years, T2DM duration of < 1 year, and HbA1c of < 7% during the current admission were found to be factors significantly associated with the occurrence of IADTs in hospitalized T2DM patients.
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Affiliation(s)
- Konjit Abebe Nigussie
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- PHARMBIOTRAC, World Bank’s ACE-II Project, Mbarara University of Science and Technology, Mbarara, Uganda
- * E-mail:
| | - Efrata Ashuro Shegena
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Obwoya Paul Stephen
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- PHARMBIOTRAC, World Bank’s ACE-II Project, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Pharmacy, College of Medicine & Health Sciences, Ambo University, Ambo, Ethiopia
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Sandholzer-Yilmaz AS, Kroeber ES, Ayele W, Frese T, Kantelhardt EJ, Unverzagt S. Randomised controlled trials on prevention, diagnosis and treatment of diabetes in African countries: a systematic review. BMJ Open 2022; 12:e050021. [PMID: 35545395 PMCID: PMC9096485 DOI: 10.1136/bmjopen-2021-050021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The epidemiological transition from infectious to chronic diseases leads to novel challenges in African health systems. The prevalence of diabetes mellitus (DM) is increasing dramatically. Undiagnosed and undertreated DM leads to numerous complications including end-organ damage and death. Our objectives were to collect the best locally generated evidence on DM interventions, identify knowledge gaps and determine underexplored research areas. DESIGN A systematic review and meta-analysis of randomised controlled trials. PARTICIPANTS AND SETTING African patients in primary, secondary and tertiary prevention, diagnosis and treatment DM type 1 (DM1), type 2 (DM2) and gestational DM (GDM). OUTCOME All-cause mortality, glycaemic control, complications, quality of life, hospital admission, treatment adherence and costs. DATA SOURCES Articles published in MEDLINE Ovid, CENTRAL, CINAHL, African Journals Online and African Index Medicus and the International Clinical Trials Registry Platform in English language without time restrictions. The systematic search was last updated in October 2020. RESULTS Out of 3736 identified publications, we included 60 eligible studies conducted in 15 countries, 75% were conducted in urban healthcare settings, including 10 112 participants. We included 8 studies on DM1, 6 on GDM, 2 on pre-DM, 37 on mainly DM2 including 7 on DM-related complications. The design of the studied intervention was heterogeneous with a focus on educational strategies. The other studies investigated the efficacy of nutritional strategies including food supplementations, pharmacological strategies and strategies to enhance physical activity. Seven studies included interventions on DM-related complications. CONCLUSIONS Research activities increased in recent years, but available evidence is still not representative for all African countries. There is a big lack of evidence in primary healthcare and rural settings, implementation research, pharmacological interventions, especially in poorer countries. Nevertheless, the identified studies offer a variety of effective interventions that can inform medical care and future research. PROSPERO REGISTRATION NUMBER CRD42019122785.
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Affiliation(s)
- Angelika Sabine Sandholzer-Yilmaz
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany
- Department of Haematology and Oncology, University of Göttingen, Gottingen, Germany
| | - Eric Sven Kroeber
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany
| | - Wondimu Ayele
- Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - T Frese
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Center of Health Sciences, Martin-Luther-University Halle-Wittenberg Medical Faculty, Halle, Germany
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany
- University Leipzig, Department of General Practice, Leipzig, Germany
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25
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Malindisa EK, Balandya E, Mashili F, Iddi S, Njelekela M. The magnitude of type 2 diabetes mellitus and cardiovascular disease risk factors among young adults in urban settings: a cross-sectional survey in Mwanza, Tanzania. Pan Afr Med J 2022; 42:19. [PMID: 35812257 PMCID: PMC9228915 DOI: 10.11604/pamj.2022.42.19.22184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/10/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction traditionally, non-communicable diseases were diseases of public health concern in developed countries. Due to economic transition, they are becoming more prevalent in low and middle-income countries. Despite the trend, little has been done in the population of young adults of developing countries. This research aimed to explore the magnitude of type 2 diabetes mellitus, hypertension, dyslipidemia, and abdominal obesity among the young adult population in an urban setting of Tanzania. Methods the current research used a cross-sectional community-based design, involving apparently healthy young adults aged 18 to 34 years, not known to have diabetes, hypertension, or dyslipidemia. Data on socio-demographic characteristics, medical history, anthropometry, blood pressure, and lipids were obtained per standard operating procedures and analyzed using STATA 13. Association between outcome variables (type 2 diabetes mellitus, hypertension, dyslipidemia, and abdominal obesity) and predictor variables (age, sex, education level, occupation, and economic status) were assessed by logistic regression. Results 245 young adults with a median age of 21 (interquartile range [IQR]: 18-25) were recruited. Prevalence of diabetes mellitus and of impaired glucose tolerance (IGT) were 7.8% and 15.5% respectively. Abdominal obesity and dyslipidemia were present in 11.8% and 45.1% respectively. 34.3% had hypertension and the risk was significantly higher in males compared to females (OR 1.8, 95%CI 1.1, 3.1). The atherogenic coefficient was significantly associated with abdominal obesity; other atherogenic indices did not show significant associations with current disease conditions. Conclusion alarmingly high prevalence of diabetes mellitus, impaired glucose tolerance, hypertension, abdominal obesity, and dyslipidemia were observed among young adults in Mwanza. This study highlights the need for concerted efforts for interventions targeting young adults in combating diabetes and cardiovascular disease (CVD) risk factors in Tanzania.
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Affiliation(s)
- Evangelista Kenan Malindisa
- Department of Physiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania,,Corresponding author: Evangelista Kenan Malindisa, Department of Physiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
| | - Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Fredirick Mashili
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Shabani Iddi
- Department of Physiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Marina Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania,,Deloitte Consulting Limited, Dar Es Salaam, Tanzania
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26
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Redmond ML, Bimali M, Ablah E, Mayes P, Dugan K. A Geo-Stratified Analysis of Associations Between Socio-Economic Factors and Diabetes Risk. Kans J Med 2022; 15:175-183. [PMID: 35646257 PMCID: PMC9126863 DOI: 10.17161/kjm.vol15.15799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction In 2019, diabetes was the seventh leading cause of death in the United States. The association between diabetes risk and socio-economic factors in the U.S. has been examined primarily at the national level; little is known about this association at the regional level. This study examined and compared the association between diabetes risk and previously established socio-economic factors across four geographic regions (South, Midwest, West, and Northwest). Methods This study analyzed the 2014 Behavioral Risk Factor Surveillance System (BRFSS) data stratified by four geographic regions of the U.S. The risk estimates of diabetes associated with previously established socio-economic factors, as well as diabetes prevalence, were compared across four geographic regions. Results There was marked variation in association between diabetes risk and previously established risk factors across the four geographic regions. In the South, rural residency was associated with increased diabetes risk, whereas in the other geographic regions rural residency had a protective effect. In the South, the diabetes risk for males was 22% higher compared to females, whereas the risk for males was 41% higher than females in the Northeast. Independently, age had the strongest discriminative ability to distinguish between a person with diabetes and a person without diabetes, whereas ethnicity, race, and sex had the weakest discriminative abilities. Conclusions These findings suggested a higher prevalence of diabetes by race/ethnicity (non-Hispanic Black and Hispanic) and income across all four regions. Rural residency was highest in the South, but protective in other regions. Overall, age and income provided the highest predictive ability for diabetes risk. This study highlighted differences in diabetes prevalence in association between previously established socio-economic variables and diabetes risk across four geographic regions. These findings could help public health professionals and policy makers in understanding the dynamic relationship between diabetes and risk factors at the regional level.
