Deaths rates in public hospitals of eastern cape province of South Africa

South Africa [SA] is experiencing a rapid epidemiologic transition as a consequence of political, economic and social changes. In this study we described, based on hospital data, the mortality patterns of Non communicable Diseases [NCD], Communicable Diseases [CD], the NCD/CD ratios, and the trends of deaths. We conducted a cross-sectional survey of all deaths occurring in several public hospitals in the Eastern Cape Province of SA between 2002 and 2006. Causes of deaths were coded according to the ICD 10 Edition. A total of 107380 admissions responded to the inclusion criteria between 2002 and 2006. The crude death rate was 4.3% [n=4566] with a mean age of 46 +/- 21 years and a sex ratio of 3.1 men [n=3453]: 1 woman [n=1113]. Out of all deaths, there were 62.9% NCD [n=2872] vs. 37.1% CD [n=1694] with NCD/CD ratio of 1.7. The ratio NCD/CD deaths in men was 1.3 [n=1951/1502] vs. NCD/CD deaths in women of 1.9 [n=735/378]. The peak of deaths was observed in winter season. The majority of NCD deaths were at age of 30-64 years, whereas the highest rate of CD deaths was at age< 30 years. The trend of deaths including the majority of NCD, increased from 2002 to 2006. There was a tendency of increase in tuberculosis deaths, but a tendency of decrease in HIV/AIDS deaths was from 2002 to 2006. Non-communicable diseases are the leading causes of deaths in rural Eastern Cape province of SA facing Post-epidemiologic transition stages. We recommend overarching priority actions for the response to the Non communicable Diseases: policy change, prevention, treatment, international cooperation, research, monitoring, accountability, and re-orientation of health systems

Higher pulse pressure, systolic arterial hypertension, duration of diabetes and family history of diabetes in Central Africans

To assess the prevalence and the risk factors of diabetic retinopathy [DR] in urban diabetics from Kinshasa, DRC. this is a community-based cross-sectional survey and a case-control study on diabetic retinopathy in Kinshasa, the capital of DRC. The medical charts of all diabetics [n=3010] >/= 20 years were studied to estimate the prevalence of DR during November 2004. 10% [n=301] of these were randomly selected to reveal 95 diabetics with DR and 206 diabetics without DR [control]. Both groups were matched for primary care centre, sex, age, body mass index, and waist circumference, attending the primary care centres between December 2004 and December 2005, and were screened for DR using stereo color photography and ophthalmoscopy. the overall prevalence rate of DR in the population was 31.6% [n=950 95% confidence interval [CI]:26.3 - 36.9]. Delayed diagnosis of diabetes [>/= 55 years] in the study sample in women, men with high socioeconomic status, and pregnancy onset after the diagnosis of DR among women, were identified as variables for Univariate analysis and for significant risk factors of DR. Logistic regression analysis showed that longer duration of diabetes [>/= 4years] [LDD], systolic arterial hypertension [SAH], higher pulse pressure [>/= 60 mmHg, clinical pre-atherosclerosis/arterial stiffness], and family history of diabetes [FHD], were the significant and independent determinants of DR in the sample study. The multivariate risk of DR conferred by these determinants is enhanced among female diabetics [y=2.679 + 1.528 SHT + 1.080 LDD + FHD; p < 0.01] and patients with type 2 diabetes [y=2.725 + 1.316 SHT + LDD + 1.246 FHD; p < 0.05]. The adjusted odds-ratio for DR conferred by higher pulse pressure was 5 [95% CI 2 - 12.8; p < 0.05. Longer duration of diabetes, arterial systolic hypertension, and higher pulse pressure [arterial stiffness] were the most significant independent risk factors of diabetic retinopathy. However, a population-based study is warranted to identify the risk factors, as well as the prevalence of diabetic retinopathy

Risk factors of poor control of HBA1c and diabetic retinopathy: Paradox with insulin therapy and high values of HDL in African diabetic patients

To determine the risk factors of poor control of glycated haemoglobin and diabetic retinopathy. The agreement between poor control of glycated haemoglobin [HbA1c] >7% and poor control of glycemia >/= 126 mg/dL to classify diabetic retinopathy was also assessed The study was a cross-sectional survey carried out on 300 African diabetic patients admitted to Lomo Medical Center, Kinshasa, Congo, between July 2005 and December 2007. Patients [150 type 1 and 151 type 2] were interviewed and underwent a complete medical assessment. HbA1c levels, anthropometry, blood pressure components, lipid profile, type of diabetes, severity and complications were determined for each patient. All patients were examined for evidence and severity of diabetic retinopathy by an ophthalmologist The rates of arterial hypertension, uncontrolled hypertension, poor control of HbA1c, poor control of glycemia, higher pulse pressure and diabetic retinopathy were 73.3%, 81.8%, 68%, 57%, 47.7% and 33.3%, respectively. Type 1 diabetes, diabetes duration >/= 4 years, female sex, underweight, diabetic retinopathy, diabetic nephropathy, elevated total cholesterol and higher levels of HDL-cholesterol were significantly associated with poor control of HbA1c. There was a poor agreement of 52% and kappa statistic of 0.19 [p < 0.0001] between poor control of HbA1c and poor glycemic control to classify diabetic retinopathy. In all diabetic patients, aged >/= 60 years, female sex, diabetes duration >/= 4 years, type 1 diabetes, higher pulse pressure, underweight, poor control of HbA1c, smoking, stroke, diabetic nephropathy and low HDL-cholesterol are significantly associated with the presence and the severity of diabetic retinopathy. However, in 87 diabetic patients with a history of intravenously administered insulin, duration diabetes >/= 4 years and good control of HbA1c < 7% are significantly associated with the presence of diabetic retinopathy. There was a J-shaped relationship between poor control of glycemia >/= 126mg/dL and the severity of non proliferative diabetic retinopathy. Urgent and efficient diabetes care and diabetes monitoring are needed in sub-Saharan Africa

Prevalence and risk factors of diabetes mellitus in Kinshasa Hinterland

To estimate the prevalence of diabetes mellitus [DM], impaired fasting glucose [IFG], and impaired glucose tolerance [IGT], and to determine the risk factors of DM among urban and rural areas of Kinshasa Hinterland Data were collected from a multistage random sample cross-sectional surveys of adult black Africans from Kinshasa region DR Congo with the help of a structured questionnaire, physical examinations and blood samples, using the WHO stepwise approach and the new criteria of WHO to define glucose intolerance. Prevalence rates were adjusted using the standard world population of Waterhouse and the standard population of Kinshasa region. A total of 9770 subjects age >/= 12 years participated [response rate of 90.3%] in this study. Age-adjusted rates to world population of IFG, IGT, DM by fasting plasma only, DM by 2h-load test only, and all cases of DM were 9.3%, 9.6%, 16.1%, 8.4% and 25.3%, respectively. Male sex, rural residence, total obesity, abdominal obesity, viral infection, milk intake, and kwashiorkor were the univariate risk factors of all cases of DM. Adjusted for confounders, advancing age, rural-urban migration, physical inactivity, smoking, abstinence of alcohol, low intake of fruits-vegetables, family history of DM, refined sugar intake, high social class, high intake of animal fat and protein, and stress, were the independents determinants of all cases of DM. This study observed epidemic rates of glucose intolerance. Primary prevention through lifestyle changes is needed to control DM among Africans under demographic and nutrition transition