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

The burden of prediabetes in low- and middle-income countries: a systematic review and meta-analysis

The global burden of diabetes is rising sharply, with a significant proportion of cases emerging in low- and middle-income countries (LMICs). Prediabetes, a condition characterized by elevated blood glucose levels that do not yet meet the threshold for diabetes, serves as a crucial stage for intervention and prevention. Despite its importance, comprehensive data on prediabetes prevalence in LMICs are sparse. Thus, we conducted a systematic review and meta-analysis to ascertain the prevalence of prediabetes in LMICs. We systematically reviewed studies on prediabetes in Low- and Middle-Income Countries (LMICs) from 1st January 2003 and 31st July 2024 using PubMed, Scopus, and Web of Science databases. The NIH study quality assessment tool assessed bias, and pooled prevalence was determined via a random-effects model. We examined publication bias through funnel plot analysis and Begg's and Egger's tests. The prevalence of prediabetes estimated from 164 studies conducted in LMICs was 13.1% (95% CI: 11.7%, 14.5%) based on the World Health Organization (WHO) criteria, and 27.0% (95% CI: 24.5%, 29.5%) based on the American Diabetes Association (ADA) criteria. The pooled prevalence did not significantly differ between males and females for both diagnostic criterias and by study design. The analysis indicated a noteworthy degree of heterogeneity in the pooled estimates (I2 > 70%; p < 0.05). The findings from this study indicated a higher burden of prediabetes within LMICs with regional variations.

Prevalence and associated factors of diabetes among adult populations of Hawassa town, southern Ethiopia: A community based cross-sectional study

INTRODUCTION

Knowing the magnitude and preventable risk factors of diabetes has a significant contribution in targeted prevention intervention which ultimately ensures the existence of healthier and productive individuals in a country. Diabetes has untoward impact on health, social and economic consequences. Exploring preventable risk factors are extremely important because of their potential association and interaction with diabetes. Therefore, the aim of this study was to investigate the magnitude and modifiable risk factors of diabetes among adult populations in Hawassa town, southern Ethiopia.

METHODS

A community based cross-sectional study was conducted from September, 2023 to November, 2023 among adult populations. A multi-stage sampling technique was employed to select 1,113 study participants between the ages of 20-69 years. An interviewer-administered questionnaire was used to collect data. Additionally, participants were also instructed to fast overnight, after which the standard fasting blood glucose test was conducted. A binary logistic regression model was fitted to identify independent predictors of diabetes.

RESULTS

The overall prevalence of diabetes was 14.4% (95% Confidence Interval (CI): 12.4%, 16.4%). Being male (Adjusted Odds Ratio (AOR):2.10; 95% CI: 1.34, 3.29), being unable to read and write (AOR: 3.38; 95% CI: 1.09, 10.47), read and write (AOR: 3.38; 95% CI: 1.09, 10.47) and medium cycle (AOR 2.79; 95% CI: 1.02, 7.63) compared to college and above, consume less than 5 servings of fruits on daily base (AOR: 2.80; 95% CI: 1.18, 6.62), having ever chewed khat (AOR 6.50; 95% CI: 4.07, 10.39) and being overweight and obese (AOR: 2.43; 95% CI: 1.54, 3.83) were independently associated with diabetes mellitus (DM).

CONCLUSION

This study identified a high prevalence of diabetes among adults in Hawassa, driven by various risk factors. This presents an opportunity to mitigate diabetes risk through public health measures, including avoiding khat chewing, promoting healthy diets, managing overweight and obesity, implementing community-based screening, enhancing health literacy, and integrating health information into daily life.

Association between Food Insecurity, Socioeconomic Status of the Household Head, and Hypertension and Diabetes in Maputo City

Background: Metabolic diseases such as hypertension and diabetes are increasingly recognized as not just medical issues, but as complex conditions influenced by various factors. Objectives: This study aimed to explore the association between food insecurity (FI) and hypertension and diabetes and how socioeconomic status influences this relationship. Methods: Based on a cross‑sectional study of 1,820 participants conducted in Maputo City, FI was measured using a modified version of the US Department of Agriculture scale; metabolic diseases were assessed using self‑reports of the actual diagnoses, and data were analyzed through multinomial regression and interaction terms. Results: The findings revealed significant links between FI, socioeconomic status, hypertension and diabetes. Socioeconomic status had a clear influence on the association between FI and hypertension but showed a nuanced influence on diabetes. Specifically, regarding diabetes, the heads of households with a higher socioeconomic position were more likely to have this health condition than their counterparts with a lower socioeconomic position. Conclusions: The study underscores the complex interplay between FI and socioeconomic status in influencing the risk of metabolic diseases. Addressing FI and improving socioeconomic status may be crucial steps in mitigating the risk of hypertension and diabetes among vulnerable populations, emphasizing the importance of a holistic approach to health promotion and disease prevention.