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Affiliation(s)
- Michelle L Redmond
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Milan Bimali
- Department of Biostatistics, University of Arkansas for Medical Services, Little Rock, AR
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Paigton Mayes
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Katelyn Dugan
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
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Kiryowa HM, Munabi IG, Buwembo W, Rwenyonyi CM, Kaddumukasa M, Sabakaki EM. Prevalence and factors associated with periodontal disease in patients with diabetes mellitus attending Kiruddu National Referral Hospital, Uganda. Pan Afr Med J 2022; 43:202. [PMID: 36942143 PMCID: PMC10024556 DOI: 10.11604/pamj.2022.43.202.35971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction patients with diabetes mellitus present with high rates of periodontal disease. Severity and extent of periodontal disease may be directly associated with poor glycemic control. The burden of periodontal disease in patients with diabetes mellitus in Uganda is not documented. This study set out to determine the prevalence and factors associated with periodontal disease in patients with diabetes mellitus attending a national referral hospital in Uganda. Methods this was a cross-sectional study involving 264 patients with diabetes mellitus. Data were collected using a pretested questionnaire to assess factors associated with periodontal disease. This was followed by an oral examination to determine the community periodontal index (CPI) and clinical attachment loss (CAL). Laboratory tests included glycated hemoglobin and fasting blood sugar. Factors associated with periodontal diseases were evaluated using logistic regression analysis. Results of the 264 participants, 68.9% were females. The average age was 48.9 (SD = 11.0) years. Majority of the participants (32.6%) had diabetes mellitus for 2 to 5 years with oral hypoglycemic drugs being the most commonly (55.7%) used medication. The overall prevalence of periodontal disease was 85%. Univariate analysis revealed that prevalence of periodontal disease was associated with male sex, lower level of education, smoking, oral hygiene practices, poor glycemic control and combined diabetic medication. However, based on multivariate model, this prevalence was only significantly associated with lower level of education: aOR: 10.77 95% CI 1.04-226.38, p=0.05. Conclusion periodontal disease is highly prevalent in patients with diabetes mellitus in Uganda, especially those with a lower level of education. All diabetic patients should be screened and managed for periodontal disease. Oral health interventions should also be packaged and presented in a simple language to allow easy comprehension by even the less educated population.
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Affiliation(s)
- Haruna Muhmood Kiryowa
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Corresponding author: Haruna Muhmood Kiryowa, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Ian Guyton Munabi
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Buwembo
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Erisa Mwaka Sabakaki
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Iyer HS, James P, Valeri L, Bajunirwe F, Nankya-Mutyoba J, Njelekela M, Chiwanga F, Sewram V, Ajayi I, Adebamowo C, Dalal S, Reid TG, Rebbeck TR, Adami HO, Holmes MD. Neighborhood greenness and burden of non-communicable diseases in Sub-Saharan Africa: A multi-country cross-sectional study. ENVIRONMENTAL RESEARCH 2021; 196:110397. [PMID: 33130166 PMCID: PMC8085185 DOI: 10.1016/j.envres.2020.110397] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 05/04/2023]
Abstract
Population growth, demographic transitions and urbanization in sub-Saharan Africa (SSA) will increase non-communicable disease (NCD) burden. We studied the association between neighborhood greenness and NCDs in a multi-country cross-sectional study. Among 1178 participants, in adjusted models, a 0.11 unit NDVI increase was associated with lower BMI (β: -1.01, 95% CI: -1.35, -0.67), and lower odds of overweight/obesity (aOR: 0.73, 95% CI: 0.62, 0.85), diabetes (aOR: 0.77, 95% CI: 0.62, 0.96), and having ≥3 allostatic load components compared to none (aOR: 0.66, 95% CI: 0.52, 0.85). Except for diabetes, these remained statistically significant after Bonferroni correction. We observed no association between NDVI and hypertension or cholesterol. Our findings are consistent with health benefits of neighborhood greenness reported in other countries, suggesting greening strategies could be considered as part of broader public health interventions for NCDs.
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Affiliation(s)
- Hari S Iyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA.
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joan Nankya-Mutyoba
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marina Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; Department of Internal Medicine, Muhimbili National Hospital, Dar Es Salaam, Tanzania; Deloitte Consulting Limited, Dar Es Salaam, Tanzania
| | - Faraja Chiwanga
- Department of Internal Medicine, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Vikash Sewram
- African Cancer Institute, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - IkeOluwapo Ajayi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Clement Adebamowo
- Institute of Human Virology, Abuja, Nigeria; Greenebaum Comprehensive Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Shona Dalal
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Todd G Reid
- Media Lab and Connection Science, Massachusetts Institute of Technology, Boston, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Timothy R Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Hans-Olov Adami
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Michelle D Holmes
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, USA
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Kagaruki GB, Mahande MJ, Kimaro GD, Ngadaya ES, Mayige T M, Selemani M, Jaacks LM, Jaffar S, Mfinanaga SG, Bonfoh B. Prevalence and Correlates of Cardio-Metabolic Risk Factors Among Regular Street Food Consumers in Dar es Salaam, Tanzania. Diabetes Metab Syndr Obes 2021; 14:1011-1024. [PMID: 33707960 PMCID: PMC7943326 DOI: 10.2147/dmso.s287999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Regular street food consumers (RSFCs) in Africa are at an increased risk of unhealthy eating practices, which have been associated with intermediate risk factors of cardio-metabolic diseases. However, knowledge of the magnitude and correlates of these risk factors is limited in Tanzania. This study aimed to fill this gap using data collected from RSFCs in Dar es Salaam, the largest city in Tanzania. METHODOLOGY A cross-sectional study was carried out among 560 RSFCs in three districts of Dar es Salaam between July and September 2018. Information on socio-economic factors and demographics, behavioral risks, anthropometric and biochemical indicators was collected. Adjusted odds ratios (OR) and prevalence ratio (PR) with corresponding 95% confidence intervals (CI) were estimated using multivariable binary logistic and modified Poisson regression models, respectively. RESULTS On average, participants consumed 11 street food meals/week. The prevalence (95% CI) of cardio-metabolic risk factors was 63.9% (60.6-69.9%) for overweight/obesity, 42.5% (38.3-46.9%) for raised blood pressure, 13.5% (10.9-16.8%) for raised triglycerides and 6.6% (4.9-9.3%) for raised glucose levels. The correlates of overweight/obesity were female vs male sex (APR=1.3; 95% CI 1.2-1.5), age of 41-64 vs 25-40 years (APR=1.4; 95% CI 1.2-1.6), high vs low income (APR=1.2; 95% CI 1.04-1.3), being married/cohabiting vs other (APR=1.2; 95% CI 1.01-1.4) and family history of diabetes vs no family history (APR=1.2; 95% CI 1.01-1.3). Age 41-64 vs 25-40 years, was the only significant factor associated with raised blood pressure APR (95% CI) 2.2 (1.7-2.9) and raised glucose AOR (95% CI) 3.9 (1.5-10.5). CONCLUSION Our study revealed that RSFCs are at risk of cardio-metabolic health problems, especially women, middle-aged people and those with higher incomes. Transdisciplinary studies to understand the drivers of street food consumption are needed in order to inform interventions to mitigate the risk of developing cardio-metabolic diseases. These interventions should target both street food vendors and their consumers.
