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Madede T, Damasceno A, Lunet N, Augusto O, Silva-Matos C, Beran D, Levitt N. Changes in prevalence and the cascade of care for type 2 diabetes over ten years (2005-2015): results of two nationally representative surveys in Mozambique. BMC Public Health 2022; 22:2174. [PMID: 36434584 PMCID: PMC9701039 DOI: 10.1186/s12889-022-14595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa is predicted to have the steepest increase in the prevalence of diabetes in the next 25 years. The latest Mozambican population-based STEPS survey (STEPS 2005) estimated a 2.9% prevalence of diabetes in the adult population aged 25-64 years. We aimed to assess the change in prevalence, awareness, and management of diabetes in the national STEPS survey from 2014/2015 compared to 2005. METHODS We conducted an observational, quantitative, cross-sectional study following the WHO STEPS surveillance methodology in urban and rural settings, targeting the adult population of Mozambique in 2015. We collected sociodemographic data, anthropometric, and 12 hour fasting glucose blood samples in a sample of 1321 adults. The analysis consisted of descriptive measures of the prevalence of impaired fasting glucose (IFG), diabetes and related risk factors by age group, sex, and urban/rural residence and compared the findings to those of the 2005 survey results. RESULTS The prevalence of IFG and diabetes was 4.8% (95CI: 3.6-6.3) and 7.4% (95CI: 5.5-10.0), respectively. These prevalence of IFG and diabetes did not differ significantly between women and men. The prevalence of diabetes in participants classified with overweight/obesity [10.6% (95CI: 7.5-14.6)] and with central obesity (waist hip ratio) [11.0% (95CI: 7.4-16.1)] was almost double the prevalence of their leaner counterparts, [6.3% (95CI, 4.0-9.9)] and [5.2% (95CI: 3.2-8.6)], respectively. Diabetes prevalence increased with age. There were 50% more people with diabetes in urban areas than in rural. Only 10% of people with diabetes were aware of their disease, and only 44% of those taking oral glucose-lowering drugs. The prevalence of IFG over time [2.0% (95CI: 1.1-3.5) vs 4.8% (95CI: 3.6-6.3)] and diabetes [2.9% (95CI: 2.0-4.2) vs 7.4% (95CI: 5.5-10.0)] were more than twofold higher in 2014/2015 than in 2005. However, awareness of disease and being on medication decreased by 3% and by 50%, respectively. Though this was not statistically significant. CONCLUSIONS While the prevalence of diabetes in Mozambique has increased from 2005 to 2015, awareness and medication use have declined considerably. There is an urgent need to improve the capacity of primary health care and communities to detect, manage and prevent the occurrence of NCDs and their risk factors.
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Affiliation(s)
- Tavares Madede
- Departament of Community Health, Faculty of Medicine, University Eduardo Mondlane, 702 Salvador Allende Ave, PO Box 257, Maputo, Mozambique
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Research Unit, Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Orvalho Augusto
- Departament of Community Health, Faculty of Medicine, University Eduardo Mondlane, 702 Salvador Allende Ave, PO Box 257, Maputo, Mozambique
| | | | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Velmurugan G, Mohanraj S, Christy Yacob J, Keppanan S, Rekha B, Krishnasamy A, Shanmugarajan S, Boopathi S, Ayyapparaja A, Ayyapparaja PC, Rs T, Gopalakrishnan M, Veerappan J, Dharmaraj V, Vaithilingam S, Purushothaman P, Chelladurai S, Pandiyan J, Selvarajan VS, Annathurai K, Vengatachalam S, Arivuruvone G, Kaliyaperumal S, G V, S K, Ramasamy S, Swaminathan K. Association of Agriculture Occupational Exposure With Diabetes and Cardiovascular Risk Factors in South Indian Villages: REDSI Study. Front Cardiovasc Med 2021; 8:737505. [PMID: 34631835 PMCID: PMC8498024 DOI: 10.3389/fcvm.2021.737505] [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: 07/07/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
There has been a huge increase in diabetes and its associated cardiovascular complications over the last decade, predominantly in the middle- and low-income countries. In these countries, the majority live in rural areas. The Rural Epidemiology of Diabetes in South India (REDSI) study was aimed to analyze the prevalence of diabetes, cardiovascular risk factors, and its complications in rural farming and non-farming villages in Tamil Nadu, South India. A research survey on the prevalence of self-reported diabetes, cardiovascular risk factors (age, sex, obesity, hypertension, hypercholesterolemia, alcohol and tobacco use) and agricultural occupational exposure was executed among 106,111 people from 61 villages in the state of Tamil Nadu, South India, during 2015-2018. Overall, we observed a diabetes prevalence of 11.9% in rural South India. A nearly two-fold higher prevalence of diabetes was observed among the farming community (15.0%) compared to that among the non-farming population (8.7%). Logistic regression analyses revealed a strong association with agrochemical exposure (P < 0.0001) and diabetes prevalence among rural farming people. Our survey indicates a high prevalence of diabetes in rural South India particularly among the farming community. This survey in conjunction with other epidemiological and experimental studies raises the need for understanding the etiology of diabetes and other cardiovascular risk factors in rural communities.
