149 research outputs found
Progression to type 2 diabetes mellitus and associated risk factors after hyperglycemia first detected in pregnancy: A cross-sectional study in Cape Town, South Africa
No full textGlobal data indicate that women with a history of hyperglycemia first detected in pregnancy (HFDP) are at up to 7 times risk of progressing to type 2 diabetes mellitus (T2DM) compared with their counterparts who have pregnancies that are not complicated by hyperglycemia. However, there are no data from the sub-Saharan African region, which has the highest projected rise in diabetes prevalence globally. The aim of this study was to determine the proportion of women who progress to T2DM and associated risk factors 5 to 6 years after HFDP in Cape Town, South Africa
High prevalence of cardiovascular risk factors and insulin resistance 6 years after hyperglycemia first detected in pregnancy in Cape Town, South Africa
No full textObjective: To investigate the prevalence and associated cardiovascular risk factors 6 years after hyperglycemia first detected in pregnancy (HFDP) in Cape Town, South Africa.
Research design and methods: Data were collected during the index pregnancy from all women diagnosed with HFDP at a major referral hospital in Cape Town. Participants were evaluated 6 years later using a cross-sectional study. At follow-up participants had a 75 g oral glucose tolerance test, fasting lipogram, blood pressure and anthropometric measurements, and a fieldworker administered the questionnaire. We used the Adult Treatment Panel III criteria for the diagnosis of metabolic syndrome and individual risk factors. Insulin resistance was assessed using the homeostatic model of insulin resistance.
Results: At follow-up 220 women were reviewed. Their mean age at follow-up was 37.2 (SD 6.0) years. The prevalence of cardiovascular disease (CVD) risk factors was 60.9% (95% CI 54.3 to 67.2) for metabolic syndrome, 75% (95% CI 65.9 to 82.3) for insulin resistance, 62.3% (95% CI 55.6 to 68.5) for dysglycemia, 41.4% (95% CI 35.0 to 48.0) for raised blood pressure, and 74.6% (95% CI 683 to 79.9) for dyslipidemia. Women with diabetes in pregnancy compared with those with gestational diabetes during the index pregnancy had a higher prevalence of metabolic syndrome (74.3% vs 54.7%, p=0.010) and dysglycemia (88.6% vs 50.0%, p<0.001) at follow-up. Lower school education attainment, having a subsequent pregnancy, waist circumference at follow-up, and fasting blood glucose at HFDP diagnosis were associated with metabolic syndrome.
Conclusion: We found a high prevalence of CVD risk factors in South African women within 6 years of HFDP, which highlights the need to develop and evaluate interventions optimizing the cardiometabolic health of this vulnerable group. The main limitations of our research are the lack of a comparative group of women without HFDP and that we did not assess for CVD risk factors before HFDP
A cross-sectional, facility based study of comorbid non-communicable diseases among adults living with HIV infection in Zimbabwe
No full textCITATION: Magodoro, I. M., Esterhuizen, T. M. & Chivese, T. 2016. A cross‑sectional, facility based study of comorbid non‑communicable diseases among adults living with HIV infection in Zimbabwe. BMC Research Notes, 9:379, doi: 10.1186/s13104-016-2187-z.The original publication is available at http://bmcresnotes.biomedcentral.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Background: Increased antiretroviral therapy uptake in sub-Saharan Africa has resulted in improved survival of the infected. Opportunistic infections are declining as leading causes of morbidity and mortality. Though comprehensive data are lacking, concern has been raised about the rapid emergence of non-communicable diseases (NCDs) in the African HIV care setting. We therefore set out to characterise the NCD/HIV burden among adults living and ageing with HIV infection in Zimbabwe.
Methods: We conducted a cross-sectional study among patients receiving care in a public sector facility. We reviewed patient records and determined the prevalence of comorbid and multi-morbid NCDs. Associations with patient characteristics were evaluated using univariate and multi-variate logistic regression modelling. Significance testing was done using 2-sided p values and 95 % confidence intervals calculated.