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Affiliation(s)
- Gibson B Kagaruki
- Research Programs, National Institute for Medical Research, Tukuyu Medical Research Centre, Mbeya, Tanzania
- Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael J Mahande
- Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Godfather D Kimaro
- Research Programs, National Institute for Medical Research, Muhimbili Centre, Dar es Salaam, Tanzania
| | - Esther S Ngadaya
- Research Programs, National Institute for Medical Research, Muhimbili Centre, Dar es Salaam, Tanzania
| | - Mary Mayige T
- Research Programs, National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Majige Selemani
- Eastern Africa Statistical Training Centre, Graduate Studies, Dar es Salaam, Tanzania
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Security, The University of Edinburgh, Midlothian, UK
| | - Shabbar Jaffar
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Sayoki G Mfinanaga
- Research Programs, National Institute for Medical Research, Muhimbili Centre, Dar es Salaam, Tanzania
- Public Health Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bassirou Bonfoh
- Public Health Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abdjan, Côte d’Ivoire
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Munyogwa MJ, Ntalima KS, Kapalata SN. Setting - based prevalence and correlates of central obesity: findings from a cross-sectional study among formal sector employees in Dodoma City, Central Tanzania. BMC Public Health 2021; 21:97. [PMID: 33413279 PMCID: PMC7792166 DOI: 10.1186/s12889-020-10142-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Obesity at the workplace has been associated with symptoms of lower self-esteem, increased individual and employer healthcare costs, increased absenteeism and presenteeism and reduced productivity. Therefore, this study was designed to study the prevalence and correlates of central obesity among formal sector employees in Dodoma City. METHODS Study design was a cross-sectional survey conducted from March to June, 2019. Participants were employees from formal sector employment defined as those paid regular monthly wage and with either a secured permanent or temporary contract. Simple random sampling was used to select four out of fifteen large buildings hosting various establishments. Respondents were obtained conveniently and interviewed face to face. Central obesity was defined as a waist circumference greater than 102 cm for males and greater than 88 cm for females. Chi-square test was conducted to assess the differences among the groups. Simple and multiple logistic regression models were fitted to identify the correlates of central obesity. RESULTS A total of 392 respondents (98% response rate) agreed and participated in the study. The overall prevalence of central obesity was found to be 41.8% (164/392). The prevalence of central obesity was significantly higher among females (67.4% p < 0.001), respondents aged ≥51 years (60%, p = < 0.001), administrators (55.1% p = < 0.05), respondents with salary of > 1,000,000 Tanzanian Shilling (TSh.) per month (54.4%, p = < 0.05), respondents who eat homemade meals at the workplace (64.2%, p = < 0.05) and respondents with hypertension (62.5%, p = < 0.05). Correlates of central obesity were found to be female sex (AOR = 9.53; 95% CI: 5.49, 16.78), increased age, eating homemade meals at the workplace (AOR = 2.32; 95% CI: 1.04, 4.19) and hypertension (AOR = 3.15; 95% CI: 1.41, 6.91). CONCLUSIONS The present study revealed high prevalence of central obesity among formal sector employees in Dodoma City. Scholars and stakeholders are urged to generate more evidences and design appropriate interventions to curb the situation.
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Affiliation(s)
- Mariam John Munyogwa
- Department of Public Health, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - Kaloli Sayi Ntalima
- Department of Public Health, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
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Tujuba T, Ayele BH, Fage SG, Weldegebreal F. Anemia among Adult Diabetic Patients Attending a General Hospital in Eastern Ethiopia: a Cross-sectional Study. Diabetes Metab Syndr Obes 2021; 14:467-476. [PMID: 33564253 PMCID: PMC7866907 DOI: 10.2147/dmso.s289298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although anemia is a common condition among patients with diabetes mellitus, there is little evidence on anemia among this segment of population in Ethiopia at large and in the study setting in particular. Thus, this study aimed at assessing the magnitude of anemia and its associated factors among adult diabetic patients attending a general hospital in Eastern Ethiopia. METHODS A health facility-based cross-sectional study was conducted among 325 randomly selected adult diabetes mellitus patients attending a follow-up clinic at Gelemso General Hospital, Eastern Ethiopia. Data were collected through an interview using a pre-tested and structured questionnaire followed by physical and laboratory measurements. Data were then entered into EpiData Version.3.1 and analyzed by using STATA version 16.0. Binary logistic regression models were fitted to identify factors associated with anemia. All statistical tests were declared significant at p-value < 0.05. RESULTS The magnitude of anemia among adult diabetic patients was 30.2% (95% confidence interval (CI): 25.4%-35.4%). Anemia was higher in males (36%) than females (20.5%). Male gender (Adjusted Odds Ratio (AOR) = 2.1, 95% CI: 1.2, 3.8), DM duration of ≥5 years (AOR= 1.9, 95% CI: 1.0, 3.7), presence of comorbidity (AOR= 1.9, 95% CI: 1.0, 3.7), and having diabetic complications (AOR= 2.3, 95% CI: 1.3, 4.2) were significantly associated with anemia. CONCLUSION Anemia was a moderate public health problem among adult DM patients in the study setting. Being male in gender, duration of DM, presence of DM complications, and DM co-morbidities were factors associated with anemia. Therefore, routine screening and appropriate management of anemia targeting males, DM patients with longer duration of DM, and those with complications and co-morbidities should be devised to improve patients' quality of life. Early diagnosis and regular monitoring of DM could also help to minimize further complications.