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Affiliation(s)
- Ganesan Velmurugan
- Chemomicrobiomics Laboratory, Department of Biochemistry & Molecular Biology, KMCH Research Foundation, Coimbatore, India
| | - Sundaresan Mohanraj
- Chemomicrobiomics Laboratory, Department of Biochemistry & Molecular Biology, KMCH Research Foundation, Coimbatore, India
| | - Jenifer Christy Yacob
- Department of Molecular Biology, School of Biological Sciences, Madurai Kamaraj University, Madurai, India
| | - Sundaravadivu Keppanan
- Department of Environmental Sciences, School of Energy, Environment and Natural Resources, Madurai Kamaraj University, Madurai, India
| | - Balakrishnan Rekha
- Department of Molecular Biology, School of Biological Sciences, Madurai Kamaraj University, Madurai, India
| | - Anbalagan Krishnasamy
- Department of Medical Lab Technology, Dr. NGP Arts & Science College, Coimbatore, India
| | - Suresh Shanmugarajan
- Department of Molecular Biology, School of Biological Sciences, Madurai Kamaraj University, Madurai, India
| | - Seenivasan Boopathi
- Department of Molecular Biology, School of Biological Sciences, Madurai Kamaraj University, Madurai, India
| | - Anitha Ayyapparaja
- Department of Management Studies, Senthamarai College of Arts & Science, Madurai, India
| | | | - Tamilselvan Rs
- Department of Management Studies, Senthamarai College of Arts & Science, Madurai, India
| | | | | | - Vithya Dharmaraj
- Department of Microbiology & Biotechnology, JJ College of Arts & Science, Pudukottai, India
| | | | | | - Sumathi Chelladurai
- Department of Microbiology & Biotechnology, JJ College of Arts & Science, Pudukottai, India
| | - Jeevan Pandiyan
- Department of Microbiology & Biotechnology, JJ College of Arts & Science, Pudukottai, India
| | | | - Kalidoss Annathurai
- Department of Microbiology & Biotechnology, JJ College of Arts & Science, Pudukottai, India
| | | | - Gorky Arivuruvone
- Department of Biotechnology, Marudhupandiyar College, Thanjavur, India
| | | | - Velsamy G
- Department of Zoology, Aringar Anna College of Arts & Science, Krishnagiri, India
| | - Kannan S
- Department of Environmental Sciences, School of Energy, Environment and Natural Resources, Madurai Kamaraj University, Madurai, India
| | - Subbiah Ramasamy
- Department of Molecular Biology, School of Biological Sciences, Madurai Kamaraj University, Madurai, India
| | - Krishnan Swaminathan
- Chemomicrobiomics Laboratory, Department of Biochemistry & Molecular Biology, KMCH Research Foundation, Coimbatore, India
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Sarah K, Abdillahi HS, Reuben M, Lydia A. Prevalence and risk factors associated with diabetes in Meru County, Kenya: a cross-sectional study. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-020-00902-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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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: 9] [Impact Index Per Article: 2.3] [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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Pastakia SD, Tran DN, Manji I, Schellhase E, Karwa R, Miller ML, Aruasa W, Khan ZM. Framework and case study for establishing impactful global health programs through academia - biopharmaceutical industry partnerships. Res Social Adm Pharm 2020; 16:1519-1525. [PMID: 32792324 DOI: 10.1016/j.sapharm.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The field of global health has grown with multiple different public and private stakeholders engaging in the effort to improve health outcomes for underserved populations around the world. There is, however, only limited published guidance on how to promote successful partnerships between academia and the biopharmaceutical industry. OBJECTIVE This analysis will provide a framework for developing successful partnerships around five central principles. This framework will then be applied to two representative pharmacy collaboration case studies focused on training and donations. FRAMEWORK DESCRIPTION AND CASE STUDY FINDINGS Within the Academic Model Providing Access to Healthcare (AMPATH), successful collaborations between the biopharmaceutical industry philanthropic entities and academic partners have consistently prioritized 1) contextualization, 2) collaboration, 3) local priorities, 4) institutional commitment, and 5) integration. In the first case study, the application of this framework to clinical pharmacy