Results: We recruited 1033 participants. 31 % were men. Significant gender differences included: older median age, more advanced disease at baseline, and greater use of stavudine and protease inhibitor containing regimens in men compared to women. The prevalence of comorbidity and multi-morbidity were, respectively, 15.3 % (95 % CI 13.3–17.7 %) and 4.5 % (95 % CI 3.4–6.0 %). Women had higher rates than men of both co-morbidity and multi-morbidity: 21.8 vs. 14.9 %; p = 0.010 and 5.3 vs. 2.9 %; p = 0.025 respectively. The commonly observed individual NCDs were hypertension [10.2 %; (95 % CI 8.4–12.2 %)], asthma [4.3 % (95 % CI 3.1–5.8 %)], type 2 diabetes mellitus [2.1 % (95 % CI 1.3–3.2 %)], cancer [1.8 % (95 % CI 1.1–2.8 %)], and congestive cardiac failure [1.5 % (95 % CI 0.9–2.5 %)]. After adjusting for confounding, only age categories 45–≤55 years (AOR 2.25; 95 % CI 1.37–3.69) and >55 years (AOR 5.42; 95 % CI 3.17–9.26), and female gender (AOR 2.12; 95 % CI 1.45–3.11) remained significantly and strongly associated with comorbidity risk.
Conclusions: We found a substantial burden of comorbid non-communicable diseases among HIV infected patients in a high HIV and low-income setting. Integrating non-communicable diseases care, including active screening, with HIV care is recommended.http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-2187-zPublisher's versio
Prevalence of overweight and obesity in children aged 5 to 6 years exposed to Gestational Diabetes Mellitus complicated pregnancies in the Western Cape, South Africa
No full textBackground: Gestational Diabetes Mellitus (GDM) has been linked with later metabolic
abnormalities in offspring due to subsequent overweight and obesity. In Sub-Saharan Africa,
there is a paucity of data on the outcomes of children exposed to GDM in utero.
Aims: The primary aim of this sub-study was to investigate the prevalence of overweight and
obesity in 5 and 6-year-old children from GDM complicated pregnancies and macrosomia at
birth in the same cohort. The secondary aim was to identify risk factors associated with
overweight and obesity in these 5 and 6-year-old children.
Outcome measures: The main outcome was the prevalence of overweight and obesity in
these children as measured by their age-specific body mass index (BMI) and Z-scores.
Additionally, the association between other risk factors, overweight and obesity was
investigated.
Methods: A cross-sectional sub-study design was employed nested within a larger study that
is investigating the progression to type 2 diabetes in women managed for GDM during 2010
and 2011. Mothers who participated in the larger study were informed about the sub-study and
invited to allow their children to participate in the sub-study. Written informed consent was
obtained from the mothers for the sub-study. The following data were collected: anthropometric
data at birth and pregnancy related information from the mothers’ hospital record, additional
demographic, social and medical information by questionnaire from the mother and at the
research center. In addition, the children were weighed and had their height measured using
standardized methods. Anthropometry was standardized using WHO standards. Risk factors
for overweight and obesity were tested using a BMI>1 Z-score cut-off, (as a binary variable) in
a manual multivariate logistic regression model.
Results: The sub-study recruited 176 participants; 78 boys (44.3%) and 98 girls (55.7%). The
mean (SD) Z-scores for the children’s anthropometry at ages 5 to 6 years were 0.28 (1.40) for
weight, 0.01 (1.07) for height and 0.37 (1.63) for BMI. The overall prevalence of macrosomia
at birth (birth weight>4000 gm) was 12.3 % (95% CI 8.2-9.1). The overall prevalence of
overweight in the 5 and 6-year-old children was 13.4% (95% CI 8.6-20.4), while the prevalence
of obesity was 14.2% (95% CI 9.2-21.2). The combined prevalence of overweight and obesity
was 27.6% (95% CI 20.6-35.9). The prevalence of macrosomia (P=0.53) or overweight/obesity
proportions (P=0.37) at ages 5 to 6 years did not differ by gender. In multivariate logistic
regression analysis, factors independently associated with the risk of overweight and obesity
were: mothers’ oral glucose tolerance test 2-hour blood glucose level during pregnancy
(AOR=2.06, 95% CI 1.14-3.74, P=0.02), birth weight (AOR=1.00, 95% CI 1.00-1.00, P=0.01),
child’s age in years (AOR=0.03, 95% CI 0.002-0.29, P=0.004) and number of adults in the
house (AOR=0.38, 95% CI 0.17-0.86, P=0.02).