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Affiliation(s)
- Teshome Tujuba
- Department of Medical Laboratory, Gelemso General Hospital, Gelemso, Ethiopia
| | - Behailu Hawulte Ayele
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sagni Girma Fage
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Correspondence: Sagni Girma Fage College of Health and Medical Sciences, Haramaya University, P.O.Box 235, Harar, Ethiopia Email
| | - Fitsum Weldegebreal
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Tonne C, Adair L, Adlakha D, Anguelovski I, Belesova K, Berger M, Brelsford C, Dadvand P, Dimitrova A, Giles-Corti B, Heinz A, Mehran N, Nieuwenhuijsen M, Pelletier F, Ranzani O, Rodenstein M, Rybski D, Samavati S, Satterthwaite D, Schöndorf J, Schreckenberg D, Stollmann J, Taubenböck H, Tiwari G, van Wee B, Adli M. Defining pathways to healthy sustainable urban development. ENVIRONMENT INTERNATIONAL 2021; 146:106236. [PMID: 33161201 DOI: 10.1016/j.envint.2020.106236] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 05/05/2023]
Abstract
Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development.
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Affiliation(s)
- Cathryn Tonne
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain.
| | - Linda Adair
- Gillings School of Public Health, University of North Carolina, Chapel Hill, NC 27516-2524, USA
| | - Deepti Adlakha
- School of Natural and Built Environment, Queen's University Belfast, David Keir Building, 39-123 Stranmillis Road, Belfast BT9 5AG, United Kingdom
| | - Isabelle Anguelovski
- ICREA Catalan Institution for Research and Advanced Studies, 08010 Barcelona, Spain; Universitat Autonoma de Barcelona, 08193 Barcelona, Spain; IMIM Medical Research Institute, Hospital del Mar, 08003 Barcelona, Spain
| | - Kristine Belesova
- Centre on Climate Change and Planetary Health, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Maximilian Berger
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, 10117 Berlin, Germany
| | - Christa Brelsford
- Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | - Payam Dadvand
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Asya Dimitrova
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Billie Giles-Corti
- RMIT University, La Trobe Street, GPO Box 2476, Melbourne, VIC 3000, Australia
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, 10117 Berlin, Germany
| | - Nassim Mehran
- Humboldt University, Unter den Linden 6, 10099 Berlin, Germany
| | - Mark Nieuwenhuijsen
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - François Pelletier
- United Nations Population Division, 2 United Nations Plaza, Rm. DC2-1950, New York, NY 10017 USA
| | - Otavio Ranzani
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Marianne Rodenstein
- Goethe University, Westend Campus - PEG Building, Theodor-W.-Adorno-Platz 6, 60323 Frankfurt am Main, Germany
| | - Diego Rybski
- Potsdam Institute for Climate, P.O. Box 60 12 03, Potsdam 14412, Germany
| | - Sahar Samavati
- Tarbiat Modares University, Jalal Ale Ahmad Highway, 9821 Tehran, Iran
| | - David Satterthwaite
- International Institute for Environment and Development, Unit, 80-86 Gray's Inn Road, London WC1X 8NH, UK
| | - Jonas Schöndorf
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, 10117 Berlin, Germany
| | - Dirk Schreckenberg
- ZEUS GmbH, Centre for Applied Psychology, Environmental and Social Research, Sennbrink 46, D-58093 Hagen, Germany
| | - Jörg Stollmann
- Institute of Architecture, TU Berlin, Strasse des 17.Juni 135, 10623 Berlin, Germany
| | - Hannes Taubenböck
- Deutsches Zentrum für Luft- und Raumfahrt, Oberpfaffenhofen, Münchener Str. 20, 82234 Weßling, Germany
| | - Geetam Tiwari
- Indian Institute of Technology Delhi, Hauz Khas, New Delhi, Delhi 110016, India
| | - Bert van Wee
- Delft University of Technology, PO Box 5015, 2600 GA Delft, the Netherlands
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, 10117 Berlin, Germany
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Armstrong-Hough M, Sharma S, Kishore SP, Akiteng AR, Schwartz JI. Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis. PLoS One 2020; 15:e0241555. [PMID: 33362249 PMCID: PMC7757794 DOI: 10.1371/journal.pone.0241555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Availability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. Methods We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. Results Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. Conclusions We conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.
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Affiliation(s)
- Mari Armstrong-Hough
- School of Global Public Health, New York University, New York, NY, United States of America
- * E-mail:
| | - Srish Sharma
- Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Sandeep P. Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Young Professionals Chronic Disease Network, New York, New York, United States of America
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Bavuma CM, Musafiri S, Rutayisire PC, Ng'ang'a LM, McQuillan R, Wild SH. Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: time to contextualize the interventions? A cross-sectional study. BMC Endocr Disord 2020; 20:180. [PMID: 33302939 PMCID: PMC7731466 DOI: 10.1186/s12902-020-00660-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/30/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Existing prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in some settings where atypical phenotypes exist. This study aims to assess the socio-demographic and clinical characteristics of people with diabetes in rural Rwanda compared to those of urban dwellers. METHODS A cross-sectional, clinic-based study was conducted in which individuals with diabetes mellitus were consecutively recruited from April 2015 to April 2016. Demographic and clinical data were collected from patient interviews, medical files and physical examinations. Chi-square tests and T-tests were used to compare proportions and means between rural and urban residents. RESULTS A total of 472 participants were recruited (mean age 40.2 ± 19.1 years), including 295 women and 315 rural residents. Compared to urban residents, rural residents had lower levels of education, were more likely to be employed in low-income work and to have limited access to running water and electricity. Diabetes was diagnosed at a younger age in rural residents (mean ± SD 32 ± 18 vs 41 ± 17 years; p < 0.001). Physical inactivity, family history of diabetes and obesity were significantly less prevalent in rural than in urban individuals (44% vs 66, 14.9% vs 28.7 and 27.6% vs 54.1%, respectively; p < 0.001). The frequency of fruit and vegetable consumption was lower in rural than in urban participants. High waist circumference was more prevalent in urban than in rural women and men (75.3% vs 45.5 and 30% vs 6%, respectively; p < 0.001). History of childhood under-nutrition was more frequent in rural than in urban individuals (22.5% vs 6.4%; p < 0.001). CONCLUSIONS Characteristics of people with diabetes in rural Rwanda appear to differ from those of individuals with diabetes in urban settings, suggesting that sub-types of diabetes exist in Rwanda. Generic guidelines for diabetes prevention and management may not be appropriate in different populations.