Dynamic Progression of Hypertension and Diabetes in the Democratic Republic of Congo from 2019 to 2023

Introduction: The Democratic Republic of Congo (DRC) does not have national prevalence data for arterial hypertension (HTN) or diabetes (type I and II combined) to aid evidence-based decision-making, despite the assumption of epidemiological transition in low- and middle-income countries. The aim of this study was to estimate a proxy of prevalence for HTN and diabetes. Methodology: This study used routine monthly reported data pertaining to HTN and diabetes from the District Health Information Software 2 (DHIS2), spanning 2019-2023. Data underwent quality assessment and adjustments using standardization before analysis. Equity analyses were carried out at the national and sub-national levels. Epidemiological curves and maps were produced to analyze trends in the prevalence of HTN and diabetes among adults aged 18 and over. Permission to use the data was obtained from the regulatory authority. Results: Over five years, incidence of HTN increased from 13.23% (CI 95%: 13.22-13.24) to 15.23% (CI 95%: 15.22-15.24) (+15.1% relative increase), and diabetes rose from 2.73% (CI 95%: 2.72-2.74) to 3.345% (CI 95%: 3.34-3.35) (+16.3% relative increase), with provincial variations observed. Conclusions: In the DRC, hypertension and diabetes are advancing rapidly. Primary and preventative healthcare services and public health interventions must prioritize these diseases.

Is the incidence rate of colorectal cancer increasing in Mozambique?

Background

Colorectal cancer (CRC) is a significant global health concern, ranking as the third most common cancer and the second leading cause of cancer-related deaths. However, in Africa, CRC is the fifth most common invasive malignancy. Limited data hinder our understanding of the evolving burden of CRC in sub-Saharan Africa. This study explores CRC trends in Mozambique, utilising data from population-based oncological registries.

Methods

CRC data were gathered from Beira and Maputo population-based cancer registries, along with supplementary information from pathology-based and hospital-based registries. Comparative analyses were performed across different time periods, focusing on trends and epidemiological characteristics.

Results

Incidence rates of CRC in Maputo and Beira were relatively low historically. However, data from recent years showed an increase, especially in age groups above 50. Analyses from pathology-based and hospital-based registries affirmed the rising trend. The age-standardised incidence rate in Maputo (2015-2017) was 3.17 for males and 2.55 for females. Beira exhibited increasing rates between 2009 and 2020, particularly in individuals aged 50 and above.

Conclusion

The study reveals an emerging burden of CRC in Mozambique, challenging the perception of low incidence. The rising trend underscores the necessity for tailored interventions, emphasizing early diagnosis, preventive strategies, and investments in healthcare infrastructure to address the increasing CRC burden in the region.

Human resources challenges in the management of diabetes and hypertension in Mozambique

BACKGROUND

The major burden of non-communicable diseases (NCDs) globally occurs in low-and middle-income countries, where this trend is expected to increase dramatically over the coming years. The resultant change in demand for health care will imply significant adaptation in how NCD services are provided. This study aimed to explore self-reported training and competencies of healthcare providers, and the barriers they face in NCD services provision.

METHODS

A qualitative design was used to conduct this study. Data was collected through semi-structured interviews with government officials within the Mozambican Ministry of Health, district health authorities, health facility managers, and health providers at urban and rural health facilities of Maputo, in Mozambique. The data was then analyzed under three domains: provider´s capacity building, health system structuring, and policy.

RESULTS

A total of 24 interviews of the 26 planed with managers and healthcare providers at national, district, and health facility levels were completed. The domains analyzed enabled the identification and description of three themes. First, the majority of health training courses in Mozambique are oriented towards infectious diseases. Therefore, healthcare workers perceive that they need to consolidate and broaden their NCD-related knowledge or else have access to NCD-related in-service training to improve their capacity to manage patients with NCDs. Second, poor availability of diagnostic equipment, tools, supplies, and related medicines were identified as barriers to appropriate NCD care and management. Finally, insufficient NCD financing reflects the low level of prioritization felt by managers and healthcare providers.

CONCLUSION

There is a gap in human, financial, and material resources to respond to the country's health needs, which is more significant for NCDs as they currently compete against major infectious disease programming, which is better funded by external partners. Healthcare workers at the primary health care level of Mozambique's health system are inadequately skilled to provide NCD care and they lack the diagnostic equipment and tools to adequately provide such care. Any increase in global and national responses to the NCD challenge must include investments in human resources and appropriate equipment.

The role of structural racism and geographical inequity in diabetes outcomes

Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.