Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study
Objectives We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention.Design Cross-sectional study.Setting Community-based study in four sub-Saharan Afr...
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BMJ Publishing Group
2023-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/4/e069193.full |
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| author | F Xavier Gómez-Olivé Lisa K Micklesfield Shane A Norris Alisha N Wade Gershim Asiki Innocent Maposa Shukri F Mohamed Nigel J Crowther Engelbert A Nonterah Michèle Ramsay Hermann Sorgho Godfred Agongo Palwende Boua Eric Maimela Solomon S R Choma |
| author_facet | F Xavier Gómez-Olivé Lisa K Micklesfield Shane A Norris Alisha N Wade Gershim Asiki Innocent Maposa Shukri F Mohamed Nigel J Crowther Engelbert A Nonterah Michèle Ramsay Hermann Sorgho Godfred Agongo Palwende Boua Eric Maimela Solomon S R Choma |
| author_sort | F Xavier Gómez-Olivé |
| collection | DOAJ |
| description | Objectives We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention.Design Cross-sectional study.Setting Community-based study in four sub-Saharan African countries.Participants 10 700 individuals, aged 40–60 years.Primary and secondary outcome measures The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG <7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis.Results Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes.Conclusions There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes. |
| format | Article |
| id | doaj-art-8b773d89d3c242f2af53de52f422d0ca |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-8b773d89d3c242f2af53de52f422d0ca2025-08-20T02:12:38ZengBMJ Publishing GroupBMJ Open2044-60552023-04-0113410.1136/bmjopen-2022-069193Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional studyF Xavier Gómez-Olivé0Lisa K Micklesfield1Shane A Norris2Alisha N Wade3Gershim Asiki4Innocent Maposa5Shukri F Mohamed6Nigel J Crowther7Engelbert A Nonterah8Michèle Ramsay9Hermann Sorgho10Godfred Agongo11Palwende Boua12Eric Maimela13Solomon S R Choma14MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaSAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa2 MRC-Wits DPHRU, University of the Witwatersrand, Johannesburg, South AfricaSouth African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa1 Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya2 Division of Epidemiology and Biostatistics, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa5 Health and Systems for Health Unit, African Population and Health Research Center, Nairobi, KenyaDepartment of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaNavrongo Health Research Centre, Ghana Health Service, Accra, GhanaSydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaClinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina FasoNavrongo Health Research Centre, Ghana Health Service, Accra, GhanaClinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina FasoDIMAMO PHRC, University of Limpopo, Polokwane, South Africa7 Department of Pathology and Medical Sciences, DIMAMO Population Health Research Centre, University of Limpopo, Sovenga, South AfricaObjectives We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention.Design Cross-sectional study.Setting Community-based study in four sub-Saharan African countries.Participants 10 700 individuals, aged 40–60 years.Primary and secondary outcome measures The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG <7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis.Results Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes.Conclusions There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes.https://bmjopen.bmj.com/content/13/4/e069193.full |
| spellingShingle | F Xavier Gómez-Olivé Lisa K Micklesfield Shane A Norris Alisha N Wade Gershim Asiki Innocent Maposa Shukri F Mohamed Nigel J Crowther Engelbert A Nonterah Michèle Ramsay Hermann Sorgho Godfred Agongo Palwende Boua Eric Maimela Solomon S R Choma Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study BMJ Open |
| title | Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study |
| title_full | Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study |
| title_fullStr | Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study |
| title_full_unstemmed | Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study |
| title_short | Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study |
| title_sort | diabetes care cascade and associated factors in 10 700 middle aged adults in four sub saharan african countries a cross sectional study |
| url | https://bmjopen.bmj.com/content/13/4/e069193.full |
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