training activities sponsored by Celgene and implemented by the Purdue Kenya Partnership has helped the program transition from an entirely donor dependent training program to a revenue generating, locally administered program which is now recognized and accredited by the Kenyan government. In the second case study, medication donations from Eli Lilly and Company have been converted from a traditional donation program in one Kenyan health facility to a replicable and sustainable supply chain model which has been expanded to more than 70 public sector facilities across western Kenya. CONCLUSION Adherence to the five core principles of the proposed framework can help guide partnerships between academic institutions and the biopharmaceutical industry to advance healthcare services for underserved populations around the world. As large-scale government-based development agencies continue to primarily focus on specific disease states, biopharmaceutical industry-based collaborations can help initiate activities in underfunded therapeutic areas such as non-communicable diseases.
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Affiliation(s)
- Sonak D Pastakia
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya.
| | - Dan N Tran
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Imran Manji
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Ellen Schellhase
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Rakhi Karwa
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Monica L Miller
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Zeba M Khan
- Celgene (Now Part of Bristol Myers Squibb), USA
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Malanda B, Burgaz C, Njenga E, Muga J, Acharya K, Gardete L, Kaur M, Kunyiha N, Saeedi P, Pathan S, McLaughlin S, Bimont X. Diabetes care and education training audit for primary care physicians - Results from IDF Diab-CET Kenya study needs assessment survey. Diabetes Res Clin Pract 2020; 159:108012. [PMID: 32014141 DOI: 10.1016/j.diabres.2020.108012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karinja M, Pillai G, Schlienger R, Tanner M, Ogutu B. Care-Seeking Dynamics among Patients with Diabetes Mellitus and Hypertension in Selected Rural Settings in Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112016. [PMID: 31174248 PMCID: PMC6603942 DOI: 10.3390/ijerph16112016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus and hypertension are two common non-communicable diseases (NCDs) that often coexist in patients. However, health-seeking behaviour in patients with diabetes mellitus or hypertension has not been extensively studied especially in low- and middle-income countries. This study aimed to examine care-seeking dynamics among participants diagnosed with diabetes and/or hypertension across nine counties in rural Kenya. We conducted a cross-sectional study among adults diagnosed with diabetes and/or hypertension through face-to-face interviews. Of the 1100 participants, 69.9% had hypertension, 15.5% diabetes while 14.7% had both. The mean age of the respondents was 64 years. The majority of the respondents (86%) were on allopathic treatment. Hospital admission, having a good self-rated health status and having social support for illness, were positively associated with appropriate health-seeking behaviour while use of alcohol and pharmacy or chemist as source of treatment were negatively associated with appropriate health-seeking behaviour. Our study found a high prevalence of appropriate health-seeking behaviour among respondents with the majority obtaining care from government facilities. The results are evidence that improving public health care services can promote appropriate health-seeking behaviour for non-communicable diseases and thus improve health outcomes.
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Affiliation(s)
- Miriam Karinja
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland.
- University of Basel, 4001 Basel, Switzerland.
- Center for Research in Therapeutic Sciences (CREATES), Strathmore University, Nairobi 00100, Kenya.
| | - Goonaseelan Pillai
- CP+ Associates GmbH, 4102 Basel, Switzerland.
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town 7701, South Africa.
| | - Raymond Schlienger
- Quantitative Safety and Epidemiology, Chief Medical Office & Patient Safety, Novartis Pharma AG, 4033 Basel, Switzerland.
| | - Marcel Tanner
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland.
