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

Kelias Phiri Msyamboza,Damson Kathyola,Chimwemwe J Mvula

doi:10.1186/1472-6823-14-41

Abstract

BackgroundPreviously 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.MethodsUsing 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.ResultsFasting 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).ConclusionHigh 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.

Highlights

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
In sub-Saharan Africa, it was estimated that 12.1 million people were living with diabetes in 2010 and this was projected to increase to 23.9 million by 2030
Study design and sample size This study was a nationwide population- householdbased cross-sectional survey designed according to a WHO STEPwise approach to chronic disease risk factor surveillance [12]

Summary

Introduction

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. Population-based data to inform prevention, treatment and control are lacking. In sub-Saharan Africa, it was estimated that 12.1 million people were living with diabetes in 2010 and this was projected to increase to 23.9 million by 2030. Due to barriers in accessing diagnosis and treatment including lack of diagnostic tools, glucose monitoring equipment and high cost of diabetes treatment; diabetic patients are often unaware, undiagnosed and those on treatment are poorly managed and monitored with glucose levels adequately controlled in less than a third (27%) and 60% or more of the patients have complications [3,6]

Methods

Results

Conclusion