Dyslipidemia and associated factors among adult type two diabetes mellitus patients in Felege Hiywot Refral, Hospital, Bahir Dar, Ethiopia, 2023

BackgroundDyslipidemia is a common condition in type two diabetic patients, and it is thought to have a significant role in moderating the cardiovascular risk associated with diabetes. Data on serum lipid profiles in type 2 diabetes patients from Bahir Dar, Ethiopia is limited. This study aimed to evaluate the prevalence of dyslipidemia among adult type 2 diabetes patients and to explore potential contributing factors.Method and materialsA facility-based cross-sectional study was conducted with 354 type 2 diabetes mellitus patients from April 3 to June 4, 2023. Data were collected through the use of structured questionnaires and checklists. The data were entered into EpiData version 4.6 and analyzed using SPSS version 26. Logistic regression was employed to identify variables significantly associated with the outcomes, with a p-value ≤ 0.05 and a 95% confidence interval.ResultsA total of 369 individuals with diabetes were approached in this study, resulting in a response rate of 96%. The overall prevalence of dyslipidemia was 61.3% (95% CI: 56.2–66.7). Of those with dyslipidemia, 11% had a single serum lipid abnormality, while 50.3% had a combined serum lipid abnormality. Significant factors associated with dyslipidemia included being over 60 years old (AOR: 2.4, 95% CI: 1.2–5.0), poor fasting blood glucose control (AOR: 2.5, 95% CI: 1.2–5.1), being overweight (AOR: 5.8, 95% CI: 3.2–11), physical inactivity (AOR: 3.4, 95% CI: 1.7–7.0), and being a past alcohol drinker (AOR: 3.1, 95% CI: 1.3–7.4).ConclusionIn the study area, a high prevalence of dyslipidemia was found among diabetic patients. Independent factors associated with dyslipidemia included older age, poor fasting blood glucose control, physical inactivity, a history of alcohol consumption, and being overweight. To address this issue, it is essential to implement preventive measures such as early detection, patient education, dietary monitoring, regular clinical visits, physical exercise, and weight management. These strategies represent the most effective approach to combating dyslipidemia

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

This online publication has been corrected. The corrected version first appeared at thelancet.com on September 28, 2023BACKGROUND : Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS : Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS : In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world’s highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION : Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.Bill & Melinda Gates Foundation.http://www.thelancet.comam2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Overcoming the socio-economic impacts of the coronavirus pandemic: social work perspectives and postcolonial reflections from Ethiopia

The coronavirus pandemic is the most challenging health emergency in generations, as it has already impacted on the capacities of health infrastructures and is dramatically affecting the local and global economy. Since the global spread of the pandemic, the importance of social distancing as well as the hygiene measures for self-protection and protection of other persons has been enforced, to reduce the rapid spread of the coronavirus. However, these ever-more restrictive protection measures are often not feasible for many, especially marginalized and subaltern groups in the Global South, as state-funded social security systems are very limited there. Therefore, it is not surprising that these developments pose a huge socioeconomic threat as well as potential for social and political unrest, especially to those communities living in already politically fragile and precarious situations in countries such as Ethiopia. Developing Santos’s understanding of social work epistemologies of the South’ and based on a small-scale explorative qualitative study in cooperation with Addis Ababa University, this chapter highlights the impact of historical postcolonial inequalities as well as contemporary political conflicts on the agency of Ethiopian Social and Community Workers as well as their perspectives regarding the multiple crises they confront

Burden of maternal high-risk fertility behaviour on under-five children’s health status in Hadiya zone, Southern Ethiopia: a facility-based cross-sectional study

Background Maternal high-risk fertility behaviours (HRFBs) are common in African countries and can potentially affect child survival. Evidence of the burden of maternal HRFB on under-five children is scant in Ethiopia.Objective To determine the burden of maternal HRFB on under-five children’s health status in Hadiya zone, Southern Ethiopia.Design A facility-based cross-sectional study was conducted.Setting All secondary and tertiary public healthcare centres; that are, one referral and three district hospitals providing comprehensive emergency obstetric care services in the Hadiya zone, Southern Ethiopia.Participants Three hundred women of reproductive age (15–49 years) who had undergone childbirth in the 5 years preceding this study and living with at least one child younger than 5 years admitted to public hospitals in Hadiya zone were included.Main outcome measure Under-five children’s health status.Results The overall proportion of maternal HRFB among currently married women was 60.3%, with 35.0% falling into a single high-risk category and 25.3% falling into multiple high-risk categories. Children younger than 5 years born to mothers having HRFB had an increased chance of acute respiratory infections five times, diarrhoea six times, fever eight times, low birth weight six times and a chance of dying before the fifth birthday two times than children born to mothers with no risk. The risks of morbidity and mortality further increased when children were born to mothers falling into multiple high-risk categories.Conclusions The overall proportion of maternal HRFB among currently married women was high in the study area. A statistically significant association was seen between maternal HRFB and health outcomes of children younger than 5 years old. Intervening to avert maternal HRFBs through family planning may help to reduce childhood morbidity and mortality

A competing risk analysis of predictors of time to lost to follow-up among adults with TB/HIV coinfection in Bahir Dar

Abstract Lost to follow-up (LTFU), defined as interrupting anti-TB treatment for ≥ 8 consecutive weeks or missing anti-retroviral therapy (ART) appointments for > 90 days, is a barrier to TB/HIV coinfection management. Poor treatment adherence, a driver of multidrug resistance in TB/HIV, poses critical challenges to case management. Overestimating effect sizes when considering mutually exclusive events, like LTFU from ART and anti-TB treatment, can occur if sources of error are not properly accounted for in competing events. However, studies estimating the effect sizes of predictors of time to LTFU using competing risk analysis are scarce. Hence, this study aimed to investigate the predictors of time to LTFU among adults with TB/HIV coinfection. We conducted a multicenter facility-based retrospective follow-up study. We randomly selected 471 TB/HIV coinfected adults. Data were extracted using standardised checklists. The LTFUs from ART and anti-TB treatment were events of interest and competing events, respectively, and others were censored. The data were entered into Epi data and then exported to Stata and Rstudio. Statistical differences were tested by Gray’s test, and the cumulative incidence of each event was estimated by a cumulative incidence function. Bivariable and multivariable competing risk regression models were fitted, and variables with p values < 0.05 were considered significant predictors. Incidence rates of LTFU for ART and TB treatment were 3.90 and 19.17 per 1000 person-months of observation (PMOs), respectively. The predictors of ART LTFU included rural residence (adjusted subdistribution hazard ratio (SDHR): 3.39), WHO stage IV (SDHR: 2.88), haemoglobin < 11 g/dl (SDHR: 3.56), and opportunistic infections (OIs) (SDHR: 3.65). For TB treatment LTFU, significant predictors were rural residence (SDHR: 0.11), divorced (SDHR: 2.81), widowed (SDHR: 5.92), BMI < 18.5 (SDHR: 0.41), ambulatory functional status (SDHR: 2.59), adverse drug effects (SDHR: 2.87), and poor ART adherence (SDHR: 5.72). Considering errors in competing events, ART LTFU was higher among rural dwellers, individuals with advanced disease, nutritional deficits, or adverse drug effects requiring prioritised, multifaceted interventions. Targeted strategies such as intensified monitoring, adherence counselling, nutritional support, proactive management of drug-related side effects, marital instability, OIs and poor ART adherence should be integrated into the existing ART/TB program to mitigate LTFU

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Background: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. Methods: Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. Findings: In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. Interpretation: Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. Funding: Bill & Melinda Gates Foundation