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Affiliation(s)
- Charlotte M Bavuma
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Sanctus Musafiri
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | - Ruth McQuillan
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Otovwe A, Akpojubaro EH. Diabetes mellitus in primary and secondary schools in Africa: an exploratory review. ALEXANDRIA JOURNAL OF MEDICINE 2020. [DOI: 10.1080/20905068.2020.1833278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Agofure Otovwe
- Department of Public and Community Health, College of Health Sciences, Novena University Ogume, Ogume, Nigeria
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Dany F, Dewi RM, Tjandrarini DH, Pradono J, Delima D, Sariadji K, Handayani S, Kusumawardani N. Urban-rural distinction of potential determinants for prediabetes in Indonesian population aged ≥15 years: a cross-sectional analysis of Indonesian Basic Health Research 2018 among normoglycemic and prediabetic individuals. BMC Public Health 2020; 20:1509. [PMID: 33023540 PMCID: PMC7539503 DOI: 10.1186/s12889-020-09592-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/22/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Based on Basic Health Research (RISKESDAS) conducted by Ministry of Health, Indonesia, prediabetes prevalence tends to increase from 2007 until 2018. The numbers are relatively higher in rural than those in urban area despite of small discrepancies between the two (~ 2-4%). The purpose of this study was to identify urban-rural differences in potential determinants for prediabetes in Indonesia. METHODS This analysis used secondary data collected from nationwide Health Survey in 2018. Respondents were aged ≥15 years who met inclusion criteria of analysis with no history of diabetes mellitus. Prediabetes criteria followed American Diabetes Association 2019. Multiple logistic regression was also employed to assess the transition probability of potential determinants for prediabetes in urban and rural Indonesia. RESULTS Up to 44.8% of rural respondents were prediabetics versus their urban counterparts at 34.9%, yet non-response bias was observed in the two. Young adults aged 30 years were already at risk of prediabetes. Urban-rural distinction for marital status and triglyceride level was observed while other determinants tended to overlap across residence. Several modifiable factors might contribute differently in both population with careful interpretation. CONCLUSIONS The minimum age limit for early prediabetes screening may start from 30 years old in Indonesia. Urban-rural distinction for marital status and triglyceride level was observed, yet non-response bias between the two groups could not be excluded. A proper model for early prediabetes screening need to be developed from a cohort study with adequate sample size.
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Affiliation(s)
- Frans Dany
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia.
| | - Rita Marleta Dewi
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Dwi Hapsari Tjandrarini
- Centre for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Julianty Pradono
- Centre for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Delima Delima
- Centre for Research and Development of Health Resources and Services, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Kambang Sariadji
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Sarwo Handayani
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Nunik Kusumawardani
- Centre for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
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Dany F, Dewi RM, Tjandrarini DH, Pradono J, Delima D, Sariadji K, Handayani S, Kusumawardani N. Urban-rural distinction of potential determinants for prediabetes in Indonesian population aged ≥15 years: a cross-sectional analysis of Indonesian Basic Health Research 2018 among normoglycemic and prediabetic individuals. BMC Public Health 2020. [PMID: 33023540 DOI: 10.1186/s12889-020-09592-7/peer-review] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Based on Basic Health Research (RISKESDAS) conducted by Ministry of Health, Indonesia, prediabetes prevalence tends to increase from 2007 until 2018. The numbers are relatively higher in rural than those in urban area despite of small discrepancies between the two (~ 2-4%). The purpose of this study was to identify urban-rural differences in potential determinants for prediabetes in Indonesia. METHODS This analysis used secondary data collected from nationwide Health Survey in 2018. Respondents were aged ≥15 years who met inclusion criteria of analysis with no history of diabetes mellitus. Prediabetes criteria followed American Diabetes Association 2019. Multiple logistic regression was also employed to assess the transition probability of potential determinants for prediabetes in urban and rural Indonesia. RESULTS Up to 44.8% of rural respondents were prediabetics versus their urban counterparts at 34.9%, yet non-response bias was observed in the two. Young adults aged 30 years were already at risk of prediabetes. Urban-rural distinction for marital status and triglyceride level was observed while other determinants tended to overlap across residence. Several modifiable factors might contribute differently in both population with careful interpretation. CONCLUSIONS The minimum age limit for early prediabetes screening may start from 30 years old in Indonesia. Urban-rural distinction for marital status and triglyceride level was observed, yet non-response bias between the two groups could not be excluded. A proper model for early prediabetes screening need to be developed from a cohort study with adequate sample size.
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Affiliation(s)
- Frans Dany
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia.
| | - Rita Marleta Dewi
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Dwi Hapsari Tjandrarini
- Centre for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Julianty Pradono
- Centre for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Delima Delima
- Centre for Research and Development of Health Resources and Services, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Kambang Sariadji
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Sarwo Handayani
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
| | - Nunik Kusumawardani
- Centre for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta Pusat, Jakarta, Indonesia
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Sanya RE, Andia Biraro I, Nampijja M, Zziwa C, Nanyunja C, Nsubuga D, Kiwanuka S, Tumusiime J, Nassuuna J, Walusimbi B, Cose S, Ocama P, Grencis RK, Elliott AM, Webb EL. Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda. Wellcome Open Res 2020; 5:39. [PMID: 32875121 PMCID: PMC7447960 DOI: 10.12688/wellcomeopenres.15616.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 01/13/2023] Open
Abstract
Background: The burden of cardiometabolic diseases, including cardiovascular diseases and diabetes, is increasing in sub-Saharan Africa and this has been linked to urbanisation. Helminths, through their immunomodulatory properties, may protect against these disorders. We hypothesised that the rural environment protects against cardiometabolic diseases and that helminths may influence rural-urban disparity of cardiometabolic disease risk. Methods: We compared metabolic parameters of individuals aged ≥10 years living in rural, high-helminth-transmission and urban, lower-helminth-transmission settings in Uganda. Cross-sectional surveys were conducted in rural Lake Victoria island fishing communities and in urban sub-wards in Entebbe municipality. Helminth infection and outcomes, including insulin resistance (computed using the homeostatic model assessment of insulin resistance [HOMA-IR]), fasting blood glucose, fasting blood lipids, blood pressure, body mass index (BMI), waist and hip circumference, were assessed. Results: We analysed 1,898 rural and 930 urban participants. Adjusting for BMI, exercise, smoking, alcohol intake, age and sex, urban residents had lower mean fasting glucose (adjusted mean difference [95%CI] 0.18 [-0.32, -0.05] p=0.01) and HOMA-IR (-0.26 [-0.40, -0.11] p=0.001) but higher blood pressure (systolic, 5.45 [3.75, 7.15] p<0.001; diastolic, 1.93 [0.57, 3.29] p=0.006). Current helminth infection did not explain the observed differences. Conclusions: In the Ugandan context, living in rural fishing communities may protect against hypertension but worsen glucose metabolism.
