Examining the burden of diabetes and hypertension in Zimbabwe

Background: In the context of the epidemiologic transition, type 2 diabetes and hypertension are part of the ten leading causes of morbidity and mortality in Zimbabwe. However, data on the burden of these conditions in Zimbabwe are to a large extent lacking. This thesis aims to assess the mortality and economic burden of diabetes, hypertension and their associated complications in Zimbabwe using secondary data. Information generated provides preliminary evidence for policy design and developing effective prevention and management programmes for type 2 diabetes and hypertension nationwide. Methods: The thesis consists of five studies. As a starting point, the prevalence of type 2 diabetes and hypertension in Zimbabwe were estimated through 2 systematic reviews with meta-analyses. Study 3 used national mortality data to assess the burden of cardiometabolic diseases (comprised of type 2 diabetes, hypertension and associated metabolic disorders), and model a projection of mortality to 2040. Study 4 examined patient medical records to determine the sociodemographic and clinical characteristics of patients with type 2 diabetes and/or hypertension attending a public hospital and private clinic in Harare. Study 5 utilized public hospital financial statements and inpatient medical records to examine the burden (hospitalization cost and indirect cost) of complications associated with type 2 diabetes and hypertension from a narrow societal perspective (patient and healthcare provider). Main findings: The overall pooled prevalence for type 2 diabetes in Zimbabwe was 5.7%, and 30% for hypertension. Cardiometabolic diseases (CMD) attributed 8.2% (95%CI: 7.7% - 8.7%) of all deaths during 1996 to 2007 (p=0.005). During this period CMD mortality increased by 33.9%. CMD mortality is predicted to increase from 9.6% to 13.7% for males, and from 11.6% to 16.2% in females from 2015 to 2040. Patients with T2DM and/or HTN were mainly overweight and obese (>50%) and did not exercise (>80%). The most common comorbidity in all patients was peripheral neuropathy. Likelihood of patients developing comorbid T2DM and HTN increased with age, family history, abdominal obesity, presence high blood pressure and hyperglycaemia and higher educational attainment. Hospitalization costs increased with complications, and the top three causes of death were renal failure, heart failure and stroke. Average costs (US dollars) for hypertensive patients with no complications were $611 (95$847 (95%CI: 766 – 936) and two complications $1173 (95$901 (95%CI: 820 – 989), and two complications $1248 (95%CI: 1009 – 1543). Factors affecting total hospitalization costs included hypertension, having one complication, cardiovascular disease, amputation, dialysis and length of stay. Conclusion Intensive preventive measures directed to reduce obesity, improve management of blood pressure and glucose in patients are urgently required and can result in the reduction of comorbidity and complications associated with T2DM and HTN, thereby decreasing healthcare and patient costs. Interventions targeting patients at high risk of heart failure, stroke and renal failure event would assist in reducing the mortality burden

Developing programs for African families, by African families: engaging African migrant families in Melbourne in health promotion interventions

Obesity is an emerging problem for African migrants in Australia, but few prevention programs incorporate their cultural beliefs and values. This study reports on the application of community capacity-building and empowerment principles in 4 workshops with Sudanese families in Australia. Workshop participants prioritized health behaviors, skill and knowledge gaps, and environments for change to identify culturally centered approaches to health promotion. The workshops highlighted a need for culturally and age-appropriate interventions that build whole-of-family skills and knowledge around the positive effects of physical activity and nutrition to improve health within communities while reducing intergenerational and gender role family conflicts

Prevalence of heart failure in Australia:A systematic review

Background: In the absence of a systematic collection of data pertaining to heart failure, summarizing the data available from individual studies provides an opportunity to estimate the burden of heart failure. The present study systematically reviewed the literature to estimate the incidence and prevalence rates of heart failure in Australia. Methods: Studies reporting on prevalence or incidence of heart failure published between 1990 and 2015 were identified through a systematic search of Embase, PubMed, Ovid Medline, MeSH, Scopus and websites of the Australian Institute of Health, and Welfare and Australian Bureau of Statistics. Results: The search yielded a total of 4978 records, of which thirteen met the inclusion criteria. There were no studies reporting on the incidence of heart failure. The prevalence of heart failure in the Australian population ranged between 1.0 % and 2.0 %, with a significant proportion of cases being previously undiagnosed. The burden of heart failure was higher among Indigenous than non-Indigenous Australians (age-standardized prevalence rate ratio of 1.7). Heart failure was prevalent in women than men, and in rural and remote regions than in the metropolitan and capital territories. Conclusion: This systematic review highlights the limited available data on the epidemiology of heart failure in Australia. Population level studies, using standardized approaches, are needed in order to precisely describe the burden of HF in the population

