Evaluation of self-care practices and emotional distress among people with Type 2 diabetes mellitus in Dar es Salaam, Tanzania

This study was conducted to determine self-care practices and diabetes related emotional distress among people with Type 2 diabetes mellitus in Dar es Salaam, Tanzania. A cross sectional survey-involving 121 Types 2 diabetics was conducted in 4 diabetic clinics located in Dar es Salaam. Anthropometric and biomedical measurements namely weight, height, waist, hip, mid-upper arm circumference, blood pressure and fasting blood glucose were measured. Self-care practices and diabetic related emotion distress were evaluated by using validated instruments. Results revealed that, the average fasting plasma glucose was 11.2 ± 5.5 mmol/l, blood pressure was 134.7/86.1 mm/Hg and the mean BMI for males and females were 25.0 ± 4.3 and 27.0 ± 5.1 kg/m(2), respectively. Subject's self-care score for general diet, specific diet, physical exercise, foot-care and medication were 4.6 ± 2.4, 3.7 ± 1.5, 3.4 ± 1.8, 3.6 ± 2.8 and 5.5 ± 2.8 days per week, respectively. Self-monitoring of blood glucose was irregular and only 46.3% of the subjects tested their levels of blood glucose at least once in between the appointments (90 days). Low income was the major limitation for complying with the self-care practices related to diet, blood glucose testing and medication. It is recommended that, the Government of Tanzania should in the short run subsidize the prices of diabetes drugs, remove all taxes on the glucose test kits and establish a national diabetes program that would coordinate and oversee provision of the basic services such as screening, glucose testing, medication, counseling and management of the condition. In the long run, the government should establish a preventive public health program in order to curtail the escalation of diabetes. Further research should be conducted to determine how factors such as socio-cultural and demographic, self-care, and psychosocial distress interact to determine biomedical outcomes such as blood pressure, blood glucose and body mass index.     

The influence of alcohol outlet density and advertising on youth drinking in urban Tanzania

Despite the detrimental effects of alcohol on adolescent health, high rates of alcohol use are reported among Tanzanian youth. We conducted systematic community mapping and participatory group activities with 177 adolescents in Dar es Salaam to explore how alcohol outlet density and advertising may contribute to adolescent drinking in urban Tanzania. Findings revealed a high density of alcohol-selling outlets and outdoor advertisements. The abundance of alcohol-related cues, including their close proximity to places where youth congregate, may facilitate and increase adolescent alcohol use in Tanzania. Participants recommended several changes to the alcohol environment to reduce adolescent drinking. Structural interventions that reduce adolescents' access and exposure to alcohol are needed in Tanzania.     

Effect of Improved access to Antiretroviral Therapy on clinical characteristics of patients enrolled in the HIV care and treatment clinic,at Muhimbili National Hospital (MNH), Dar es Salaam,Tanzania

Background  

Sub-Saharan Africa has been severely affected by the HIV and AIDS pandemic. Global efforts at improving care and treatment has included scaling up use of antiretroviral therapy (ART). In Tanzania, HIV care and treatment program, including the provision of free ART started in 2004 with a pilot program at Muhimbili National Hospital in Dar es Salaam. This study describes the socio-demographic and clinical features of patients enrolled at the care and treatment clinic at MNH, Dar es Salaam, Tanzania.     

Dietary Patterns,Nutrient Intake,and Sociodemographic Characteristics in HIV-Infected Tanzanian Pregnant Women

Routinely collected dietary intakes were available for 925 HIV-infected pregnant women participating in a longitudinal clinical trial of vitamin supplementation in Dar es Salaam, Tanzania. Information on sociodemographic and economic characteristics was recorded. Dietary macronutrient intakes were computed and analyzed using the Tanzania Food Composition Tables. Women's age, parity, education level, and economic independence were positively related to diet intake. Women younger than 25 years were at highest risk of inadequate food and nutrient intake. By World Health Organization recommendations, almost two-thirds of the participants were energy deficient, and nearly half were protein deficient.     