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Affiliation(s)
- Richard E Sanya
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Irene Andia Biraro
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Margaret Nampijja
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Christopher Zziwa
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Carol Nanyunja
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Denis Nsubuga
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Samuel Kiwanuka
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Josephine Tumusiime
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jacent Nassuuna
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Bridgious Walusimbi
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Stephen Cose
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ponsiano Ocama
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard K Grencis
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison M Elliott
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Munyogwa MJ, William R, Kibusi SM, Gibore NS. Clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania: a cross-sectional study. BMC Health Serv Res 2020; 20:527. [PMID: 32522187 PMCID: PMC7288541 DOI: 10.1186/s12913-020-05407-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 06/05/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Tanzania is among the sub-Saharan African countries facing a tremendous increase in the burden of type 2 diabetes mellitus. In order to provide diabetes health care services, the government has established diabetes care clinics in secondary and tertiary healthcare facilities. However, previous studies have demonstrated a disparity in availability of supplies and equipment for provision of diabetes health care services at these healthcare facilities. This study aims to assess the clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania. METHODS A cross-sectional study was conducted in Mwanza Region from June to September, 2018.Three hundred and thirty patients were selected by systematic random sampling from three healthcare facilities. A structured questionnaire was utilized to collect information on patient characteristics, health care received and patient perception of care. Patient blood pressure, blood glucose, weight and height were measured during the study. Percentages, chi-square tests and multivariable analysis were conducted to obtain the proportions, make comparisons and determining the correlates of tertiary-level healthcare facility. RESULTS Approximately half of respondents (54.5%) were from secondary healthcare facilities. The prevalence of hypertension (63.3%), hyperglycemia (95.8%) and obesity (93.3%) were high. The prevalence of hyperglycemia was slightly higher at secondary-level healthcare facility (p = 0.005). The proportion of respondents recently diagnosed with diabetes (≤ 10 years) was significantly higher at tertiary-level healthcare facility (p = 0.000). The prevalence of diabetes related complications was higher at tertiary-level healthcare facility (80.7% versus 53.3%, p = 0.000). Assessments of body weight, blood pressure, blood glucose, feet and eye examination were conducted on a monthly basis at all facilities. None of the respondents had undergone lipid profile testing. All of the respondents (100%) received care from a nurse during diabetes clinic visits and half of the respondents (49.7%) also received care from a clinician. Relatively young patients, married and recently diagnosed patients were more likely to attend clinic at tertiary facilities. Tertiary-level healthcare facilities were more likely to have patients with complications and to have a dietitian available at the clinic.
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Affiliation(s)
- Mariam J Munyogwa
- Department of Public Health, University of Dodoma, P. O. Box 395, Dodoma, Tanzania.
| | - Reuben William
- Department of Research, Sumve School of Nursing, P. O. O. Box 7, Mantare, Mwanza, Tanzania
| | - Stephen M Kibusi
- Department of Public Health, University of Dodoma, P. O. Box 395, Dodoma, Tanzania
| | - Nyasiro S Gibore
- Department of Public Health, University of Dodoma, P. O. Box 395, Dodoma, Tanzania
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Sanya RE, Andia Biraro I, Nampijja M, Zziwa C, Nanyunja C, Nsubuga D, Kiwanuka S, Tumusiime J, Nassuuna J, Walusimbi B, Cose S, Ocama P, Grencis RK, Elliott AM, Webb EL. Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda. Wellcome Open Res 2020; 5:39. [DOI: 10.12688/wellcomeopenres.15616.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The burden of cardiometabolic diseases, including cardiovascular diseases and diabetes, is increasing in sub-Saharan Africa and this has been linked to urbanisation. Helminths, through their immunomodulatory properties, may protect against these disorders. We hypothesised that the rural environment protects against cardiometabolic diseases and that helminths may influence rural-urban disparity of cardiometabolic disease risk. Methods: We compared metabolic parameters of individuals aged ≥10 years living in rural, high-helminth-transmission and urban, lower-helminth-transmission settings in Uganda. Cross-sectional surveys were conducted in rural Lake Victoria island communities and in urban sub-wards in Entebbe municipality. Helminth infection and outcomes, including insulin resistance (computed using the homeostatic model assessment of insulin resistance [HOMA-IR]), fasting blood glucose, fasting blood lipids, blood pressure, body mass index (BMI), waist and hip circumference, were assessed. Results: We analysed 1,898 rural and 930 urban participants. Adjusting for BMI, exercise, smoking, alcohol intake, age and sex, urban residents had lower mean fasting glucose (adjusted mean difference [95%CI] -0.13 [-0.24, -0.01] p=0.04) and HOMA-IR (-0.13 [-0.25, -0.01] p=0.04) but higher blood pressure (systolic, 4.64 [3.23, 6.06] p<0.001; diastolic, 1.89 [0.81, 2.97] p=0.001). Current helminth infection did not explain the observed differences. Conclusions: In low-income countries, rural living may protect against hypertension but impair glucose metabolism.
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Spires M, Berggreen-Clausen A, Kasujja FX, Delobelle P, Puoane T, Sanders D, Daivadanam M. Snapshots of Urban and Rural Food Environments: EPOCH-Based Mapping in a High-, Middle-, and Low-Income Country from a Non-Communicable Disease Perspective. Nutrients 2020; 12:E484. [PMID: 32075027 PMCID: PMC7071357 DOI: 10.3390/nu12020484] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 11/23/2022] Open
Abstract
A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high income), with one matched pair of urban-rural sites per country. Fifty formal and informal food retail outlets were assessed, and descriptive and comparative statistical analyses were performed. We found that formal food retail outlets in these countries had both positive and negative traits, as they were the main source of basic food items but also made unhealthy food items readily available. The Ugandan setting had predominantly informal outlets, while the Swedish setting had primarily formal outlets and South Africa had both, which fits broadly into the traditional (Uganda), mixed (South Africa) and modern (Sweden) conceptualized food systems. The promotion of unhealthy food products was high in all settings. Uganda had the highest in-community advertising, followed by South Africa and Sweden with the lowest, perhaps related to differences in regulation and implementation. The findings speak to the need to address contextual differences in NCD-related health interventions by incorporating strategies that address the food environment, and for a critical look at regulations that tackle key environment-related factors of food on a larger scale.
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Affiliation(s)
- Mark Spires
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (M.S.); (P.D.); (T.P.)
- Centre for Food Policy, City, University of London, London EC1R 1UW, UK
| | | | - Francis Xavier Kasujja
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda;
| | - Peter Delobelle
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (M.S.); (P.D.); (T.P.)
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town 7925, South Africa
- Department of Public Health, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (M.S.); (P.D.); (T.P.)
| | - David Sanders
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (M.S.); (P.D.); (T.P.)
| | - Meena Daivadanam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, 75122 Uppsala, Sweden;
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
- International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, 75237 Uppsala, Sweden
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Young E, Nwatu C. Prediabetes in sub-saharan Africa: Pathophysiology, predictors, and prevalence. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_30_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhang Y, Santosa A, Wang N, Wang W, Ng N, Zhao Q, Jiang Y, Weinehall L, Zhao G. Prevalence and the Association of Body Mass Index and Other Risk Factors with Prediabetes and Type 2 Diabetes Among 50,867 Adults in China and Sweden: A Cross-Sectional Study. Diabetes Ther 2019; 10:2061-2077. [PMID: 31512070 PMCID: PMC6848580 DOI: 10.1007/s13300-019-00690-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Understanding socioeconomic differences for prediabetes and type 2 diabetes (T2DM) can offer guidance for the most effective development of both prevention and intervention programmes in different settings. This study aims to determine the prevalence and risk factors for prediabetes and T2DM and to explore the effect of high body mass index (BMI) on the probability of T2DM being present among adults in China and Sweden. METHODS This study enrolled 25,356 adults (35-64 years old) from the Shanghai Survey in China and 25,511 adults (aged 40, 50, 60) from the Västerbotten Intervention Programme in Sweden. Data on haemoglobin A1c, capillary fasting plasma glucose, 2-h plasma glucose and self-reported diagnoses of T2DM were used in the analysis. Multinomial logistic regression was used to examine the determinants of prediabetes and T2DM. The average predicted probabilities of T2DM developing or presenting were determined for the different ages and levels of BMI in each population. RESULTS Chinese participants had a higher adjusted prevalence of T2DM (men 12.8% vs. 4.6%; women 10.6% vs. 3.1%) and prediabetes (men 12.4% vs. 12.2%; women 14.4% vs. 12.2%) than Swedish participants. Age, overweightedness/obesity, hypertension and a family history of diabetes were significant risk factors for prediabetes and T2DM. In both populations, the predicted probability of T2DM increased as the BMI increased in all age groups. At the same BMI level, Chinese participants were more likely to have T2DM compared to their Swedish counterparts. The average predicted probability of T2DM was less than 20% in nearly all age groups among Swedish women. CONCLUSIONS Chinese adults had the higher prevalence of prediabetes and T2DM and a higher probability of T2DM at the same BMI level compared with Swedish adults. These results indicate the importance of addressing the ongoing obesity epidemic as a matter of urgency in order to curb what has become an apparent diabetes epidemic in both countries.
