Prevalence of haemoglobin A1c based dysglycaemia among adult community dwellers in selected states in Nigeria: a descriptive cross-sectional study

Background

Type 2 diabetes mellitus (T2DM) is a disease of public health importance globally with an increasing burden of undiagnosed pre-diabetes and diabetes in low- and middle-income countries, Nigeria in particular. Pre-diabetes and diabetes are established risk factors for cardiovascular complications. However, data are scanty on the current prevalence of these conditions in Nigeria, based on haemoglobin A1c (HbA1c) diagnosis as recommended by the WHO in 2009. We aimed to determine the prevalence of pre-diabetes, diabetes, and undiagnosed diabetes among the adult population of Nigeria using HbA1c.

Methodology

A cross-sectional, multi-site population study was carried out in selected states in Nigeria (namely, Ekiti, Lagos, Osun, Oyo, and Kwara states) involving 2,708 adults (≥18 years) in rural and urban community dwellers, without prior diagnosis of pre-diabetes or diabetes. Participants with ongoing acute or debilitating illnesses were excluded. Data were collected using an interviewer-administered pretested, semi-structured questionnaire. Socio-demographic, clinical (weight, height, blood pressure, etc.), and laboratory characteristics of participants including HbA1c were obtained. Data were analysed using STATA version 16.

Results

The mean age of participants was 48.1 ± 15.8 years, and 65.5% were female. The overall prevalence of pre-diabetes and undiagnosed diabetes was 40.5% and 10.7%, respectively, while the prevalence of high blood pressure was 36.7%. The prevalence of pre-diabetes was the highest in Lagos (48.1%) and the lowest in Ekiti (36.7%), while the prevalence of diabetes was the highest in Kwara (14.2%) and the lowest in Ekiti (10%). There was a significant association between age of the participants (p< 0.001), gender (p = 0.009), educational status (p = 0.008), occupation (p< 0.001), tribe (p = 0.004), marital status (p< 0.001), blood pressure (p< 0.001), and their diabetic or pre-diabetic status. Independent predictors of diabetes and pre-diabetes include excess weight gain, sedentary living, and ageing. Participants within the age group 45-54 years had the highest total prevalence (26.6%) of pre-diabetes and diabetes.

Conclusion

Over half of the respondents had pre-diabetes and diabetes, with a high prevalence of undiagnosed diabetes. A nationwide screening campaign will promote early detection of pre-diabetes and undiagnosed diabetes among adult Nigerians. Health education campaigns could be an effective tool in community settings to improve knowledge of the risk factors for diabetes to reduce the prevalence of dysglycaemia.

Low Immunization Completion among Under-Five Children: Are Underserved Nomadic and Farming Communities in a North Central State of Nigeria doing Better?

Background

The recent drop in immunization coverage in Nigeria has left more than 3.25 million children unimmunized and has risen concern over immunization completion among the under-five children. More so among underserved communities of pastoralist nomads and farmers that were isolated from immunization services because of operational and sociocultural factors.

Materials and Methods

A cross-sectional analytical (comparative analysis) study was carried out among 550 eligible caregivers of under-five children in nomadic and farming communities in Niger State, Nigeria. The mothers and caregivers paired with under-five children were recruited into the study using a multistage sampling technique. Data was collected using a validated interviewer-administered questionnaire. Data was analyzed with the statistical software package (version 23).

Results

More than half of the under-five children studied were males in both the nomadic (57.5%) and farming (52.0%) communities. The aggregated score of immunization knowledge was significantly (P < 0.001) better (Good 44.4%; Fair 49.8%) among farmers compared to their nomads' counterpart (Good 21.1%; Fair 43.6%). Conversely, almost all the respondents (98.2%) in nomadic community significantly had a good overall perception of childhood immunization compared to 77.1% in the farming community. More farmers' children (99.6%) had received immunization compared to 92.4% of the nomads' children. About 87.3% of farmers compared to 76% of the nomads' (76.0%) children reported immunization completion. About 50.5% of the farmers' and 41.4% of the nomads' children have achieved immunization on card inspection.

Conclusion

This study revealed that average immunization completion reported among under-five children in both farming and nomadic communities is higher than the national average. It is recommended that more strategies are needed to intensify immunization campaigns targeted at populations in Nigeria.

Evaluation of obstetric outcomes for women in commuter versus non-commuter marriages: A comparative study

Objectives

The study aims to determine obstetric outcomes for women in commuter marriages (CoMs) compared to women in non-CoMs, as well as the influence of living-in-companions on the obstetric outcomes.

Methods

A prospective, multicentre, comparative study was conducted among antenatal clinic attendees in CoMs (160 women) and non-CoMs (160 women). Following consent, participants were recruited and monitored from antenatal booking until six weeks postpartum. The primary outcome measure was the obstetric outcomes (miscarriages, antenatal illness-associated hospital admissions, gestational ages at delivery, pregnancy-induced hypertension, gestational diabetes, and birth weights), while the secondary outcome measure was the influence of living-in-companions on the obstetric outcomes, which was measured by comparing the outcomes in women with those without living-in-companions. Data analysis was conducted using chi-square and t-tests, as applicable; a p < 0.05 was significant.

Results

The commuting partners were males in the majority (n = 151; 94.4%), due to work-transfer (n = 76; 47.5%) or new employment (n = 60; 37.5%). There was a statistically significant association between CoM and delay before index pregnancy (n = 27 vs. 15; p = 0.047), higher mean gestational age at booking (22.2 ± 7.70 years vs. 19.9 ± 6.93 years; p = 0.005), higher antenatal illness-associated hospital admission (n = 39 vs. 19; p = 0.004), preterm delivery (33.8% vs. 6.9%; p = 0.001), and low birth weight (16.3% vs. 5.0%; p = 0.001). The mean gestational age at delivery (35.1 ± 2.53 years vs. 38.0 ± 2.38 years, p = 0.001) and birth weight (2445 ± 749 vs. 3146 ± 1646 g, p = 0.043) were lower and statistically significant among women in CoMs without than among those with living-in-companions.

Conclusion

CoM was associated with adverse obstetric outcomes; however, living-in-companions appeared to ameliorate these adverse outcomes.