Erectile dysfunction in hypertensive males in Kenya: a tertiary referral hospital experience.

Erectile dysfunction (ED) in males can be organic or/and psychological. Objective: To determine the burden of ED among adult hypertensive men attending ambulatory clinic at Kenyatta National Hospital, Nairobi, Kenya. Methods: Descriptive cross-sectional study on patients on antihypertensive medications, followed for ≥ one month. The tools used were five-item International Index of Erectile Function (IIEF-5) for ED and Alcohol Use Disorders Identification Test for alcohol use. Results: Among 385 patients, the mean age was 56.2 ±11.3 years, median follow up in medical clinic was 5 years. The mean body mass index was 26.3 ± 4.6 kg/m2, 209(54.3%) were pre-obese/obese. Current smokers were 76(19.7%) while 133(34.5%) were former smokers. Alcohol use in the past year was reported by 256(68.5%), while hazardous alcohol intake was in 54(14%). Prescribed antihypertensives in various combinations included angiotensin converting enzyme inhibitors/angiotensin receptor blockers to 292(75.8%), calcium channel blockers to 238(61.8%), beta blockerso 129(33.5%) and thiazide diuretics on 77(20%). Using IIEF-5 tool, the prevalence of ED was 364(94.5%) (95%CI 92.2-96.6) distributed as mild in 255(70%), moderate 76(21.9%) and 33(9.1%) severe. Conclusion: The burden of ED is high among hypertensive males. Precipitants of ED like cigarette smoking and alcohol use and use of antihypertensives which can cause ED are prevalent too.

Glucose-lowering therapies, adequacy of metabolic control, and their relationship with comorbid depression in outpatients with type 2 diabetes in a tertiary hospital in Kenya.

BACKGROUND: Depression and diabetes mellitus are important comorbid conditions with serious health consequences. When depression and diabetes are comorbid, depression negatively affects self-management activities of diabetes with serious consequences. Relationship between treatment regimens of diabetes, the adequacy of glycemic control, and occurrence of comorbid depression is not known among our patients. PATIENTS AND METHODS: This was a cross-sectional descriptive study at the outpatient diabetes clinic of the Kenyatta National Hospital where 220 ambulatory patients with type 2 diabetes on follow-up were systematically sampled. Sociodemographic data and clinical information were documented. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression. Ethylenediaminetetraacetic acid-anticoagulated blood was used for glycated hemoglobin (HbA1C) assay on automated system, COBAS INTEGRA machine. RESULTS: Two hundred twenty patients with type 2 diabetes were enrolled. The prevalence of comorbid depression by PHQ-9 was 32.3% (95% confidence interval: 26.4%-38.6%). The majority, 69.5%, had poor glycemic control, HbA1C >7.0%, mean HbA1C was 8.9%±2.4%. Half, 50.4%, of the study subjects were on insulin-containing regimens. Over 8% (84.5%) of the participants with comorbid depression had poor glycemic control, which worsened with increasing severity of depression. There was significant correlation between comorbid depression and poor glycemic control, which is more consistent in the insulin-treated patients. However, patients on oral agents only, both with and without comorbid depression, were similar in their glycemic control. CONCLUSION: Among our type 2 diabetic population with comorbid depression, a large proportion had poor glycemic control, which worsened with increasing severity of depression. The insulin treatment increased the odds of comorbid depression and poor glycemic control in patients. It is justifiable to screen for comorbid depression in patients with type 2 diabetes who are in poor glycemic control, especially the insulin-treated, and then provide specific and appropriate interventions that are necessary to optimize their metabolic outcomes.

A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi, Kenya.

BACKGROUND: Urban slum populations in Africa continue to grow faster than national populations. Health strategies that focus on non-communicable diseases (NCD) in this segment of the population are generally lacking. We determined the prevalence of diabetes and associated cardiovascular disease (CVD) risk factors correlates in Kibera, Nairobi's largest slum. METHODS: We conducted a population-based household survey utilising cluster sampling with probability proportional to size. Households were selected using a random walk method and consenting residents aged 18 years and above were recruited. The WHO STEPS instrument was administered. A random capillary blood sugar (RCBS) was obtained; known persons with diabetes and subjects with a RCBS >11.1 had an 8 hours fasting blood sugar (FBS) drawn. Diabetes was defined as a RCBS of ≥ 11.1 mmol/l and a FBS of ≥ 7.0 mmol/l, or a prior diagnosis or receiving diabetes drug treatment. RESULTS: Out of 2061 enrolled; 50.9% were males, mean age was 33.4 years and 87% had a minimum of primary education. Only 10.6% had ever had a blood sugar measurement. Age adjusted prevalence of diabetes was 5.3% (95% CI 4.2-6.4) and prevalence increased with age peaking at 10.5% (95% CI 6.8-14.3%) in the 45-54 year age category. Diabetes mellitus (DM) correlates were: 13.1% smoking, 74.9% alcohol consumption, 75.7% high level of physical activity; 16.3% obese and 29% overweight with higher rates in women.Among persons with diabetes the odds of obesity, elevated waist circumference and hypertension were three, two and three fold respectively compared to those without diabetes. Cardiovascular risk factors among subjects with diabetes were high and mirrored that of the entire sample; however they had a significantly higher use of tobacco. CONCLUSIONS: This previously unstudied urban slum has a high prevalence of DM yet low screening rates. Key correlates include cigarette smoking and high alcohol consumption. However high levels of physical activity were also reported. Findings have important implications for NCD prevention and care. For this rapidly growing youthful urban slum population policy makers need to focus their attention on strategies that address not just communicable diseases but non communicable diseases as well.