Global disability burden and its predictors among adult Nigerians living with Type-2 diabetes

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

BACKGROUND

There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo.

METHODS

We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I2.

RESULTS

A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6-32.9). The glycaemic control prevalence ranged from 10-60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control.

CONCLUSION

Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.

Impact of post-stroke disability and disability-perception on health-related quality of life of stroke survivors: the moderating effect of disability-severity

OBJECTIVE

The influence of disability-perception on health-related quality of life (HRQoL) remains unclear. This study investigated impact of disability and disability-perception on HRQoL of stroke survivors and explores the moderating effect of disability-severity.

METHODS

Post-stroke disability, disability-perception/acceptance and HRQoL were assessed in 102 stroke survivors using the World Health Organisation Disability Assessment Schedule, Attitudes towards Disabled Persons Form-A and Short Form-36, respectively.

RESULTS

There was significant disability score of at least 42 in the participants with severe disability accounting for 76.5% while 52% of them having positive disability-perception. Although no sex difference exists in their HRQoL, their score was just fair (46.1 ± 1.9) with their physical health being most affected. Severe disability impacted negatively on their HRQoL but disability-perception had no significant effect except in 'role limitation due to the emotional problem' domain. Only severe disability moderated the effects of disability on the overall HRQoL (R ² change = 3.2%; p = 0.018). Disability-severity (mild/moderate and severe disability) moderated the effects of disability level on their physical health (R ² change = 3.1% and 6%; p = 0.012 and 0.0001, respectively).

CONCLUSION

Significant disability exists among stroke survivors and impaired their HRQoL while disability-severity moderating the effect. More stroke survivors have positive attitude towards their disability and impact positively on their physical health.