- University of Basel, 4001 Basel, Switzerland.
| | - Bernhards Ogutu
- Center for Research in Therapeutic Sciences (CREATES), Strathmore University, Nairobi 00100, Kenya.
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi 00100, Kenya.
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Pastakia SD, Nuche-Berenguer B, Pekny CR, Njuguna B, O’Hara EG, Cheng SY, Laktabai J, Buckwalter V, Kirui N, Chege P. Retrospective assessment of the quality of diabetes care in a rural diabetes clinic in Western Kenya. BMC Endocr Disord 2018; 18:97. [PMID: 30591044 PMCID: PMC6307239 DOI: 10.1186/s12902-018-0324-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa continues to face the highest rate of mortality from diabetes in the world due to limited access to quality diabetes care. We assessed the quality of diabetes care in a rural diabetes clinic in western Kenya. METHODS To provide a comprehensive assessment, a set of clinical outcomes, process, and structure metrics were evaluated to assess the quality of diabetes care provided in the outpatient clinic at Webuye District Hospital. The primary clinical outcome measures were the change in HbA1c and point of care blood glucose. In assessing process metrics, the primary measure was the percentage of patients who were lost to follow up. The structure metrics were assessed by evaluating different facets of the operation of the clinic and their accordance with the International Diabetes Federation (IDF) guidelines. RESULTS A total of 524 patients were enrolled into the diabetes clinic during the predefined period of evaluation. The overall clinic population demonstrated a statistically significant reduction in HbA1c and point of care blood glucose at all time points of evaluation after baseline. Patients had a mean baseline HbA1C of 10.2% which decreased to 8.4% amongst the patients who remained in care after 18 months. In terms of process measures, 38 patients (7.3%) were characterized as being lost to follow up as they missed clinic visits for more than 6 months. Through the assessment of structural metrics, the clinic met at least the minimal standards of care for 14 out of the 19 domains recommended by the IDF. CONCLUSION This analysis illustrates the gains made in various elements of diabetes care quality which can be used by other programs to guide diabetes care scale up across the region.
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Affiliation(s)
- Sonak D. Pastakia
- Moi University School of Medicine, Nandi Hills Road, Eldoret, 30100 Kenya
- USAID-Academic Model Providing Access to Healthcare (AMPATH) /Moi Teaching and Referral Hospital, Nandi Hills Road, Eldoret, 30100 Kenya
- Purdue Kenya Partnership, Purdue University College of Pharmacy, PO Box 5760, Eldoret, 30100 Kenya
- Webuye District Hospital, PO Box 25, Webuye Road, Webuye, 50205 Kenya
| | - Bernardo Nuche-Berenguer
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 31 Center Dr, Bethesda, MD 20892 USA
| | - Chelsea Regina Pekny
- Ohio State University, College of Pharmacy, 500 W 12th Ave, Parks Hall, Columbus, OH 43210 USA
| | - Benson Njuguna
- USAID-Academic Model Providing Access to Healthcare (AMPATH) /Moi Teaching and Referral Hospital, Nandi Hills Road, Eldoret, 30100 Kenya
| | | | - Stephanie Y. Cheng
- Purdue Kenya Partnership, Purdue University College of Pharmacy, PO Box 5760, Eldoret, 30100 Kenya
| | - Jeremiah Laktabai
- Moi University School of Medicine, Nandi Hills Road, Eldoret, 30100 Kenya
- USAID-Academic Model Providing Access to Healthcare (AMPATH) /Moi Teaching and Referral Hospital, Nandi Hills Road, Eldoret, 30100 Kenya
- Webuye District Hospital, PO Box 25, Webuye Road, Webuye, 50205 Kenya
| | - Victor Buckwalter
- Webuye District Hospital, PO Box 25, Webuye Road, Webuye, 50205 Kenya
| | - Nicholas Kirui
- USAID-Academic Model Providing Access to Healthcare (AMPATH) /Moi Teaching and Referral Hospital, Nandi Hills Road, Eldoret, 30100 Kenya
| | - Patrick Chege
- Moi University School of Medicine, Nandi Hills Road, Eldoret, 30100 Kenya
- Webuye District Hospital, PO Box 25, Webuye Road, Webuye, 50205 Kenya