Conclusion: This is the first study to report the prevalence of overweight and obesity in
children born from GDM complicated pregnancies, in the Western Cape, South Africa. The
combined prevalence of overweight and obesity found in 5 and 6-year-old children exposed to
GDM in the Western Cape is higher than overweight and obesity in children reported in other
South African studies. This can imply a higher tendency towards overweight and obesity in
children exposed to GDM which needs further exploration
Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review
No full textINTRODUCTION: Many adults diagnosed with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) also have other known or unknown comorbid conditions. The rising prevalence of GDM and T2DM within a broader context of multimorbidity can best be addressed through an integrated management response, instead of stand-alone programs targeting specific infectious and/or chronic diseases. AIM: To describe GDM and T2DM screening, care and cost-effectiveness outcomes in the context of multimorbidity through integrated interventions in Africa. METHODS: A systematic review of all published studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I) was used to assess risk of bias. Data synthesis was conducted using narrative synthesis of included studies. RESULTS: A total of 9 out of 13 included studies reported integrated diabetes mellitus (DM) screening, 7 included integrated care and 9 studies addressed cases of newly detected DM who were asymptomatic in pre-diabetes stage. Only 1 study clearly analysed cost-effectiveness in home-based care; another 5 did not evaluate cost-effectiveness but discussed potential cost benefits of an integrated approach to DM screening and care. Compared to partial integration, only 2 fully integrated interventions yielded tangible results regarding DM screening, care and early detection of cases despite many that reported barriers to its sustainability. CONCLUSION: Though few, integrated interventions for screening and/or care of DM in the context of multimorbidity within available resources in health systems throughout Africa exist and suggest that this approach is possible and could improve health outcomes
Type 2 diabetes, cardiovascular risk factors and offspring overweight and obesity 5 to 6 years after hyperglycaemia first detected in pregnancy in Cape Town, South Africa
No full textBackground The number of people with type 2 diabetes mellitus (T2DM) is increasing rapidly in Africa, straining already overstretched health systems. The association between hyperglycaemia first detected in pregnancy (HFDP), which includes both diabetes mellitus in pregnancy (DIP) and gestational diabetes mellitus (GDM), and the later development of T2DM and cardiovascular disease risk in the mothers and possibly overweight in their children is well recognised. This thesis contributes to the largely unexplored body of work on the prevalence of T2DM and CVD risk factors in African women after HFDP and the relationship between HFDP and childhood overweight and obesity. The thesis investigated: 1) the prevalence of T2DM and impaired glucose metabolism in African women of childbearing age; 2) the prevalence of T2DM and cardiovascular disease risk factors in women within 6 years after HFDP, and 3) the influence of maternal blood glucose levels during pregnancy and overweight and obesity in the offspring at the preschool age. Methods A systematic review and meta-analysis of all studies published from January 2000 to 2017 was carried out to estimate the prevalence of T2DM and impaired glucose regulation states. In the PROgression to Diabetes study (PRO2D), women diagnosed with GDM using the 2008 National Institute for Health and Care Excellence (NICE) criteria during 2010 and 2011 at a major referral hospital and their offspring were reviewed up to 6 years later. Relevant maternal and foetal/neonatal data were routinely collected during pregnancy and birth. The women were recalled for an assessment of T2DM (OGTT and HbA1C) and other cardiovascular