Abstract
Background: Uganda is located in East Africa and is among the countries with the lowest income globally. The ten health centres in this project serve populations in the under-privileged communities of Kampala. The objective of the study was to implement diabetes mellitus (DM) screening among tuberculosis (TB) patients in a routine program setting with limited resources and high human immunodeficiency virus (HIV) prevalence. Methods: A descriptive cross-sectional observational study was conducted in ten health centres in Kampala, Uganda. As part of a project to implement DM screening in a routine setting, TB patients were screened for DM by trained health workers. A fasting blood glucose (FBG) value ≥7.0mmol/l was considered to indicate DM. For this study, aggregate data was collected and analysed using SPSS for Windows, version 13.0. Results: Among 4,590 TB patients registered, 4,016 (88.0%) were screened with random blood glucose (RBG). Of those with RBG ≥6.1mmol/l, 1,093 (83.3%) were screened with FBG. In total, 92 (2.3%) patients were diagnosed with DM and 66 (71.8%) of them were newly diagnosed. The proportion of TB patients screened with FBG in the health centres varied from 58.2% to 100%. The proportion of patients screened with FBG and the prevalence of DM were significantly higher in private health centres compared with public health centres. The health centres in peri-urban areas screened more patients with RBG than those in urban areas. Health centres without DM services screened a larger number of patients with RBG and FBG than those with DM services. Conclusions: It appears feasible to implement screening TB patients for DM in routine program settings with limited resources and high HIV prevalence. Its introduction requires close collaboration between TB and DM services. The challenges identified need government attention and certain institutional and service-related factors need to be better managed at times.
Highlights
Significant progress has been achieved in tuberculosis (TB) care and prevention during the past decades, TB remains a major public health problem and is responsible for more deaths than any other single infectious disease worldwide[1]
The proportion of patients screened with fasting blood glucose (FBG) and the prevalence of diabetes mellitus (DM) were significantly higher in private health centres compared with public health centres
The proportion of patients screened with RBG was significantly higher in the health centres located in peri-urban areas compared with the centres in urban areas; and in those without DM services compared with those with DM services (Table 4)
Summary
Significant progress has been achieved in tuberculosis (TB) care and prevention during the past decades, TB remains a major public health problem and is responsible for more deaths than any other single infectious disease worldwide[1]. Uganda is among the 30 high TB and human immunodeficiency virus (HIV) burden countries, with an estimated TB prevalence of 253 per 100,000 population (95% CI: 196-317) and 40% HIV co-infection rate[2,3]. Along with socio-economic development, urbanization, dietary and lifestyle changes, the prevalence of diabetes mellitus (DM) is escalating in most low- and middle-income countries. In Uganda, some risk factors for DM, such as obesity, were greater among persons of a high socio-economic status in rural areas, though the prevalence of DM in the adult population of the entire country was relatively low (1.4% in a nationwide cross-sectional survey in 2014)[6,7]. The objective of the study was to implement diabetes mellitus (DM) screening among tuberculosis (TB) patients in a routine program setting with limited resources and high human immunodeficiency virus (HIV) prevalence. Aggregate data was collected and analysed using SPSS for Windows, version 13.0
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