A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes

We assessed the effectiveness of a brief structured diabetes education programme based on the concept of self-efficacy on self-care and glycaemic control using single-blind study design. One hundred and sixty-four participants with poorly controlled diabetes from two settings were randomized using computer-generated list into control (n = 82) and intervention (n = 82) groups, of which 151 completed the study. Monthly interventions over 12 weeks addressed the self-care practices of diet, physical activity, medication adherence and self-monitoring of blood glucose (SMBG). These self-care practices were assessed at Weeks 0 and 12 using pre- and post-questionnaires in both groups together with glycated haemoglobin A1c (HbA1c) and diabetes knowledge. In the intention-to-treat analysis (n = 164), the intervention group improved their SMBG (P = <0.001), physical activity (P = 0.001), HbA1c (P = 0.03), diabetes knowledge (P = <0.001) and medication adherence. At Week 12, HbA1c difference adjusted for SMBG frequency, medication adherence and weight change remained significant (P = 0.03) compared with control group. For within group comparisons, diabetes knowledge (P = <0.001), HbA1c level (P = <0.001), SMBG (P = <0.001) and medication adherence (P = 0.008) improved from baseline in the intervention group. In the control group, only diabetes knowledge improved (P = <0.001). These findings can contribute to the development of self-management diabetes education in Malaysia.     

Self-Care Behaviors of Adults with Type 2 Diabetes Mellitus in Greece

The purpose of this study was to examine self-care behaviors of adults with type 2 diabetes mellitus living in the Metropolitan Area of Thessaloniki in Northern Greece. The Summary of Diabetes Self-Care behaviors measurement was administered to 215 patients, out of which 177 were eligible to participate (87 males). Patients, aged 30 years or more, were recruited through a university hospital day-clinic. Older patients (>65 years), as well as those with “higher educational level” did not distribute their daily carbohydrate intake equally. Nevertheless, they were more likely to adapt to their physician’s recommendations regarding medication and to regularly perform suggested blood glucose checking. Exercise patterns were more often found for higher educated, earlier diagnosed males. Younger patients were less likely to follow their healthcare professional’s recommendations, regarding diet, medication intake, blood glucose checking, foot care and exercise compared to older patients. These results pose a higher risk for complications and morbidity in younger patients with type 2 diabetes mellitus, who most possibly will require intensive treatment in the future.     

The Cincinnati lipid research clinic family study: Analysis of commingling and family resemblance for fasting blood glucose

Our specific aim in this study was to investigate commingling and family resemblance for fasting blood glucose in 160 randomly selected white families from the Princeton School District Lipid Research Clinics Family Study. Adjustment of fasting blood glucose for the influence of age, sex, and the use of oral contraceptives and construction of indices were performed simultaneously using multiple regression methods. Path analysis was carried out, constructing an environmental index based on special diet usage, hematocrit, and obesity, which was also adjusted for the influences of age and sex. Commingling analysis and segregation analysis using the mixed model were also performed. Nearly 16% of the variance of fasting blood glucose was accounted for by age and sex. Obesity itself, which constituted the index, explained an additional 4% of the variance of fasting blood glucose. Significant genetic heritability for fasting blood glucose was documented by both path analysis and segregation analysis. In aggregate, we conclude that though there was a major familial vector accounting for within-family aggregation of blood glucose, it was probably generated by a multifactorial component as compared to a major locus. Under the most parsimonious model, path analysis estimated the genetic and cultural heritabilities as h² = .39 ± .08 and c² = .06 ± .03., respectively.     

Is two days of intermittent energy restriction per week a feasible weight loss approach in obese males? A randomised pilot study

Aim

The 5:2 diet (two non‐consecutive days of 2460 KJ (600 calories) and 5 days of ad libitum eating per week) is becoming increasingly popular. This pilot study aimed to determine whether the 5:2 diet can achieve ≥5% weight loss and greater improvements in weight and biochemical markers than a standard energy‐restricted diet (SERD) in obese male war veterans.

Methods

A total of 24 participants were randomised to consume either the 5:2 diet or a SERD (2050 KJ (500 calorie) reduction per day) for 6 months. Weight, waist circumference (WC), fasting blood glucose, blood lipids, blood pressure and dietary intake were measured at baseline, 3 and 6 months by a blinded investigator.

Results

After 6 months, participants in both groups significantly reduced body weight (P = <0.001), WC (P = <0.001) and systolic blood pressure (P = 0.001). Mean weight loss was 5.3 ± 3.0 kg (5.5 ± 3.2%) for the 5:2 group and 5.5 ± 4.3 kg (5.4 ± 4.2%) for the SERD group. Mean WC reduction for the 5:2 group was 8.0 ± 4.5 and 6.4 ± 5.8 cm for the SERD group. There was no significant difference in the amount of weight loss or WC reduction between diet groups. There was no significant change in diastolic blood pressure, fasting blood glucose or blood lipids in either dietary group.

