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ORIGINALRESEARCHOpenAccessCombinedprevalenceofimpairedglucoselevelordiabetesanditscorrelatesinLusakaurbandistrict,Zambia:apopulationbasedsurveyMutaleNsakashalo-Senkwe1,SeterSiziya2*,FastoneMGoma3,PeterSongolo4,VictorMukonka1,OlusegunBabaniyi4AbstractBackground:Developingcountriesareundergoinganepidemiologicaltransition,fromCommunicableorInfectiousto'Non-Communicable'diseases(NCDs),suchthatcardiovasculardisease,chronicrespiratorydiseases,cancer,anddiabeteswereresponsiblefor60%ofalldeathsgloballyin2005,withmorethan75%ofthesedeathsoccurringindevelopingcountries.
Asurveywasconductedtodetermineamongotherobjectivestheprevalenceofdiabetesanditsassociationwithphysicalfitnessandbiologicalfactors.
Methods:AcrosssectionalstudyutilizingamodifiedWorldHealthOrganization'sSTEPwiseapproachtosurveillanceofNCDswasconductedinLusakadistrict,Zambia.
Amulti-stageclustersamplingtechniquewasusedtoselectstudyparticipantsofage25yearsorolder.
Alleligiblemembersofahouseholdthatwasselectedwereinvitedtoparticipateinthestudy.
Unadjustedoddsratios(OR),andadjustedoddsratios(AOR)togetherwiththeir95%ConfidenceIntervals(CI)wereobtainedusingComplexsampleslogisticregressionResults:Atotalof1928individualsparticipatedinthesurvey,ofwhich33.
0%weremales.
Abouthalfoftheparticipantswereofage25-34years(53.
2%),andaboutathirdoftherespondentshadattainedsecondarylevelofeducation(35.
8%).
Thecombinedprevalenceforimpairedglucoselevelordiabeteswas4.
0%.
Ageandmildhypertensionweresignificantlyassociatedwithimpairedlevelsofglucoseordiabetes.
Comparedtoparticipantsintheagegroup25-34years,olderparticipantsweremorelikelytohaveimpairedglucoselevelordiabetes(AOR=2.
49(95%CI[1.
35,2.
92])for35-44yearsagegroup,andAOR=3.
80(95%CI[2.
00,7.
23])for45+yearsagegroup).
Mildhypertensionwasassociatedwithimpairedglucoselevelordiabetes(AOR=2.
57)(95%CI[1.
44,4.
57])).
Conclusions:TheprevalenceofdiabetesinLusakadistricthasnotreachedanalarminglevelanditisnowthatinterventionstargetingtheyoungeragegroup25-34yearsshouldbeputinplacetocurtailthespreadofdiabetes.
BackgroundThemajorNon-CommunicableDiseases(NCDs)thatincludediabetescontributeimmenselytomortality[1].
AlltheNCDsareassociatedwithidentifiablebeha-viouralriskfactorsandbiologicalriskfactors.
Thesetwogroupsofriskfactorsarecloselylinked.
Themajorbehaviouralriskfactorsaretobaccouse,unhealthydietandphysicalinactivity[2].
Andthemajorbiologicalriskfactorsinclude;obesity,hypertension,diabetesanddyslipidemia[3];andgeneticpredispositionmainlyaccountingfortypeIdiabetes.
Mostofthesefactorsaremodifiablethroughlifestyleinterventions.
Workandlivingsituationshavebecomemoreseden-tarythusincreasingtheriskofNCDs[2].
Physicalinac-tivityincreasestheriskofmanychronicdiseases,suchastype2diabetes[4,5].
Metabolicsyndromewhichisagroupofdisordersthatincludeobesity,insulinresis-tance,glucoseintolerance,abnormallipidsandhyper-tensionhasbeenassociatedwithreducedphysicalactivities[6,7].
Lowphysicalactivitylikeprolongedtele-visionviewingmaycontributetometabolicsyndromethroughrelatedpooreatinghabits[4].
Severalstudies*Correspondence:ssiziya@yahoo.
com2DepartmentofCommunityMedicine,SchoolofMedicine,UniversityofZambia,Lusaka,ZambiaFulllistofauthorinformationisavailableattheendofthearticleNsakashalo-Senkweetal.
InternationalArchivesofMedicine2011,4:2http://www.
intarchmed.
com/content/4/1/22011Nsakashalo-Senkweetal;licenseeBioMedCentralLtd.
ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense(http://creativecommons.
org/licenses/by/2.
0),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
haveshowedanassociationbetweenprolongedtelevi-sionviewingandmetabolicsyndrome[4,6].
Metabolicsyndromehasbeenlinkedtotype2Diabetesmellitus,cardiovasculardiseasesandmortalityandthereforereducingsedentarybehaviourhasaroleinthepreven-tionofthesechronicdiseases[4].
NelsonandGordon-Larsen[7]observedthatenhancingopportunitiesforincreasedexercisesandsportmayhaveabeneficialeffectinmodulatingriskbehavioursintheadolescentpopulation.
ThecontrolofNCDsincludingdiabeteshasreceivedlittleattention.
Forinstance,thereductionofNonCom-municablediseasesisnotaMillenniumDevelopmentGoal.
