Glycaemic control in diabetic patients in Zambia

Introduction: the glycaemic control status of diabetic patients affects the management of their disorder. We examined the glycaemic control and clinical factors that may influence the achievement of the glycaemic control targets among diabetic out-patients. Methods: this was a hospital based cross-sectional study carried out at the University Teaching Hospital diabetic clinic in Lusaka, Zambia. A simple random sample of 198 consenting participants was selected from diabetic out-patients between September and December 2013. A structured interview schedule was used to capture socio-demographic data as well as needed clinical data from clients’ medical records and laboratory results. Multivariate binary logistic regression analysis was carried out to examine factors that may be associated with the glycaemic control status of these diabetic patients. Results: overall (n=198), mean (SD) age was 53.19±13.32 years. Majority (61.3%) of the patients had poor glycaemic control status (HbA1c≥49 mmol/mol). Insulin treatment (OR 0.13, 95% CI: 0.01 - 1.41), systolic blood pressure (OR 1.04, CI: 1.00 - 1.08) and fasting plasma glucose (previous; OR 0.81, CI: 0.72 - 0.90 and current; OR 0.85, CI: 0.78 - 0.93) were statistically significantly associated with glycaemic control. The poor glycaemic control observed in this study is similar to that reported in other published studies. Conclusion: we found evidence of poor glycaemic control in the study population suggesting need to explore the reasons for this. Association of Insulin, systolic blood pressure and fasting plasma glucose with glycaemic control further suggests the efficiency of traditional basic monitoring parameters which should be exploited in sharpening primary preventive strategies especially those that support lifestyle modification. Such efforts should also be integrated in all information, education and communication strategies that target but not limited to hospital based patients too

Relationship between glycated haemoglobin and fasting plasma glucose among diabetic out-patients at the University Teaching Hospital, Lusaka, Zambia

Background: Glycated haemoglobin (HbA1c) measurement provides an accurate result of glycaemic levels from blood drawn at any time of day without reference to prandial state. We established the relationship between HbA1c and fasting plasma glucose (FPG) in diabetic out-patients among diabetic outpatients in Lusaka, Zambia.Methods: This cross-sectional study was carried out at the University Teaching Hospital diabetic clinic, Lusaka, Zambia. A total sample of 198 consenting participants was selected randomly from diabetic out-patients between September and December 2013. A structured interview schedule was used to capture data on socio-demographics and laboratory examination results. The Pearson’s correlation coefficient, Student’s t-test and Paired Samples t-test were used for data analysis.Results: A total of 198 patients (mean age+SD= 53.19±13.32 years) were involved in the study. Majority (60.10%) of the patients were females while 39.90 per cent were males. The mean±SD of FPG of the patients slightly increased from the previous 10.75±7.78 mmo/L to the current 11.09±6.23 mmo/L (p = 0.592). The mean±SD of HbA1c of the patients was 54.77±17.12 mmol/mol. There was a statistically significant weak and moderate positive correlation between HbA1c and the previous and current FPG (r = 0.282, P = 0.001 and (r = 0.385, p = 0.001), respectively. However, there was a statistically significant but weak negative correlation between HbA1c and age (r = -0.163, p = 0.023).Conclusion: We found evidence of an association between HbA1c and FPG proposing that as the FPG levels increase, the HbA1c levels also increase in a predictable way. There is need to sensitise more especially the major stakeholders in the management of diabetes mellitus to consider FPG as an alternative in glycaemic control monitoring in the absence of HbA1c

Insights and efforts to control rabies in Zambia: Evaluation of determinants and barriers to dog vaccination in Nyimba district.

The current rabies control strategy in Zambia is based on dog vaccination, dog population control and dog movement restrictions. In Nyimba district of Zambia, dog vaccination coverage is low but the incidence of dog bites is high which places the community at risk of rabies infection. The renewed global interest eliminating rabies in developing countries has spurred interest to identify determinants and barriers of dog vaccination in an effort to reduce the overall disease burden.A mixed methods cross sectional design was used in the study. This consisted of three parts: Evaluation of medical records regarding dog bite injuries, implementation and analysis of a household survey and in-depth review of key informant interviews. Data was collected into a Microsoft Excel database and subsequently transferred to STATA for descriptive, inferential and thematic analysis.Dog vaccination coverage overall was 8.7% (57/655), with 3.4% (22/655) in urban areas, 1.8% (12/655) in peri-urban and 3.5 (23/655) in the rural regions. Financially stable households were more likely to have their dogs vaccinated. Only 10.3% (31/300) of the respondents had vaccinated their dogs and these had a reliable source of income as 6% (18/300) were peasant farmers, 2% (6/300) were dependants whose guardians were financially stable and 2.3% (7/300) were in steady employment. Important barriers to dog vaccination included cost, limited awareness of vaccination program and access.Current rabies control strategies in Nyimba district, Zambia, appear quite limited. Improvements in the regional dog vaccination program may provide benefits. Enhancement of educational efforts targeting behavioural factors may also prove useful. Finally, the cost of dog vaccination can be reduced with scaled up production of a local vaccine

