Progress in diabetes care in the KwaZulu-Natal public health sector: A decade of analysis

Aims: This study analysed diabetes-related information routinely collected by the KwaZulu-Natal (KZN) Department of Health (DOH).Methods: Primary data were obtained for all public health facilities through the District Health Information System (DHIS) for the period 2006–2016 inclusive (11 years). Additional open source data on population estimates were obtained from Statistics South Africa.   Quantitative analysis of DHIS data was performed using Microsoft Excel before graphical representations were generated using the ThinkCell software.Results: The number of clinical visits by diabetic patients in KZN increased by 305% in the 10 years between 2006 and 2015. According to the data collected by the Department of Health, a large majority of patients diagnosed with diabetes are seeking medical care in the more populated district of eThekwini. The number of patients not returning for scheduled treatment (defaulters) has reduced since recording began in 2012. According to the data, the incidence of diabetes in KZN is oscillating; however, a strong correlation is found between incidence and patient screening.Conclusion: The largest number of diabetic patients were seen in the highly urbanised district of eThekwini. The screening of high-risk patients has increased in frequency and exhibits strong correlations with incidence, further supporting the effectiveness of screening and its inclusion in a new primary healthcare protocol. There was a sharp reduction in number of defaulting patients in 2016, probably indicating improved compliance. The inconsistency of data input is a limitation of the study. However, this study within these constraints highlights the importance of ‘big data’ for healthcare policy and more effective health care in KZN

A diabetes profile of the eight districts in the public health sector, Eastern Cape Province, South Africa

Background. The International Diabetes Federation (IDF) recently reported that there are 1.8 million South Africans with diabetes, and estimates an additional undiagnosed population of 69% of the total number of diabetics. The African continent is expected to see the highest increase in diabetes globally by 2045. Healthcare measures to manage this surge in diabetes and its related complications should be tailored to Africa’s unique challenges; however, the epidemiolocal data essential for policy development are lacking. Bridging the data gap will guide funding distribution and the creation of evidence-based initiatives for diabetes.Objectives. To investigate the frequency, age proportion and distribution of new patients diagnosed with diabetes in the public healthcare sector of Eastern Cape (EC) Province, South Africa (SA).Methods. All data collected to date were obtained from the EC District Health Information System. According to the information collected from the Department of Health, diabetes-related data collection fields were implemented in 2013, which resulted in this 4-year study. Additional open-source data on population estimates, mortality and medical aid coverage were provided by Statistics SA.Results. Of the eight districts in the province, O R Tambo was recorded as having the highest average proportion of new patients diagnosed with diabetes. A positive correlation was found between the calculated incidence of disease and the diabetes mortality rate.Conclusions. The study showed an annual growth in the incidence of diabetes in the EC since 2014, and highlights the issue of an increasing burden of diabetes in the rural population. This increase is consonant with predictions by authoritative bodies on the growing burden of diabetes in Africa. The pattern of distribution highlights the deprived district of O R Tambo contradicting the well-known link between diabetes and urbanisation

Distribution, incidence, prevalence and default of patients with diabetes mellitus accessing public healthcare in the 11 districts of KwaZulu-Natal, South Africa

Background. The global increase in the prevalence of diabetes mellitus is most marked in African countries. The District Health Information System (DHIS) is the primary data collection system of the Department of Health in KwaZulu-Natal Province (KZN), South Africa. Data are routinely collected at all public healthcare facilities in the province and are aggregated per facility.Objective. To investigate the distribution, incidence and prevalence of diabetes in the public healthcare sector of KZN.Methods. Data collected by the DHIS for all patients with diabetes in KZN from 1 January 2010 to 31 December 2014 inclusive were analysed. Additional open-source databases were accessed to enable further exploration of the data collected.Results. The study showed that the majority (38.7%) of patients with diabetes on the public sector register were from the district of eThekwini. Positive correlations were found between the prevalence of diabetes, the mortality rate and the number of defaulters (patients with diabetes who did not return for regular treatment).Conclusions. Provincial estimates of the prevalence of diabetes in this study were higher than the known national prevalence. This may be due to the large proportion of Indians in KZN, who have a genetic predisposition to diabetes mellitus. However, allowance must be made for possible inaccurate data collection at source with miscounting of individuals. This study supports the global trend of an association between diabetes and urbanisation and highlights the need for regular diabetes screening and education, particularly in the public healthcare domain

Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda : a descriptive retrospective study

BACKGROUND: Although the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda. METHODS: We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients' registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients' LTFU rates in hazard ratios (HRs). RESULTS: Between July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2-36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy. CONCLUSION: We found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients