Chronic pancreatitis in African diabetics

Diabetes in tropical Africa: a prospective study, 1981-7. II. Course and prognosis

OBJECTIVE

To determine the clinical course of diabetes mellitus in tropical Africa.

DESIGN

Continuing care and follow up until 31 March 1989 of all newly diagnosed diabetic patients registered at one hospital between 1 June 1981 and 31 May 1987.

SETTING

Muhimbili Medical Centre, Dar es Salaam, Tanzania.

SUBJECTS

1250 Newly diagnosed diabetic patients seen over a six year period. 272 (21.8%) Had diabetes requiring insulin, 825 (66.0%) diabetes not requiring insulin, and 153 (12.2%) diabetes of uncertain type.

MAIN OUTCOME MEASURES

Survival rates during each year of follow up.

RESULTS

205 (16.4%) Patients were known to have died, 126 (61.5%) in hospital and 79 (38.5%) in the community. At least a further 71 patients were likely to have died. The five year survival rates (95% confidence intervals) for patients with diabetes requiring and not requiring insulin were 71% (62% to 80%) and 84% (80% to 89%) respectively for known deaths and 60% (51% to 69%) and 82% (77% to 86%) respectively for known plus probable deaths. 49 (3.9%) Patients died at the time of presentation. Severe diabetic ketoacidosis and infection were responsible for most deaths in patients with diabetes requiring insulin. Infection was responsible for 24% of deaths in patients with diabetes not requiring insulin and was the main cause of death in the group with uncertain type of diabetes. Cardiovascular and renal causes were responsible for 24% of hospital deaths of patients with diabetes not requiring insulin. Diabetes requiring insulin, young age, and ketonuria at presentation were associated with a significantly worse five year survival on multivariate analysis. On univariate analysis underweight, female sex, low educational background, and manual occupations were additional factors with a worse prognosis.

CONCLUSION

Diabetes in sub-Saharan Africa is, in many patients, a serious disease with a poor prognosis. Most deaths, however, are due to preventable causes. More effort is therefore required to increase public awareness of diabetes and to improve patient detection, management, and follow up.

Endemic tropical sprue in Rhodesia

The existence of tropical sprue in Africa is controversial. In this paper we present 31 cases seen in Rhodesia over a 15 month period. They have the clinical features, small intestinal morphology, malabsorption pattern, and treatment response of tropical sprue. Other causes of malabsorption, and primary malnutrition, have been excluded. The severity of the clinical state and intestinal malabsorption distinguish these patients from those we have described with tropical enteropathy. The previous work on tropical sprue in Africa is reviewed and it is apparent that, when it has been adequately looked for, it has been found. It is clear that the question of tropical sprue in Africa must be re-examined and that it existence may have hitherto been concealed by the assumption that primary malnutrition is responsible for the high prevalence of deficiency states.