Prevalence and correlates of diabetes mellitus in Malawi: population-based national NCD STEPS survey

BMC Endocrine Disorders

Damson Kathyola¹  Chimwemwe J Mvula¹  Kelias Phiri Msyamboza² 

[1] Ministry of Health, Lilongwe, Malawi;University of Malawi, College of Medicine, Community Health Department, Lilongwe, Malawi

关键词: Malawi;    Sub-Saharan Africa;    Non-communicable diseases;    Diabetes;   

Others  :  864924
DOI  :  10.1186/1472-6823-14-41

 received in 2013-12-10, accepted in 2014-05-08,  发布年份 2014

【 摘 要 】

Background

Previously considered as a disease of the affluent, west or urban people and not of public health importance, diabetes mellitus is increasingly becoming a significant cause of morbidity and mortality in sub-Saharan Africa. However, population-based data to inform prevention, treatment and control are lacking.

Methods

Using the WHO STEPwise approach to chronic disease risk factor surveillance, a population-based, nationwide cross-sectional survey was conducted between July and September 2009 on participants aged 25–64 years. A multi-stage cluster sample design and weighting were used to produce a national representative data for that age range. Detailed findings on the magnitude of diabetes mellitus and impaired fasting blood glucose are presented in this paper.

Results

Fasting blood glucose measurement was conducted on 3056 participants (70.2% females, 87.9% from rural areas). The age- sex standardised population-based mean fasting blood glucose was 4.3 mmol/L (95% CI 4.1-4.4 mmol/L) with no significant differences by age, sex and location (urban/rural). The overall prevalence of impaired fasting blood glucose was 4.2% (95% CI 3.0%-5.4%). Prevalence of impaired blood glucose was higher in men than in women, 5.7% (95% CI 3.9%-7.5%) vs 2.7% (95% CI 1.6%- 3.8%), p < 0.01. In both men and women, prevalence of raised fasting blood glucose or currently on medication for diabetes was 5.6% (95% CI 2.6%- 8.5%). Although the prevalence of diabetes was higher in men than women, 6.5% (95% CI 2.6%-10.3%) vs 4.7% (95% CI 2.4%-7.0%), in rural than urban, 5.4% (95% CI 2.4%-8.4%) vs 4.4% (95% CI 2.8%-5.9%) and in males in rural than males in urban, 6.9% (95% CI 2.8%-11.0%) vs 3.2% (95% CI 0.1%-6.3%), the differences were not statistically significant, p > 0.05. Compared to previous estimates, prevalence of diabetes increased from <1.0% in 1960s to 5.6% in 2009 (this study).

Conclusion

High prevalence of impaired fasting blood glucose and diabetes mellitus call for the implementation of primary healthcare approaches such as the WHO package for essential non-communicable diseases to promote healthy lifestyles, early detection, treatment and control.

【 授权许可】

   
2014 Msyamboza et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Shaw JE, Sicree RA, Zimmet PZ: Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010, 87(1):4-14.
• [2]Whiting DR, Guariguata L, Weil C, Shaw J: IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011, 94(3):311-321.
• [3]Hall V, Thomsen RW, Henriksen O, Lohse N: Diabetes in Sub Saharan Africa 1999–2011: Epidemiology and public health implications. A systematic review. BMC Public Health 2011, 11:564. BioMed Central Full Text
• [4]Levitt NS: Diabetes in Africa: epidemiology, management and healthcare challenges. Heart 2008, 94:1376-1382.
• [5]Sicree R, Shaw J: Zimmet. The Global Burden: Diabetes and Impaired Glucose Tolerance. Diabetes Atlas, IDF. 4th edition. Brussels: International Diabetes Federation; 2009.
• [6]Ayah R, Joshi MD, Wanjiru R, Njau EK, Otieno CF, Njeru EK, Mutai KK: A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi. Kenya BMC Public Health 2013, 13:371. BioMed Central Full Text
• [7]Goodall JWD, Pilbeam STHH: Diabetes in Nyasaland (Malawi). Trans R Soc Trop Med Hyg 1964, 58(6):575-578.
• [8]Wicks ACB, Castle WM, Gelfand M: Effect of Time on the Prevalence of Diabetes in the Urban African of Rhodesia. Diabetes 1973, 22(10):733-737.
• [9]Chilima DM, Ismail SJ: Anthropometric characteristics of older people in rural Malawi. Eur J Clin Nutr 1998, 52(9):643-649.
• [10]Msyamboza KP, Kathyola D, Dzowela T: Anthropometric measurements and prevalence of underweight, overweight and obesity in adult Malawians: nationwide population based NCD STEPS survey. Pan Afr Med J 2013, 15:108.
• [11]Msyamboza KP, Ngwira B, Dzowela T, Mvula C, Kathyola D, Harries AD, Bowie C: The Burden of Selected Chronic Non-Communicable Diseases and Their Risk Factors in Malawi: Nationwide STEPS Survey. PLoS ONE 2011, 6:e20316.
• [12]World Health Organization: Noncommunicable Diseases and Mental Health Cluster. WHO STEPS Surveillance Manual: The WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance. Geneva: World Health Organization; 2005.
• [13]Msyamboza KP, Kathyola D, Dzowela T, Bowie C: The burden of hypertension and its risk factors in Malawi: nationwide population-based STEPS survey. Int Health 2012, 4:246-252.
• [14]Msyamboza KP, Mvula C, Kathyola D: Prevalence and correlates of tobacco smoking, use of smokeless tobacco and passive smoking in adult Malawians: National population-based NCD STEPS survey. Sci Postprint 2013, 1(1):e00002.
• [15]Miranda JJ, Kinra S, Casas JP, Davey Smith G, Ebrahim S: Non-communicable diseases in low- and middle-income countries: context, determinants and health policy. Trop Med Int Health 2008, 13(10):1225-1234.
• [16]Hilawe EH, Yatsuya H, Kawaguchi L, Aoyama A: Differences by sex in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa: a systematic review and meta-analysis. Bull World Health Organ 2013, 91(9):671-682D.
• [17]Cohen DB, Allain TJ, Glover S, Chimbayo D, Dzamalala H, Hofland HW, Banda NPK, Zijlstra EE: A survey of the management, control, and complications of diabetes mellitus in patients attending a diabetes clinic in Blantyre, Malawi, an area of high HIV prevalence. Am J Trop Med Hyg 2010, 83(3):575.
• [18]WHO: Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Geneva: World Health Organization; 2010.
• [19]WHO: 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases: Prevent and Control Cardiovascular Diseases, Cancers, Chronic Respiratory Diseases and Diabetes. Geneva: World Health Organization; 2009.
• [20]Maher D, Harries AD, Zachariah R, Enarson D: A global framework for action to improve the primary care response to chronic noncommunicable diseases: a solution to a neglected problem. BMC Public Health 2009, 9:355. BioMed Central Full Text
• [21]Malawi National Statistical Office: Population and Housing Census 2008: main report. Zomba, Malawi: National Statistical Office; 2009.