Conclusions

Results suggest that the 5:2 diet is a successful but not superior weight loss approach in male war veterans when compared to a SERD. Future research is needed to determine the long‐term effectiveness of the 5:2 diet and its effectiveness in other population groups.     

Maternal and neonatal colonisation of group B streptococcus at Muhimbili National Hospital in Dar es Salaam, Tanzania: prevalence, risk factors and antimicrobial resistance

Background  

Group B streptococcus (GBS), which asymptomatically colonises the vaginal and rectal areas of women, is the leading cause of septicemia, meningitis and pneumonia in neonates. In Tanzania no studies have been done on GBS colonisation of pregnant women and neonates. This study was conducted in Dar es Salaam, Tanzania to determine the prevalence of GBS colonisation among pregnant women, the neonatal colonisation rate and the antimicrobial susceptibility, thus providing essential information to formulate a policy for treatment and prevention regarding perinatal GBS diseases.     

The importance of injury as a cause of death in sub-Saharan Africa: results of a community-based study in Tanzania

This paper describes rates and causes of injury deaths among community members in three districts of the United Republic of Tanzania. A population-based study was carried out in two rural districts and one urban area in Tanzania. Deaths occurring in the study areas were monitored prospectively during a period of six years. Censuses were conducted annually in the rural areas and biannually in the urban area to determine the denominator populations. Cause-specific death rates and Years of Life Lost (YLL) due to injury were calculated for the three study areas. During a 6 year period (1992-1998), 5047 deaths were recorded in Dar es Salaam, 9339 in Hai District and 11 155 in Morogoro Rural District. Among all ages, deaths due to injuries accounted for 5% of all deaths in Dar es Salaam, 8% in Hai and 5% in Morogoro. The age-standardised injury death rates among men were approximately three times higher than among women in all study areas. Transport accidents were the commonest cause of mortality in all injury-related deaths in the three project areas, except for females in Hai District, where it ranked second after intentional self-harm. We conclude that injury deaths impose a considerable burden in Tanzania. Strategies should be strengthened in the prevention and control of avoidable premature deaths due to injuries.     

明日叶查尔酮对2型糖尿病大鼠肝脏和骨骼肌葡萄糖转运体表达的影响

目的研究明日叶查尔酮对2型糖尿病大鼠肝脏葡萄糖转运体2(Glut2)和骨骼肌葡萄糖转运体4(Glut4)蛋白表达的影响。方法制造2型糖尿病大鼠模型,随机分成高、中、低剂量组和糖尿病对照组,分别每日灌胃给予30、10、5和0mg/kg BW明日叶查尔酮。各组以高脂饲料喂养4周后,用葡萄糖氧化酶法检测空腹血糖;放射免疫法检测血清胰岛素含量;免疫组化法检测葡萄糖转运体蛋白表达水平。结果经图像分析,高剂量组肝脏和骨骼肌葡萄糖转运体蛋白表达平均光密度值分别为(0.036±0.0030)和(0.063±0.0139),均较糖尿病对照组显著升高(P<0.05)。高剂量组空腹血糖和胰岛素水平分别为(12.3±1.64)mmol/L和(25.65±3.34)μIU/ml,均较糖尿病对照组显著性降低(P<0.05)。结论明日叶查尔酮可上调2型糖尿病大鼠肝脏葡萄糖转运体2和骨骼肌葡萄糖转运体4蛋白表达水平,降低空腹血糖和胰岛素水平,改善糖尿病胰岛素抵抗状况。     

Individuals with type 2 diabetes and depressive symptoms exhibited lower adherence with self-care

OBJECTIVE: Our study aimed to determine whether depressive symptoms are associated with poor self-care behaviors among patients with type 2 diabetes. METHODS: Study subjects were 168 patients with diabetes, aged >30 years, who had a diabetes history of 1-15 years. Using a self-reported questionnaire, we evaluated diabetes self-care behaviors and depressive symptoms. Self-care behaviors were evaluated in five categories: medication taking, self-monitoring of blood glucose (SMBG), diet, exercise, and participation in patient education programs. Depressive symptoms were evaluated using the Centers for Epidemiologic Studies-Depression (CES-D) scales. Multiple logistic regression analyses were used to determine the association between self-care behaviors and depressive symptoms. RESULTS: Higher depressive-symptom scores were associated with poor self-care behaviors, significantly with poor participation in education programs (odds ratio OR=1.21, 95% confidence interval CI=1.06-1.38) and poor diet (OR=1.11, 95% CI=1.01-1.22), and marginally with poor medication taking (OR=1.14, 95% CI=1.00-1.31). Depressive symptoms were not significantly associated with either SMBG or exercise. CONCLUSIONS: These data suggest that the evaluation and control of depressive symptoms among diabetic patients would improve their adherence to self-care behaviors.     