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Mannik J, Figol A, Churchill V, Aw J, Francis S, Karino E, Chesire JK, Opot D, Ochieng B, Hawkes MT. Community-based screening for cardiovascular risk using a novel mHealth tool in rural Kenya. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:176-182. [PMID: 30398461 DOI: 10.14236/jhi.v25i3.1012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/03/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An increasing burden of cardiovascular disease (CVD) in low-resource settings demands innovative public health approaches. OBJECTIVES To design and test a novel mHealth tool for use by community health workers (CHWs) to identify individuals at high CVD risk who would benefit from education and/or pharmacologic interventions. METHODS We designed and implemented a novel two-way mobile phone application, "AFYACHAT," to rapidly screen for CVD risk in rural Kenya. AFYACHAT collects and stores SMS text message data entered by a CHW on a subject's age, sex, smoking, diabetes, and systolic blood pressure, and returns as SMS text message the category of 10-year CVD risk: "GREEN" (<10% 10 year risk of cardiovascular event), "YELLOW" (10 to <20%), "orange"(20 to <30%), or "RED" (≥30%). CHWs were equipped and trained to use an automated blood pressure device and the mHealth tool. RESULTS Five CHWs screened 2,865 subjects in remote rural communities in Kenya over a 22 month period (2015-17). The median age of subjects was 50 (IQR 43 to 60) and 1581 (55%) were female. Point prevalence of hypertension (systolic blood pressure>140mmHg), diabetes, and tobacco use were 23%, 3.2%, and 22%, respectively. Overall, the 10-year risk of CVD among patients was <10% in 2778 (97%) patients, 10 to <20% in 65 (2.3%), 20 to <30% in 12 (0.4%), and ≥30% in 10 (0.2%). CONCLUSION We have developed a mHealth tool that can be used by CHWs to screen for CVD risk factors, demonstrating proof-of-concept in rural Kenya.
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Atun R, Davies JI, Gale EAM, Bärnighausen T, Beran D, Kengne AP, Levitt NS, Mangugu FW, Nyirenda MJ, Ogle GD, Ramaiya K, Sewankambo NK, Sobngwi E, Tesfaye S, Yudkin JS, Basu S, Bommer C, Heesemann E, Manne-Goehler J, Postolovska I, Sagalova V, Vollmer S, Abbas ZG, Ammon B, Angamo MT, Annamreddi A, Awasthi A, Besançon S, Bhadriraju S, Binagwaho A, Burgess PI, Burton MJ, Chai J, Chilunga FP, Chipendo P, Conn A, Joel DR, Eagan AW, Gishoma C, Ho J, Jong S, Kakarmath SS, Khan Y, Kharel R, Kyle MA, Lee SC, Lichtman A, Malm CP, Mbaye MN, Muhimpundu MA, Mwagomba BM, Mwangi KJ, Nair M, Niyonsenga SP, Njuguna B, Okafor OLO, Okunade O, Park PH, Pastakia SD, Pekny C, Reja A, Rotimi CN, Rwunganira S, Sando D, Sarriera G, Sharma A, Sidibe A, Siraj ES, Syed AS, Van Acker K, Werfalli M. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol 2017; 5:622-667. [PMID: 28688818 DOI: 10.1016/s2213-8587(17)30181-x] [Citation(s) in RCA: 284] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Justine I Davies
- Centre for Global Health, King's College London, Weston Education Centre, London, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Parktown, South Africa
| | | | - Till Bärnighausen
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute, KwaZulu, South Africa
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naomi S Levitt
- Division of Diabetic Medicine & Endocrinology, University of Cape Town, Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Moffat J Nyirenda
- Department of NCD Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; NCD Theme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW, Australia; Diabetes NSW & ACT, Glebe, NSW, Australia
| | | | - Nelson K Sewankambo
- Department of Medicine, and Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eugene Sobngwi
- University of Newcastle at Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Solomon Tesfaye
- Sheffield Teaching Hospitals and University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
| | - Sanjay Basu
- Center for Population Health Sciences and Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Christian Bommer
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Esther Heesemann
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Jennifer Manne-Goehler
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Iryna Postolovska
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Vera Sagalova
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Sebastian Vollmer
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, and Abbas Medical Centre, Dar es Salaam, Tanzania
| | - Benjamin Ammon
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Akhila Annamreddi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ananya Awasthi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Agnes Binagwaho
- Harvard Medical School, Harvard University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; University of Global Health Equity, Kigali, Rwanda
| | | | - Matthew J Burton
- International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeanne Chai
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Felix P Chilunga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Anna Conn
- The Fletcher School of Law and Diplomacy, Tufts University, Medford, MA, USA
| | - Dipesalema R Joel
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Arielle W Eagan
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Julius Ho
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simcha Jong