Vitamin D supplementation to reduce depression in adults : meta-analysis of randomized controlled trials

Objectives The aim of this study was to estimate the weighted mean effect of vitamin D supplementation in reducing depressive symptoms among individuals aged ≥18 y diagnosed with depression or depressive symptoms. Methods A meta-analysis of randomized controlled trials (RCTs) in which vitamin D supplementation was used to reduce depression or depressive symptoms was conducted. Databases MEDLINE, EMBASE, psych INFO, CINAHL plus, and the Cochrane library were searched from inception to August 2013 for all publications on vitamin D and depression regardless of language. The search was further updated to May 2014 to include newer studies being published. Studies involving individuals aged ≥18 y who were diagnosed with depressive disorder based on both the Diagnostic and Statistical Manual of Mental Disorders or other symptom checklist for depression were included. Meta-analysis was performed using random effects model due to differences between the individual RCTs. Results The analysis included nine trials with a total of 4923 participants. No significant reduction in depression was seen after vitamin D supplementation (standardized mean difference = 0.28; 95% confidence interval, −0.14 to 0.69; P = 0.19); however, most of the studies focused on individuals with low levels of depression and sufficient serum vitamin D at baseline. The studies included used different vitamin D doses with a varying degree of intervention duration. Conclusions Future RCTs examining the effect of vitamin D supplementation among individuals who are both depressed and vitamin D deficient are needed

Additional file 2: of Prevalence of heart failure in Australia: a systematic review

Literature search history: a sample using Ovid MEDLINE. (DOC 63 kb

Hypertension in Zimbabwe : a meta-analysis to quantify its burden and policy implications

Aim: To estimate the pooled prevalence of hypertension in Zimbabwe and describe its trend since independence in 1980 using secondary source data. Methods: Medline, Embase and Scopus databases from April 1980 to December 2013 were searched for population and community based studies on the prevalence of hypertension among adults (≥ 18 years) in Zimbabwe. The key words used were “prevalence”, “epidemiologic studies”, “hypertension” or “high blood pressure”, based on the cut-off (≥ 140 mmHg systolic blood pressure and/or ≥ 90 mmHg diastolic blood pressure). We conducted a meta-analysis on the published studies, using the random-effects model to estimate the pooled prevalence. Results: The search retrieved 87 publications, of which four studies met the selection criteria. The four studies had a total of 4829 study participants between 1997 and 2010 across 5 provinces in Zimbabwe. Two studies were in urban areas, while the other two had mixed study settings (urban and rural). The overall pooled prevalence of hypertension was 30% (95%CI: 19%, 42%, I 2= 98%, χ 2 = 164.15, P = 0.00). Conclusion: Our results show a high prevalence of hypertension in Zimbabwe, with urban areas having higher prevalence than rural areas

The Hospitalization Costs of Diabetes and Hypertension Complications in Zimbabwe: Estimations and Correlations

Objective. Treating complications associated with diabetes and hypertension imposes significant costs on health care systems. This study estimated the hospitalization costs for inpatients in a public hospital in Zimbabwe. Methods. The study was retrospective and utilized secondary data from medical records. Total hospitalization costs were estimated using generalized linear models. Results. The median cost and interquartile range (IQR) for patients with diabetes, $994 (385–1553) mean$1319 (95% CI: 981–1657), was higher than patients with hypertension, $759 (494–1147) mean$914 (95% CI: 825–1003). Female patients aged below 65 years with diabetes had the highest estimated mean costs ($1467 (95$2884 (95% CI: 2004–4149) for patients with diabetes and $2239 (95% CI: 1589–3156) for patients with hypertension. Age below 65 years, medical procedures (amputation, wound care, dialysis, and physiotherapy), the presence of two or more comorbidities, and being prescribed two or more drugs were associated with significantly higher hospitalization costs. Conclusion. Our estimated costs could be used to evaluate and improve current inpatient treatment and management of patients with diabetes and hypertension and determine the most cost-effective interventions to prevent complications and comorbidities