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Affiliation(s)
- Yue Zhang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Ailiana Santosa
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Na Wang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Weibing Wang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Qi Zhao
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yonggen Jiang
- Songjiang District Centre for Disease Prevention and Control, Shanghai, China
| | - Lars Weinehall
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden.
| | - Genming Zhao
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
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Cai L, Li X, Cui W, You D, Golden AR. Trends in diabetes and pre-diabetes prevalence and diabetes awareness, treatment and control across socioeconomic gradients in rural southwest China. J Public Health (Oxf) 2019; 40:375-380. [PMID: 28977385 DOI: 10.1093/pubmed/fdx097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 07/12/2017] [Indexed: 01/06/2023] Open
Abstract
Background This study aimed to determine trends in pre-diabetes and diabetes prevalence and diabetes awareness, treatment and control across socioeconomic gradients in rural southwest China. Methods Data were collected from two cross-sectional health interviews and examination surveys among individuals aged ≥35 years in rural China. Fasting blood sugar levels were measured for each participant. Results From 2009 to 2016, the overall prevalence of pre-diabetes and diabetes increased from 8.4 and 7.7% to 19.0 and 9.5%, respectively, while awareness, treatment and control of diabetes increased from 32.7, 20.0 and 6.1% to 49.3, 32.1 and 13.5%, respectively (P < 0.01). Participants with higher annual incomes had higher diabetes prevalence and treatment levels than their counterparts and showed a remarkably high increase in rate of pre-diabetes (P < 0.01). Whereas prevalence of pre-diabetes and diabetes increased across all ethnic groups during the study period, increased rates of diabetes awareness, treatment and control were only observed among Han Chinese (P < 0.01). Diabetic patients with higher levels of education had higher awareness, control and treatment of diabetes than their counterparts (P < 0.05). Conclusions The prevalence of pre-diabetes and diabetes and the level of diabetes awareness, treatment and control increased substantially across all socioeconomic gradients in rural southwest China.
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Affiliation(s)
- Le Cai
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Xiao Li
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Wenlong Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Dingyun You
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Allison Rabkin Golden
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
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Birabwa C, Bwambale MF, Waiswa P, Mayega RW. Quality and barriers of outpatient diabetes care in rural health facilities in Uganda - a mixed methods study. BMC Health Serv Res 2019; 19:706. [PMID: 31619234 PMCID: PMC6796349 DOI: 10.1186/s12913-019-4535-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. METHODS This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. RESULTS The mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. CONCLUSION The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.
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Affiliation(s)
- Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Mulekya F. Bwambale
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Roy W. Mayega
- Department of Epidemiology and Biostatistics, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
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A Study on the Relationship between Urban Residents’ Perception of Recreational Sports and Their Participation in Recreational Sports: Based on Gender Differences. SUSTAINABILITY 2019. [DOI: 10.3390/su11195466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The health of urban residents plays an important role in increasing the well-being of citizens, and therefore promoting the sustainable development of cities. Studies in Western countries have provided some evidence of the relationship between the urban residents’ perception of the recreational sports (RS), including perception of industry, space, experience, type, and support affecting recreational behaviors. Yet, evidence in China is not sufficient and, particularly, gender difference has not been discussed anywhere. Objectives: The present study aimed to see urban residents’ perception of RS and its effect on recreational sport participation by the residents. Method: The study was conducted in three big cities (Hangzhou, Chengdu, and Shanghai) of China to test the association between the urban residents’ perception of RS and their RS participation, in which gender differences were discussed. After taking their consent, a total of 764 participants (397 male and 367 female) aged from 15 to 65 were approached between April and October, 2018. The participants were given a survey to assess their perception and behavior of RS. T-test and the structural equation modeling were used to analyze gender differences in association between perception and behavior of RS. Results: For females, industry perception (β = 0.17, p = 0.00), space perception (females: β = 0.16, p = 0.00), and support perception (females: β = 0.09, p = 0.03) had a significant positive effect on RS participation. For males, industry perception (males: β = 0.13, p = 0.01) and type perception (males: β = 0.23, p = 0.00) showed a significant positive impact on participation of RS. However, space perception of males (β = −0.12; p = 0.01) and type perception of females (β = −0.11; p = 0.01) are negatively associated with their RS participation. The perception of experience was the most important factor influencing RS behaviors. Significant gender differences have appeared in all five different perception factors. The industry perception has significant and positive effects on both males and females’ RS participation. The type perception has significant positive effects on the male but negative on the female RS, while the space perception is just the opposite. The support perception has significant positive effects on the female RS practice but the influence is not obvious in the case of males. Conclusion: By adopting some measures, perception of RS may improve urban residents’ participation in RS.
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Hypoglycemic and Toxic Effect of Morus mesozygia Leaf Extract on the Liver and Kidneys of Alloxan-Induced Hyperglycemic Wistar Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:6712178. [PMID: 32030095 PMCID: PMC6770302 DOI: 10.1155/2019/6712178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 01/30/2023]
Abstract
Purpose We investigated the hypoglycemic and toxic effect of Morus mesozygia leaf extract on the liver and kidneys of alloxan-induced hyperglycemic wistar rats. Method Phytochemical analysis was done. Diabetes was induced by the use of alloxan monohydrate in six groups of rats, i.e., 200 mg/kg, 400 mg/kg, 800 mg/kg, glibenclamide, normal saline, and normal control group. Blood glucose was measured at the time of inoculation, then at 1, 2, 3, and 4 hours after. After 14 days, rats were killed under anesthesia; blood collected for measurement of total protein, albumin, TAGs, cholesterol, AST, ALT, urea, and creatinine; and whole tissue of liver and kidneys used for histological studies. Results The extract possessed antidiabetic effects between 400 mg/kg and 800 mg/kg doses, which we attributed to the presence of flavonoids, tannins, terpenoids, and amino acids. There was a drop in total protein and albumin with no statistical significance (P ≥ 0.05). The changes in levels of ALT, TAGs, cholesterol, AST, creatinine, and urea were not statistically different from the standard diabetic drug. The extract was protective against histological damage as there were no significant lesions suggestive of toxicities in the liver and kidneys at doses below 800 mg/kg. Conclusion We established credible evidence that Morus mesozygia leaf extract has hypoglycemic effects between 400 mg/kg and 800 mg/kg and that it is safe on the liver and kidneys of wistar rats at doses less than 800 mg/kg.