- Leiden University, Science Based Business, Leiden, Netherlands
| | - Sujay S Kakarmath
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Ramu Kharel
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Kyle
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Seitetz C Lee
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Amos Lichtman
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Maïmouna N Mbaye
- Clinique Médicale II, Centre de diabétologie Marc Sankale, Hôpital Abass Ndao, Dakar, Senegal
| | - Marie A Muhimpundu
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | - Mohit Nair
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simon P Niyonsenga
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Obiageli L O Okafor
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Oluwakemi Okunade
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Paul H Park
- Partners In Health, Rwinkwavu, South Kayonza, Rwanda
| | - Sonak D Pastakia
- Purdue University College of Pharmacy (Purdue Kenya Partnership), Indiana Institute for Global Health, Uasin Gishu, Kenya
| | | | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Rwunganira
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - David Sando
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Anshuman Sharma
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Azhra S Syed
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristien Van Acker
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mahmoud Werfalli
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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11
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Amendezo E, Walker Timothy D, Karamuka V, Robinson B, Kavabushi P, Ntirenganya C, Uwiragiye J, Mukantagwabira D, Bisimwa J, Uwintwali Marie H, Umulisa H, Niyomwungeri S, Ndayambaje B, Dusabejambo V, Bavuma C. Effects of a lifestyle education program on glycemic control among patients with diabetes at Kigali University Hospital, Rwanda: A randomized controlled trial. Diabetes Res Clin Pract 2017; 126:129-137. [PMID: 28237859 DOI: 10.1016/j.diabres.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/15/2017] [Accepted: 02/02/2017] [Indexed: 12/20/2022]
Abstract
AIM Evidence to show whether lifestyle intervention programs are beneficial for patients with diabetes in resource-limited countries is lacking. The present study assessed the additional efficacy of a structured lifestyle education program, as compared to the current standard of diabetic care in Rwanda. METHODS 251 consecutive adult patients attending a tertiary diabetic care practice were randomly assigned to either an intervention group (standard of care plus monthly lifestyle group education sessions of 45min duration) or to a control group. The primary outcome was between-groups difference in glycated hemoglobin (HbA1c) observed after 12-months follow up. Outcome measures in the intervention and control groups were compared using the ANCOVA test with a two-sided significance of 5%. RESULTS Of the 251 subjects recruited, 223 were included in the analysis; of whom 115 were assigned to the intervention group, and 108 to the control group. After 12-months, the median HbA1c levels reduced by 1.70 (95% CI: -2.09 to -1.31; p<0.001) in the intervention group; and by 0.52 (95% CI: -0.95 to -0.10; p=0.01) in the control group. The difference in HbA1c reduction between the intervention and control groups was statistically significant (p<0.001) after adjustment for subjects' age, sex, education level, BMI, diabetes duration and diabetic medications. CONCLUSIONS This study demonstrated that a structured lifestyle group education program for people with diabetes is an attractive option in a resource-limited setting, as it showed significant benefits in improved glycemic control over a 12-month period. TRIAL REGISTRATION ClinicalTrials.gov: NCT02032108.
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Affiliation(s)
- Etienne Amendezo
- Department of Internal Medicine, University of Rwanda, Rwanda; King Faisal Hospital, Kigali, Rwanda.
| | - David Walker Timothy
- Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Butare, Rwanda
| | | | - Brian Robinson
- University Teaching Hospital of Kigali, Rwanda; Human Resources for Health, Rwanda; Brown University, USA
| | - Patrick Kavabushi
- Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Kigali, Rwanda
| | - Cyprien Ntirenganya
- Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Butare, Rwanda
| | | | | | | | | | | | | | | | - Vincent Dusabejambo
- Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Kigali, Rwanda
| | - Charlotte Bavuma
- Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Kigali, Rwanda
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