risk factors (insulin resistance, dysglycaemia, dyslipidaemia and obesity) and their offspring for overweight/obesity. The women were reclassified into DIP and GDM using the WHO 2013 criteria for the diagnosis of HFDP. The pooled prevalence of T2DM was; 7.2% (95% CI 5.6% to 8.9%), impaired fasting glycaemia, 6.0% (95% CI 4.2% to 8.2%) IGT, 0.9% to 37.0% from 39 studies in 27 African countries, and 53 075 participants. The response rate for the PRO2D was 44.2% (final sample n=220). At follow up, almost half of the women, [48% (95% CI 41.2–54.4)], had T2DM, 83% in the DIP subtype and 31% with GDM had T2DM. The type of treatment [insulin (OR 25.8, 95% CI 3.9–171.4, p = 0.001), oral antidiabetic drugs (OR 4.1, 95% CI 1.3–12.9, p = 0.018)], fasting glucose(OR 2.7, 95% CI 1.5–4.8, p = 0.001), OGTT 2-hour glucose (OR 4.3, 95% CI 2.4–7.7, p < 0.001), during pregnancy; current anthropometry [waist circumference (OR 1.1, 95% CI 1.0–1.1, p = 0.007), hip circumference (OR 0.9, 95% CI 0.8–1.0, p = 0.001), BMI (OR 1.1, 95% CI 1.0–1.3, p = 0.001)]) were associated with T2DM. The prevalence of CVD risk factors was: insulin resistance 75% (95%CI 65.9-82.3), dyslipidaemia 74.6% (95%CI 68.3- 79.9), dysglycaemia 62.3% (95%CI 55.6-68.5), and raised blood pressure 41.4% (95%CI 35.0-48.0) and metabolic syndrome 60.9% (95%CI 54.3- 67.2). Of the 443 neonates exposed to HFDP during pregnancy, almost one-third [29.6% (95%CI 25.5 – 34.0)] were large-for-gestational-age (LGA) at birth and just over a fifth [21% (95%CI 15.4 – 27.8)] were either overweight or obese at preschool age. A strong association was found between maternal fasting glucose at HFDP diagnosis and birth weight zscore (OR 1.11, 95%CI 1 -1.22, p=0.046), maternal postprandial 2-hour glucose during the third trimester and weight z-score at birth (OR 1.23, 95%CI: 1.07 - 1.42, p = 0.005) and at preschool age (OR 1.37, 95%CI: 1.03 - 1.81, p = 0.031). Conclusion The high prevalence of T2DM and CVD risk factors in relatively young women and overweight and obesity in their offspring within 6 years of the index pregnancy demonstrates the need for context-specific interventions to prevent HFDP, to optimise screening for HFDP and to reduce cardiometabolic disease risk in the postpartum period
Prevalence of type 2 diabetes mellitus in women of childbearing age in Africa during 2000-2016: A systematic review and meta-analysis
No full textObjectives
The aim of this research was to estimate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), in African women of childbearing age.
Study design
Systematic review and meta-analysis of relevant African studies published from January 2000 to December 2016.
Data sources
We searched several databases, including EMBASE, MEDLINE, CINAHL, grey literature and references of included studies.
Setting
Studies carried out in African communities or any population-based studies were included.
Participants
We included studies, carried out in Africa, with non-pregnant women of childbearing age. Studies must have been published between the years 2000 and 2016.
Outcomes
The primary outcome was prevalent T2DM. The secondary outcomes were IFG and IGT.
Data extraction and synthesis
Two reviewers independently extracted data and, using the adapted Hoy risk of bias tool, independently assessed for risk of bias. We used random-effects meta-analysis models to pool prevalence estimates across studies. We used Cochran’s Q statistic and the I2 statistic to assess heterogeneity.
Results
A total of 39 studies from 27 countries were included, totaling 52 075 participants, of which 3813 had T2DM. The pooled prevalence of T2DM was 7.2% (95% CI 5.6% to 8.9%) overall and increased with age. The pooled prevalence was 6.0% (95% CI 4.2% to 8.2%) for impaired fasting glycemia while the prevalence of IGT ranged from 0.9% to 37.0% in women aged 15–24 and 45–54 years, respectively. Substantial heterogeneity across studies was not explained by major studies characteristics such as period of publication, rural/urban setting or whether a study was nationally representative or not.