Glycaemic Control and Associated Self-Management Behaviours in Diabetic Outpatients: A Hospital Based Observation Study in Lusaka, Zambia

Background. The control of diabetes mellitus depends on several factors that also include individual lifestyles. We assessed glycaemic control status and self-management behaviours that may influence glycaemic control among diabetic outpatients. Methods. This cross-sectional study among 198 consenting randomly selected patients was conducted at the University Teaching Hospital diabetic clinic between September and December 2013 in Lusaka, Zambia. A structured interview schedule was used to collect data on demographic characteristics, self-management behaviours, and laboratory measurements. Binary logistic regression analysis using IBM SPSS for Windows version 20.0 was carried out to predict behaviours that were associated with glycaemic control status. Results. The proportion of patients that had good glycaemic control status (HbA1c≤ 48 mmol/mol) was 38.7% compared to 61.3% that had poor glycaemic control status (HbA1c≥ 49 mmol/mol). Adherence to antidiabetic treatment and fasting plasma glucose predicted glycaemic control status of the patients. However, self-blood glucose monitoring, self-blood glucose monitoring means and exercise did not predict glycaemic control status of the patients.  Conclusion. We find evidence of poor glycaemic control status among most diabetic patients suggesting that health promotion messages need to take into account both individual and community factors to promote behaviours likely to reduce nonadherence

DETERMINATION OF OXYTETRACYCLINE RESIDUE LEVELS IN EDIBLE TISSUES OF SLAUGHTERED CATTLE

Worldwide, antimicrobials are widely used in food producing animals for treatment and/or prophylaxis of diseases. In Tanzania, irrational administration of antimicrobials, notably oxytetracycline (OTC) is common because of the under-developed animal health service delivery system. The administration of OTC and other drugs is often done by animal keepers, thereby leading to drug residues in meat and milk. The study established the level of OTC residues in edible tissues of cattle slaughtered within Dodoma City Tanzania. This was cross-sectional analytical study design which quantified drug residues in muscle, liver, kidney from licenced and unlicenced premises. Samples from licenced as well as unlicenced premises were collected and used in determining OTC levels using High Performance Liquid Chromatography (HPLC) method. The HPLC method was validated to establish the reliability of the method in quantifying OTC residues. The results indicated that OTC residues were 0.6 mg/kg, 0.25mg/Kg and 1.28 mg/kg for muscle, liver and kidney tissues, respectively against corresponding Maximum Residue Limit (MRL) 0.2mg/kg, 0.6mg/kg and 1.2mg/kg. Regardless of the licensure status and source of the sample, 53% of muscle, 65% of liver and 7.1% of kidney tissues were above MRL. The quantities of OTC residues in samples from licensed and unlicensed food vending settings were not significantly different (p = 0.3676) but above the MRL. The above results show unacceptably high levels of OTC residues in meat with most beef value chain actors being ignorant of the impending public health threat/risks of consuming beef with high drug residues

Parts of the study.

<p>Parts of the study.</p

Insights and efforts to control rabies in Zambia: Evaluation of determinants and barriers to dog vaccination in Nyimba district

<div><p>Background</p><p>The current rabies control strategy in Zambia is based on dog vaccination, dog population control and dog movement restrictions. In Nyimba district of Zambia, dog vaccination coverage is low but the incidence of dog bites is high which places the community at risk of rabies infection. The renewed global interest eliminating rabies in developing countries has spurred interest to identify determinants and barriers of dog vaccination in an effort to reduce the overall disease burden.</p><p>Methodology</p><p>A mixed methods cross sectional design was used in the study. This consisted of three parts: Evaluation of medical records regarding dog bite injuries, implementation and analysis of a household survey and in-depth review of key informant interviews. Data was collected into a Microsoft Excel database and subsequently transferred to STATA for descriptive, inferential and thematic analysis.</p><p>Results</p><p>Dog vaccination coverage overall was 8.7% (57/655), with 3.4% (22/655) in urban areas, 1.8% (12/655) in peri-urban and 3.5 (23/655) in the rural regions. Financially stable households were more likely to have their dogs vaccinated. Only 10.3% (31/300) of the respondents had vaccinated their dogs and these had a reliable source of income as 6% (18/300) were peasant farmers, 2% (6/300) were dependants whose guardians were financially stable and 2.3% (7/300) were in steady employment. Important barriers to dog vaccination included cost, limited awareness of vaccination program and access.</p><p>Conclusion</p><p>Current rabies control strategies in Nyimba district, Zambia, appear quite limited. Improvements in the regional dog vaccination program may provide benefits. Enhancement of educational efforts targeting behavioural factors may also prove useful. Finally, the cost of dog vaccination can be reduced with scaled up production of a local vaccine.</p></div

Categories of number of dogs kept per household by area of residence.

<p>Categories of number of dogs kept per household by area of residence.</p

Rabies confirmed cases between 2004 and 2013 in Zambia.

<p>Rabies confirmed cases between 2004 and 2013 in Zambia.</p

2013 to 2015 dog bite case records evaluation.

<p>2013 to 2015 dog bite case records evaluation.</p