Prevalence of diabetes in Zimbabwe : a systematic review with meta-analysis

Objective: Diabetes appears to be a growing problem in the African region. This study aims to estimate the prevalence of diabetes in Zimbabwe by collating and analyzing previously published data. Methods: Systematic review and meta-analysis of data reporting prevalence of diabetes in Zimbabwe was conducted based on the random effects model. We searched for studies published between January 1960 and December 2013 using MEDLINE, EMBASE and Scopus and University of Zimbabwe electronic publication libraries. In the meta-analysis, sub-groups were created for studies conducted before 1980 and after 1980, to understand the potential effect of independence on prevalence. Results: Seven studies were included in the meta-analysis with a total of 29,514 study participants. The overall pooled prevalence of diabetes before 1980 was 0.44 % (95 % CI 0.0–1.9 %), after 1980 the pooled prevalence was 5.7 % (95 % CI 3.3–8.6 %). Conclusions: This study showed that the prevalence of diabetes in Zimbabwe has increased significantly over the past three decades. This poses serious challenges to the provision of care and prevention of disabling co-morbidities in an already disadvantaged healthcare setting

Burden attributable to cardiometabolic diseases in Zimbabwe : a retrospective cross-sectional study of national mortality data

Background: Cardiometabolic diseases (CMDs) are an important cause oif mortality worldwide and the burden associated with them is increasing in Sub-Saharan Africa. The tracking of mortality helps support evidence based health policy and priority setting. Given the growing prevalence of non-communicable diseases in Zimbabwe, a study was designed to determine the mortality attributable to CMDs in Zimbabwe. Methods: The study design was a retrospective cross-sectional analysis of national mortality from 1996 to 2007, collated by the Ministry of Health and Child Welfare in Zimbabwe. We employed generalized additive models to flexibly estimate the trend of the CMD mortality and a logistic regression model was used to find significant factors (cause of death according to the death certificate) of the CMD mortality and predict CMD mortality to 2040. Results: CMDs accounted for 8.13% (95% CI: 8.08% - 8.18%) of all deaths during 1996 to 2007 (p = 0.005). During the study period CMD mortality rate increased by 29.4% (95% CI: 19.9% - 41.1%). The association between gender and CMD mortality indicated female mortality was higher for diabetes (p < 0.001), while male mortality was higher for ischaemic (p = 0.010) and urinary diseases (p < 0.001). There was no gender difference for endocrine disease (p = 0.893). Overall, females have 1.65& higher mortality than males (p < 0.0001). CMD mortality is predicted to increase from 9.6% (95% CI: 8.0% - 11.1%) in 2015 to 13.7% (95% CI: 10.2% - 17.2%) in 2040 for males, and from 11.6% (95% CI: 10.2% - 12.9%) in 2015 to 16.2% (95% CI: 13.1% - 19.3%) in 2040 in females. Conclusion: The findings of this study indicate a growing prevalence of CMDs and related mortality in Zimbabwe. Health policy decisions and cost-effective preventive strategies to reduce the burden of CMDs are urgently required

Burden attributable to Cardiometabolic Diseases in Zimbabwe: a retrospective cross-sectional study of national mortality data

BACKGROUND: Cardiometabolic diseases (CMDs) are an important cause of mortality worldwide and the burden associated with them is increasing in Sub-Saharan Africa. The tracking of mortality helps support evidence based health policy and priority setting. Given the growing prevalence of non-communicable diseases in Zimbabwe, a study was designed to determine the mortality attributable to CMDs in Zimbabwe. METHODS: The study design was a retrospective cross-sectional analysis of national mortality from 1996 to 2007, collated by the Ministry of Health and Child Welfare in Zimbabwe. We employed generalized additive models to flexibly estimate the trend of the CMD mortality and a logistic regression model was used to find significant factors (cause of death according to the death certificate) of the CMD mortality and predict CMD mortality to 2040. RESULTS: CMDs accounted for 8.13 % (95 % CI: 8.08 % - 8.18 %) of all deaths during 1996 to 2007 (p = 0.005). During the study period CMD mortality rate increased by 29.4 % (95 % CI: 19.9 % - 41.1 %). The association between gender and CMD mortality indicated female mortality was higher for diabetes (p < 0.001), hypertensive disease (p < 0.001), CVD (p < 0.001) and pulmonary disease (p < 0.001), while male mortality was higher for ischaemic (p = 0.010) and urinary diseases (p < 0.001). There was no gender difference for endocrine disease (p = 0.893). Overall, females have 1.65 % higher mortality than males (p < 0.001). CMD mortality is predicted to increase from 9.6 % (95 % CI: 8.0 % - 11.1 %) in 2015 to 13.7 % (95 % CI: 10.2 % - 17.2 %) in 2040 for males, and from 11.6 % (95 % CI: 10.2 % - 12.9 %) in 2015 to 16.2 % (95 % CI: 13.1 % - 19.3 %) in 2040 in females. CONCLUSION: The findings of this study indicate a growing prevalence of CMDs and related mortality in Zimbabwe. Health policy decisions and cost-effective preventive strategies to reduce the burden of CMDs are urgently required