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Owusu BA, Doku DT. Living with type 1 diabetes and schooling among young people in Ghana: a truism of health selection, inadequate support, or artefactual explanation of educational inequalities? BMC Public Health 2024; 24:1137. [PMID: 38654212 DOI: 10.1186/s12889-024-18590-y] [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: 04/27/2023] [Accepted: 04/14/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is mostly diagnosed among young people. Despite the evidence that T1DM is disruptive, and affects individuals' health and cognitive ability, there is dearth of knowledge on the impact of T1DM on schooling in LMICs including Ghana. In this research, we explored the impact of T1DM on the schooling of young people living with the disease, and discussed the results within health selection, social support, and artefactual perspectives of inequality. METHODS Data were extracted from a qualitative project on T1DM lived experiences in southern Ghana. The study participants were young persons living with T1DM (n = 28) and their caregivers (n = 12). They were purposively recruited to participate in the study using maximum variation and snowball sampling techniques and interviewed in their support group centres, homes, or healthcare facilities using semi-structured interview guides. A computer-assisted qualitative data analysis was performed using QSR NVivo 14 software, and the results were categorised into themes. RESULTS Three themes were identified from the transcripts. These themes were school and classroom attendance, choice of school, and school/academic performance. T1DM was a major reason for patients' limited contact hours with teachers, school drop-out, preference for day schools rather than boarding, opting for vocational training instead of continuation of formal education, limited concentration at school, and delayed educational progression. CONCLUSION T1DM impacted the schooling of young people living with the disease. The mechanisms of these impacts, and young peoples lived experiences are not artefactual, but rather support discourses on health selection and inadequate social support for young people living with the disease. The results call for the need to develop educational and social interventions to address these barriers. The full implementation of the Inclusive Education Policy (IEP) may contribute to reducing educational and social inequalities caused by ill-health.
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Affiliation(s)
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Kushwaha S, Srivastava R, Kumar Bhadada S, Khanna P. Prevalence of pre-diabetes and diabetes among school-age children and adolescents of India: A brief report. Diabetes Res Clin Pract 2023:110738. [PMID: 37285966 DOI: 10.1016/j.diabres.2023.110738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
The prevalence study of pre-diabetes and diabetes among children and adolescents is crucial for early detection and intervention, public health resource allocation and monitoring the trend. The national prevalence of pre-diabetes and diabetes among school-age children was 15.35% and 0.94%, whereas, among adolescents, the prevalence was 16.18% and 0.56%, respectively.
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Affiliation(s)
- Savitesh Kushwaha
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rachana Srivastava
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Poonam Khanna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Khadilkar AV, Oza C, Mondkar SA, Khadilkar V, Kanungo A, Sethi BK, Kumar KMP, Tandon N, Rao PV, Kumar S, Bandgar TR, Raghupathy P. Nutritional Status of Underprivileged Indian Children and Youth with Type-1 Diabetes - A Multicentre Study. Indian J Endocrinol Metab 2023; 27:216-222. [PMID: 37583405 PMCID: PMC10424112 DOI: 10.4103/ijem.ijem_224_22] [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: 06/03/2022] [Revised: 10/25/2022] [Accepted: 11/20/2022] [Indexed: 08/17/2023] Open
Abstract
Background India has the highest number of prevalent type-1 diabetes (T1D) cases in the under-20-year age population. Data on the anthropometry of underprivileged Indian children with T1D are scarce. In economically disadvantaged countries like India, poor growth in patients with T1D is a major concern due to limited accessibility and affordability. Besides, due to the double burden of malnutrition, the prevalence of obesity is increasing mirroring the global trends, which may lead to the development of insulin resistance. Objectives This study aims to assess the prevalence of malnutrition in Indian children and youth with T1D and to identify the determinants of short stature. Methods A registry-based cross-sectional analysis of data collected from various centres across India enrolled in the Changing Diabetes in Children (CDiC) programme. Results We observed that 6.4% were undernourished (3.4% severe undernutrition) and 17.7% (overweight 13.2%) had combined overweight/obesity. 21.2% of participants had short stature (adjusted for mid-parental height) with 7.4% cases of familial short stature. Longer duration of illness and insulin requirement were significant positive predictors of short stature while glycaemic control, insulin regimen and mid-parental height did not have a significant relationship with short stature. Participants on basal-bolus regimen had significantly higher insulin requirements and better glycaemic control than the ones on mixed-split regimen. Conclusion We report that around one-fifth of children and youth with T1D were overweight/obese and around a fourth were stunted, especially those with longer duration of diabetes and higher insulin requirements. Close monitoring of anthropometric parameters is necessary for all children with T1D to optimize growth and nutrition.