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Tino S, Wekesa C, Kamacooko O, Makhoba A, Mwebaze R, Bengo S, Nabwato R, Kigongo A, Ddumba E, Mayanja BN, Kaleebu P, Newton R, Nyerinda M. Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda - a descriptive retrospective study. BMC Health Serv Res 2019; 19:598. [PMID: 31443649 PMCID: PMC6708238 DOI: 10.1186/s12913-019-4415-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/09/2019] [Indexed: 12/21/2022] Open
Abstract
Background Although the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda. Methods We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients’ registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients’ LTFU rates in hazard ratios (HRs). Results Between July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2–36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy. Conclusion We found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients.
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Affiliation(s)
- Salome Tino
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
| | - Clara Wekesa
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Onesmus Kamacooko
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Anthony Makhoba
- St. Francis Hospital Nsambya, P. O. Box, 7146, Kampala, Uganda
| | - Raymond Mwebaze
- St. Francis Hospital Nsambya, P. O. Box, 7146, Kampala, Uganda
| | - Samuel Bengo
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Rose Nabwato
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Aisha Kigongo
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Edward Ddumba
- St. Francis Hospital Nsambya, P. O. Box, 7146, Kampala, Uganda
| | - Billy N Mayanja
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Pontiano Kaleebu
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Rob Newton
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.,Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
| | - Moffat Nyerinda
- MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
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Abdulai T, Li Y, Zhang H, Tu R, Liu X, Zhang L, Dong X, Li R, Wang Y, Wang C. Prevalence of impaired fasting glucose, type 2 diabetes and associated risk factors in undiagnosed Chinese rural population: the Henan Rural Cohort Study. BMJ Open 2019; 9:e029628. [PMID: 31383706 PMCID: PMC6686996 DOI: 10.1136/bmjopen-2019-029628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study estimated the burden and characterised the risk factors associated with diabetes and impaired fasting glucose (IFG) in an undiagnosed rural population. DESIGN Data for 36 960 participants from the Henan Rural Cohort baseline with undiagnosed diabetes were analysed. X2 test and multivariate logistic regression analyses were performed to test for association between risk factors and diabetes and IFG. RESULTS Women constituted 60.30% of the study participants, mean age of participants was 55.32±12.18 years, risk factors for diabetes and IFG were prevalent (75% dyslipidaemia, 57% overweight/obese, 50% central obesity and 18% metabolic syndrome). The prevalence of diabetes and IFG was 4.19% and 7.22%, respectively. Having a metabolic syndrome (adjusted OR (aOR) 4.7, 95% CI 4.27 to 5.33), dyslipidaemia (aOR 2.76, 95% CI 2.31 to 3.21), centrally obese (aOR 2.38, 95% CI 2.11 to 2.70), being overweight/obese (aOR 1.66, 95% CI 1.45 to 1.79) and a family history of diabetes (aOR 1.50, 95% CI 1.15 to 1.92) were associated with diabetes. These factors were also associated with IFG. Intake of high salt diet (aOR 1.16, 95% CI 1.02 to 1.32) and smoking (aOR 1.22, 95% CI 1.02 to 1.47; significant in men) were also associated with diabetes. Engaging in moderate physical activity (aOR 0.94, 95% CI 0.89 to 0.98) was noted to be negatively associated with diabetes. CONCLUSION Diabetes and IFG remain prevalent in Chinese population with obesity and dyslipidaemia being some of the most significant predictors. Regular physical activity and consumption of fruits and vegetables may be beneficial in keeping blood glucose level low. TRIAL REGISTRATION NUMBER ChiCTR-OOC-15006699.
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Affiliation(s)
- Tanko Abdulai
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Community Health and Family Medicine, SMHS, University for Development Studies, Tamale, Ghana
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, China
| | - Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Runqi Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Liying Zhang
- School of Information Engineering, Zhengzhou University, Zhengzhou, China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuming Wang
- Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
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Magan T, Pouncey A, Gadhvi K, Katta M, Posner M, Davey C. Prevalence and severity of diabetic retinopathy in patients attending the endocrinology diabetes clinic at Mulago Hospital in Uganda. Diabetes Res Clin Pract 2019; 152:65-70. [PMID: 31063850 DOI: 10.1016/j.diabres.2019.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/30/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
Abstract
AIMS The epidemiology for diabetic retinopathy (DR) has been well described in the western population. Countries in Sub-Saharan Africa have attempted to identify the prevalence of diabetic eye disease, however, there still remains a degree of paucity across the continent due to inadequacy in health system organisations and resource poor settings. We aimed to identify the severity and prevalence of DR and maculopathy of patients attending the diabetes clinic at Mulago Hospital, Kampala, Uganda. METHODS A cross-sectional observational study of 44 patients who attended a diabetes clinic at Mulago Hospital in April 2016. Parameters measured included visual acuity (VA) using a Snellen chart, blood glucose (mmol/l) and blood pressure (mmHg). Screening for DR grading was carried out with indirect fundoscopy and retinal photograph. Only the highest graded eye of retinopathy of each patient was included. RESULTS A total of 41 eyes from 41 patients were included. Of these patients 15 were male. The average age of patients was 50.4 years. Six eyes (14.6%) had a VA < 6/18. Prevalence of DR was 19.5% (8 eyes) and 14.6% (6 eyes) had maculopathy. Of all eyes 14.6% had sight-threatening retinopathy, which was 85.7% of total cases of retinopathy in our study. CONCLUSIONS We observed a high prevalence of DR and maculopathy, particularly sight threatening retinopathy, considering the proportion of patients screened. There is a need for a co-ordinated diabetes screening service through integration of the diabetes clinic and eye clinic at Mulago Hospital to better identify and treat this sight-threatening condition.
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Affiliation(s)
- Tejal Magan
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK; Ophthalmology Department, Mulago Hospital, Kampala, Uganda.
| | - Anna Pouncey
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK; Ophthalmology Department, Mulago Hospital, Kampala, Uganda
| | - Kunal Gadhvi
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK; Ophthalmology Department, Mulago Hospital, Kampala, Uganda
| | - Mohamed Katta
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK; Ophthalmology Department, Mulago Hospital, Kampala, Uganda
| | - Marcus Posner
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK; Ophthalmology Department, Mulago Hospital, Kampala, Uganda
| | - Clare Davey
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK; Ophthalmology Department, Mulago Hospital, Kampala, Uganda
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