Glycemic control and complications of type 1 diabetes among children in Tanzania.

INTRODUCTION: Knowledge on Type 1 Diabetes (T1D) in sub-Saharan Africa is scarce. This study aimed at assessing microvascular complications of Type 1 diabetes in young patients. METHOD: A retrospective study based on medical recordings from 2010-2016 was done. 604 children and young adults with T1D were recruited from five hospitals with pediatric diabetes clinics. 559 patients aged 2-35 years with known date of birth were included. Clinical data on retinopathy and neuropathy were analyzed. There was no information on renal function/ nephropathy. RESULTS: Most data were missing. There was documentation on HbA1C, plasma glucose and complications in less than half of the patient files. Of those with registered HbA1c values (42.2%), 36% had HbA1c > 12.5%. There was high prevalence of retinopathy (21.5%) and neuropathy (29.4%) in spite of short mean duration of diabetes (6.2 ± 4.1 years). CONCLUSION: Many patients with T1D in Tanzania have poor metabolic control. Microvascular complications are common already after a short duration of diabetes, but the results have to be interpreted with great caution because of study limitations. Better pediatric diabetes care as well as increased awareness of diabetes is needed. Studies in resource-poor countries need careful planning, if possible with prospective design.

Incidence, prevalence and clinical manifestations at onset of juvenile diabetes in Tanzania.

Better knowledge on incidence, prevalence and clinical manifestations is needed for planning diabetes care in Sub Saharan Africa. AIMS: To find a crude incidence/prevalence of diabetes in children and young adults in a low resource setting, classify the diabetes and audit the health record keeping. METHODS: A retrospective observational study based on medical recordings 2010-2016. Target population was children and adolescent registered in Changing Diabetes in Children (CDiC) or Life for a Child (LFAC) programs for children with T1DM and diagnosed at 5 diabetes clinics in three geographical regions of Tanzania. 604 patients' files were available from five hospitals. RESULTS: 336/604 files covered patients <15 years of age at diagnosis. The prevalence of diabetes <15 years of age ranged from 10.1 to 11.9 per 100,000 children and the annual incidence 1.8-1.9/100,000 children, with peak incidence at 10-14 years. A lot of data were missing. The great majority of the patients presented with typical signs and symptoms of T1D, 83.7% with plausible ketoacidosis (DKA). CONCLUSIONS: Diabetes incidence and prevalence is still low. T1D seems to dominate with very high frequency of DKA at diagnosis. Increased awareness of diabetes both in health care and community is needed.

Application of granular media filtration in wastewater reclamation and reuse.

Laboratory experiments were conducted at room temperature (20-25 degrees C) using four identical filter columns made of Plexiglas, each of 1 m height and 15 cm internal diameter, packed with granular media of 70 cm depth. Each filter was operated at a constant filtration rate, thus four rates were tested in the range of 2-15 m(3) m(-2) d(-1). Mono-media (sand) and dual-media (sand and anthracite) were tested and three types of municipal wastewaters, namely raw, primary and secondary-treated effluents were applied. The results obtained indicate that considerable improvements in effluent quality could be attained by tertiary sand filtration. Removal of solids, organics and bacteria was not significantly affected by the increase in filtration rate from 2 to 15 m(3) m(-2) d(-1). The highest removal efficiency was obtained at low filtration rate of 2 m(3) m(-2) d(-1), but higher filtration rates achieved acceptable removal efficiencies and provided effluents of good quality to satisfy the irrigation water quality standards. Since the conventional sand filters in wastewater treatment plants operate at a rate in the range of 2-5 m(3) m(-2) d(-1), utilization of high rate filtration is advantageous and would result in significant cost savings. However, with high filtration rates the filters require more frequent backwashing. Dual-media filters achieved 50% reductions in BOD suggesting that filtration could be used to treat primary effluents in emergency cases.