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Affiliation(s)
- Anuradha V. Khadilkar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, Odisha, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, Odisha, India
| | - Chirantap Oza
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, Odisha, India
| | - Shruti A. Mondkar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, Odisha, India
| | - Vaman Khadilkar
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, Odisha, India
- Department of Paediatric Endocrinology, Senior Paediatric Endocrinologist, Jehangir Hospital, Pune, Maharashtra, Odisha, India
| | - Alok Kanungo
- Department of Pediatric Endocrinology, Kanungo Institute of Diabetes Specialties, 1120, Dumduma, Bhubhaneswar, Odisha, India
| | - Bipin K. Sethi
- Department of Endocrinology – Tapadia Diagnostics, Hyderabad, Telangana, India
| | - KM Prasanna Kumar
- Department of Endocrinology, Centre for Diabetes and Endocrine Care, Bengaluru, Karnataka, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, Delhi, India
| | - P V Rao
- Diabetes Research Society, Hyderabad, Telangana, India
| | - Surendra Kumar
- Department of Endocrinology, Patna Medical College, Patna, Bihar, India
| | - Tushar R. Bandgar
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Palany Raghupathy
- Department of Pediatric Endocrinology, Paediatric and Adolescent Endocrinology Division, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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Joseph N, Sharma S, Modi V, Manjunatha S, Siddiqui SA, Sinha M. Early Occurrence Cases of Diabetes Mellitus: Clinical Picture in Two Major Tertiary Care Hospitals in India. Curr Diabetes Rev 2019; 15:141-148. [PMID: 29692258 DOI: 10.2174/1573399814666180424123255] [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: 09/08/2017] [Revised: 01/05/2018] [Accepted: 04/13/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1D) is one of the most common endocrine diseases in childhood. However, very limited information is available on this disease. OBJECTIVES This study was done to assess risk factors, clinical features and management practices in T1D patients. METHODS A review of records of 39 T1D cases admitted over the past five years in two hospitals was done. RESULTS The mean age at diagnosis among males (n=21) was 19.9±10.3 years and among females (n=18) was 12.3±7.5 years (t=2.614, p=0.013). Mean age at diagnosis of patients who were underweight (n=7) was 9.9±4.4 years, compared to 17.8±10.1 years among patients (n=32) with normal or overweight status (t=2.028, p=0.05). The family history of T1D was present among 7(18.0%) cases. The most common symptoms among the cases were fatigue 22(56.4%), polyuria 19(48.7%) and polydipsia 18(46.1%). The most common sign was weight loss 27(69.2%). The most common complications were diabetic nephropathy and skin infections seen each among 10(25.6%) cases. Mean duration of T1D was significantly more among patients with diabetic nephropathy (p<0.001), compared to those without. Mean HbA1c value among patients was 12.9±2.7. It was significantly more among patients with Diabetic Ketoacidosis (DKA) (p=0.012). A short-acting insulin was used in the management of T1D among 59.5% cases. The outcome of the management showed a loss of one patient who developed DKA. CONCLUSION Routine growth monitoring and blood glucose analysis is required among T1D cases. The present study provides a database of risk factors, clinical features, and management practices among patients with T1D in this region and addresses several issues important to both patients and their care providers.
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Affiliation(s)
- Nitin Joseph
- Department of Community Medicine, Kasturba Medical College, Light House Hill Road, Manipal Academy of Higher Education, Mangalore, India
| | - Shreya Sharma
- Kasturba Medical College, Light House Hill Road, Manipal Academy of Higher Education, Mangalore, India
| | - Vinisha Modi
- Kasturba Medical College, Light House Hill Road, Manipal Academy of Higher Education, Mangalore, India
| | - Sanath Manjunatha
- Kasturba Medical College, Light House Hill Road, Manipal Academy of Higher Education, Mangalore, India
| | - Saad A Siddiqui
- Kasturba Medical College, Light House Hill Road, Manipal Academy of Higher Education, Mangalore, India
| | - Mihika Sinha
- Kasturba Medical College, Light House Hill Road, Manipal Academy of Higher Education, Mangalore, India
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Verloo H, Meenakumari M, Abraham EJ, Malarvizhi G. A qualitative study of perceptions of determinants of disease burden among young patients with type 1 diabetes and their parents in South India. Diabetes Metab Syndr Obes 2016; 9:169-76. [PMID: 27274298 PMCID: PMC4876838 DOI: 10.2147/dmso.s102435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Diabetes is a leading threat to public health in India. A huge prevalence of type 1 diabetes among young patients is documented in literature; India is one of the countries with the highest number of new cases per year (10,900), of which 3-4 million face poverty along with diabetes. OBJECTIVE The aim of this study was to explore the perceptions of determinants of the disease burden among young patients with type 1 diabetes and their parents. METHODS In June 2014, perceptions were collected from eleven young patients and five available parents using the critical incident technique. RESULTS Disease burdens associated with the management of type 1 diabetes can vary significantly according to the different social and economic determinants facing each household. Determinants associated with good practices in the management of childhood type 1 diabetes included socioeconomic status, unawareness of health complications, and beliefs about nutrition. Coping strategies applied via lifestyle changes included monitoring glycemia and regular checkups by diabetologists. A general lack of awareness about type 1 diabetes in Indian society, stigmatization, and limited access and systematic barriers to the delivery of optimal health care were all perceived to be factors hindering the successful management of chronic type 1 diabetes by young patients and their parents. CONCLUSION Stigmatization, a lack of therapeutic adherence, and the financial strains placed on families, particularly on poor ones, are critical. More emphasis must be put on the prevention of acute and long-term complications and education.
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Affiliation(s)
- Henk Verloo
- Department Nursing Sciences, University of Applied Nursing Sciences, La Source, Lausanne, Switzerland
- Correspondence: Henk Verloo, Department Nursing Sciences, University of Applied Nursing Sciences, La Source, 30, Avenue Vinet, CH-1004 Lausanne, Switzerland, Tel +41 21 641 3867, Fax +41 21 641 3810, Email
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