Conclusion
This review highlights the need for interventions to prevent and control diabetes in African women of childbearing age, in view of the significant prevalence of T2DM and prediabetes
COVID-19 pregnancy analytic dataset.xlsx
No full text
The aim of this study was to investigate the association between pregnancy and COVID-19 symptoms in Qatar. </p
Occupational exposure to HIV among nurses at a major tertiary hospital: Reporting and utilization of post-exposure prophylaxis; A cross-sectional study in the Western Cape, South Africa
No full textBackgroundWhile treatment for HIV has greatly improved patient outcomes, health care workers, including nurses, remain at high risk of occupational exposure. The risk of exposure is a continuous concern in the South African health system that is overburdened by multiple stressors, including the highest HIV caseload in the world. The aim of this study was to estimate the prevalence of occupational exposure to HIV, reporting and utilization of post-exposure prophylaxis, knowledge, attitudes towards HIV post-exposure prophylaxis and infection control practices amongst nurses at a tertiary hospital in the Western Cape, South Africa.MethodsA cross-sectional study was conducted at Tygerberg hospital from the 4th to the 16th February 2019. Participants were front line nurses working in randomly selected wards. A self-administered questionnaire was used to collect data from participants.ResultsOf the 160 participants who took part in the survey, 17 reported occupational exposure to HIV (prevalence 10.6%, 95% CI 6.7–16.6), and of the 17 exposed, 10(58.8%) reported needlestick injuries. From those who were exposed, only 10 (58.8%) reported the incidents and went on post-exposure prophylaxis. However, only 6 out of the 10 completed their treatment. Half (50%) of the participants had inadequate knowledge on HIV post-exposure prophylaxis, 83.3% had adequate attitudes towards HIV post-exposure prophylaxis and 75% had adequate infection control practices.ConclusionOne out of every nine nurses had occupational exposure to HIV at a major tertiary hospital with poor reporting and utilization of post-exposure prophylaxis. The high proportion of needle stick injuries highlights the need for better infection control training. Similarly, the low levels of HIV post-exposure prophylaxis knowledge show the need for structured intervention and in-service training for health care workers.</div
High prevalence of cardiovascular risk factors and insulin resistance 6 years after hyperglycemia first detected in pregnancy in Cape Town, South Africa
No full textObjective To investigate the prevalence and associated cardiovascular risk factors 6 years after hyperglycemia first detected in pregnancy (HFDP) in Cape Town, South Africa. Research design and methods Data were collected during the index pregnancy from all women diagnosed with HFDP at a major referral hospital in Cape Town. Participants were evaluated 6 years later using a cross-sectional study. At follow-up participants had a 75 g oral glucose tolerance test, fasting lipogram, blood pressure and anthropometric measurements, and a fieldworker administered the questionnaire. We used the Adult Treatment Panel III criteria for the diagnosis of metabolic syndrome and individual risk factors. Insulin resistance was assessed using the homeostatic model of insulin resistance. Results At follow-up 220 women were reviewed. Their mean age at follow-up was 37.2 (SD 6.0) years. The prevalence of cardiovascular disease (CVD) risk factors was 60.9% (95% CI 54.3 to 67.2) for metabolic syndrome, 75% (95% CI 65.9 to 82.3) for insulin resistance, 62.3% (95% CI 55.6 to 68.5) for dysglycemia, 41.4% (95% CI 35.0 to 48.0) for raised blood pressure, and 74.6% (95% CI 683 to 79.9) for dyslipidemia. Women with diabetes in pregnancy compared with those with gestational diabetes during the index pregnancy had a higher prevalence of metabolic syndrome (74.3% vs 54.7%, p=0.010) and dysglycemia (88.6% vs 50.0%, p<0.001) at follow-up. Lower school education attainment, having a subsequent pregnancy, waist circumference at follow-up, and fasting blood glucose at HFDP diagnosis were associated with metabolic syndrome. Conclusion We found a high prevalence of CVD risk factors in South African women within 6 years of HFDP, which highlights the need to develop and evaluate interventions optimizing the cardiometabolic health of this vulnerable group. The main limitations of our research are the lack of a comparative group of women without HFDP and that we did not assess for CVD risk factors before HFDP. - Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Funding This research was funded by the Chronic Disease Initiative for Africa. We acknowledge funding from the International Development Research Centre (IDRC) (fund number: 411592) for TC (under the IINDIAGO project).Scopu
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