Differential effect of obesity on bone mineral density in White, Hispanic and African American women: a cross sectional study

Background

The low-carbohydrate, ketogenic diet (LCKD) may be effective for improving glycemia and reducing medications in patients with type 2 diabetes.

Methods

From an outpatient clinic, we recruited 28 overweight participants with type 2 diabetes for a 16-week single-arm pilot diet intervention trial. We provided LCKD counseling, with an initial goal of <20 g carbohydrate/day, while reducing diabetes medication dosages at diet initiation. Participants returned every other week for measurements, counseling, and further medication adjustment. The primary outcome was hemoglobin A_1c.

Results

Twenty-one of the 28 participants who were enrolled completed the study. Twenty participants were men; 13 were White, 8 were African-American. The mean [± SD] age was 56.0 ± 7.9 years and BMI was 42.2 ± 5.8 kg/m². Hemoglobin A_1c decreased by 16% from 7.5 ± 1.4% to 6.3 ± 1.0% (p < 0.001) from baseline to week 16. Diabetes medications were discontinued in 7 participants, reduced in 10 participants, and unchanged in 4 participants. The mean body weight decreased by 6.6% from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg (p < 0.001). In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A_1c. Fasting serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001) while other serum lipid measurements did not change significantly.

Conclusion

The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.     

Attitudes,beliefs and norms relating to contraceptive use among young migrant and non-migrant adults in urban Dar es Salaam,Tanzania

The young urban population of Tanzania is growing rapidly, primarily due to rural-urban migration. More information is needed on the challenges facing young adult urban women and men in using family planning (FP). The purpose of this study is to identify perceptions, interpersonal and familial attitudes, and sociocultural norms regarding FP among young adults (18–25 years) in Dar es Salaam, Tanzania, comparing responses by sex, marital status and migration status. We conducted 12 focus groups with young adult men and women (n = 74) in Dar es Salaam in December 2009. Participants knew of modern contraceptive methods, but had serious concerns about side effects. Single men and women preferred condoms. Female migrants stated that traditional methods were ineffective, yet commonly used in rural areas. Men's desires for more children frequently led female migrants not to use FP, while many married long-term residents used FP discreetly. Single women sometimes received the support of their parents/boyfriends to access and use contraception. Findings highlight differences in experiences among young adult men and women based on their migrant and marital status at the individual, interpersonal and normative levels. Future efforts to promote FP should engage existing social support systems and cultivate new ones in response to barriers.     

糖尿病病人和健康人的血铬、尿铬含量

对83名非胰岛素依赖型糖尿病病人及24名健康人进行了血、尿铬测定。结果显示糖尿病病人的空腹血铬(39.9±17.4ppb)和血铬面积(128.6±48.5ppb/b)明显低于健康人(80.9±28.5ppb、270.6±88.4ppb/h)(P<<0.001),提示糖尿病病人可能缺铬。健康男性于馒头试验后60、120、180分钟时的血铬值明显高于空腹血铬值,而健康女性和糖尿病病人无明显波动,提示健康男性对铬的反应力较好。血铬和尿铬值随年令增大而增加,表现出老年人体内铬库对铬的释放、排泄增快。糖尿病病人的血铬与病程成反比,尿铬与病情成正比。     

"For someone who's rich,it's not a problem". Insights from Tanzania on diabetes health-seeking and medical pluralism among Dar es Salaam's urban poor

The prevalence of chronic non-communicable disease, such as type 2 diabetes mellitus (T2DM), is rising worldwide. In Africa, T2DM is primarily affecting those living in urban areas and increasingly affecting the poor. Diabetes management among urban poor is an area of research that has received little attention. Based on ethnographic fieldwork in Dar es Salam, the causes and conditions for diabetes management in Tanzania have been examined. In this paper, we focus on the structural context of diabetes services in Tanzania; the current status of biomedical and ethnomedical health care; and health-seeking among people with T2DM. We demonstrate that although Tanzania is actively developing its diabetes services, many people with diabetes and low socioeconomic status are unable to engage continuously in treatment. There are many challenges to be addressed to support people accessing diabetes health care services and improve diabetes management.     

Balancing collective responsibility,individual opportunities and risks: a qualitative study on how police officers reason around volunteering in an HIV vaccine trial in Dar es Salaam,Tanzania

Background  

Results from HIV vaccine trials on potential volunteers will contribute to global efforts to develop an HIV vaccine. The purpose of this study among police officers in Dar es Salaam, Tanzania, was to explore the underlying reasons that induce people to enrol in an HIV vaccine trial.     

运动护理指导和个体化饮食在妊娠期糖尿病患者中的应用研究

目的探讨运动护理指导和个体化饮食在妊娠糖尿病患者中的应用效果。方法将我院2010年5月至2012年9月收治的80例妊娠糖尿病病人作为观察组,对照组选择我院既往接受治疗的80例妊娠糖尿病病人。观察组实施个体化饮食并给予运动护理指导;对照组提供常规饮食,并按照病人自身习惯开展随意的自我活动。观察并记录两组病人出院时的血糖水平改变幅度、孕产妇及新生儿并发症的发生率。结果观察组空腹血糖与对照组相比无明显差异(P>0.05),但餐后2 h血糖明显低于对照组(P<0.05)。观察组在妊高征、羊水过多、羊水过少、酮症酸中毒、早产及感染等方面的发生率显著低于对照组(P均<0.05);对照组在新生儿低血糖、巨大儿、新生儿窒息以及呼吸窘迫综合征等方面发生率显著高于观察组(P均<0.05)。结论个体化的饮食指导及运动护理指导能够有效调节孕产妇的血糖水平处于合理范围,可明显降低孕产妇以及新生儿各种并发症的发生率。     

Evidence of a substantial decline in prevalence of HIV-1 infection among pregnant women: data from 1995 to 2003 in Dar es Salaam, Tanzania

OBJECTIVE: To determine the prevalence trends of HIV-1 infection among pregnant women seen between 1995 and 2003 at public antenatal clinics (ANC) in the city of Dar es Salaam. DESIGN AND SETTINGS: Cross-sectional studies among pregnant women at selected antenatal clinics who were offered HIV testing as part of research and service programmes to prevent vertical transmission of HIV infection and improve pregnancy outcomes. SUBJECTS AND METHODS: Consenting women gave blood for HIV antibody testing using a sequential ELISA protocol. Sociodemographic information was collected using structured interviews. RESULTS: In total, 62% of women attending the antenatal clinics gave informed consent for HIV testing and 51,076 had final confirmed results available for this analysis. Women below 20 years of age had the lowest HIV seroprevalence. The HIV-1 prevalence declined from 14.2% in 1995 to 10.6% in 2003. CONCLUSION: There is a definite substantial decline in prevalence of HIV-1 infection among pregnant women in Dar es Salaam following ongoing interventions, which have been carried out in Tanzania. There is a need to further strengthen these interventions.     

食物血糖生成指数在糖尿病营养教育中的应用研究

目的 :　通过营养教育 ,观察糖尿病患者对食物血糖生成指数 (glycemic index,GI)知、信、行的变化 ,以及改变膳食 GI对血糖、血脂的影响。方法 :　选择了 72例糖尿病病例作为研究对象 ,随机分为 2组。试验组以食物 GI为主要教育材料 (GI组 ) ;对照组以食物交换份 (food ex-change list,FEL)为主要教育材料 (FEL组 )。采用课堂讲座、个别辅导、电话咨询等方式教育 5个月。观察教育前后研究对象对所授知识的知晓率、膳食行为、血糖和血脂变化等。结果 :　经过连续教育 5个月后 ,GI组对 GI问题知晓率由 0 %提高到 92 .2 %(P<0 .0 1 ) ,FEL组对 FEL问题的知晓率由 6 .5 %提高到 79.4%(P<0 .0 1 ) ;GI组空腹血糖 (FBG)、餐后 2 h血糖 (2 h PBG)、糖化血红蛋白 (Hb A1c)、总胆固醇 (TC)、血脂综合指数 (LCI)均有显著性下降 (P<0 .0 1 ) ,FEL组仅 FBG、2 h PBG有显著性下降 (P<0 .0 1 )。结论 :　糖尿病营养教育是控制血糖、血脂的有效手段 ;GI知识较易被患者理解和掌握 ,通过 GI知识教育达到控制血糖和血脂的效果较为理想 ,便于在医院门诊和社区教育中广泛推广和应用。