ManygovernmentsandorganisationshavefocussedoncontrollingdiseaseslikeHIV/AIDS,malariaandTuberculosis,andneglectingNCDs[8].
In2004,33.
1%ofmaleand32.
7%offemaleschoolgoingadolescentsofage13-15yearsinZambiareportedspendingthreeormorehoursduringatypicaldaysit-tingandwatchingtelevision,playingcomputergames,talkingwithfriends,ordoingothersittingactivities[9].
Nosimilarstudieshavebeenconductedamongnon-schoolgoingadolescentsoramongolderagegroups.
Asurveywasconductedtodetermineamongotherobjectivesthecombinedprevalenceofimpairedglucoselevelordiabetesanditsassociationwithphysicalfitnessandbiologicalfactors.
MethodsThestudywasconductedinLusakadistrictinlow,mediumandhighdensityresidentialareas.
Acrosssec-tionalstudyutilisingamodifiedWHOglobalsurveil-lanceinitiativeNCD-STEP3[10]wasusedinthecurrentstudy.
SamplesizeInastudywhoseresultsweredesignedtoreflectnationalestimates,atotalsamplesizeof6128respon-dentswascalculatedfortheentirecountry.
Thesamplesizewaspoweredenoughtoproduceestimatesforrural/urbancomparisons,andforbetweengenderanddistricts.
Lusakadistrictsamplesizewas1915participants.
SamplingAmulti-stageclustersamplingtechniquewasusedtoselectstudyparticipants.
LusakaprovincebeingthemosturbanisedprovinceinZambiawasconvenientlysampled.
Inthesecondstageofsampling,onlyLusakaurbandistrictwasconvenientlyselectedfromthethreedistrictsinLusaka(theothertwobeingKafuethatisaperi-urbandistrict;andChongwethatisaruraldistrict).
Lusakadistricthad7constituenciesoutofwhich5wererandomlyselected.
Fromeachselectedconstituency,onewardwasselected.
ThenumberofStandardEnumera-tionAreas(SEAs)selectedineachwardwaspropor-tionaltoitspopulationsize.
SEAswereselectedusingasystematicrandomsamplingmethod.
HouseholdswerethensystematicallysampledinordertowidelycovertheselectedSEAs.
Allpersonsofages25ormoreyearswereinvitedtoparticipateinthesurvey.
EthicalconsiderationsThestudyprotocolwasreviewedbytheUniversityofZambia(UNZA)ResearchEthicsCommittee(REC),andthestudyonlycommencedwhenapprovalfromtheUNZARECwasgranted.
AllentryformswerekeptintheofficeofthePrincipalInvestigator.
Entryformswereonlyviewedbyapprovedstudypersonnel.
DatacollectionTheWHOglobalsurveillanceinitiativeforNCD(WorldHealthOrganization,2005b)hasthreesteps:Step1isthequestionnaire,Step2isphysicalexaminations,andStep3isbiochemicalexaminations.
Allthesestepswereconductedwithintheparticipants'houses.
InterviewsAninterviewschedulewasusedtoelicitresponsesfromtheinterviewees.
Thequestionnairewasdividedintothefollowingsectionsamongothers:Demographicinforma-tion,Alcoholconsumption,Sedentarybehaviour(timeusuallyspentsittingorrecliningonatypicalday),Physi-calmeasurements(HeightandWeight,Waist,Bloodpressure,andHipcircumference)andBiochemicalmea-surements(Bloodglucose,andHDLcholesterol).
Inter-viewswereconductedinthehomesoftheparticipants.
MeasurementsTheWHOSTEPssurveillancetrainingandpracticalguiderecommendsthatphysicalmeasurementsbetakeninthefollowingorder:height,weight,waistcircumfer-ence,andbloodpressure.
Wechosetotakebloodpressurereadingsfirst,afterhavingadministeredthequestionnaire.
Thisgavetheparticipantenoughtimetohavesettleddown.
BloodpressureTheOmronDigitalAutomaticBPMonitorM4-1wasusedtomeasurethebloodpressureoftheparticipants.
Threeminutesofrestwasgiventotheparticipantinbetweenthreesuccessivereadingsofbloodpressure.
Althoughthethreereadingsweredifferentwiththelar-gestvaluebeingthefirstreadingandthesmallestbeingthethirdreadingonaverage,thesedifferedbynomorethan2mm/Hgofsystolicbloodpressure,andnomorethan4.
5mm/Hgofdiastolicbloodpressure.
Wechosetotakeanaverageofthethreereading,andnottheaverageofthesecondandthirdreadingsasrecom-mendedbyWorldHealthOrganisationinordertoincreasethedegreesoffreedomforthemean.
Nsakashalo-Senkweetal.
InternationalArchivesofMedicine2011,4:2http://www.
intarchmed.
com/content/4/1/2Page2of6Systolicbloodpressure(SBP)wasgroupedintofourlevels:1(raised).
Theana-lysisincludedrunningfrequencies,cross-tabulations,bivariate,andmultivariateComplexsampleslogisticregression.
Unadjustedoddsratios(OR),andadjustedoddsratios(AOR)togetherwiththeir95%CIwerecomputed.
ResultsAtotalof1928individualsparticipatedinthesurvey,ofwhich33.
0%weremales.
Abouthalfoftheparticipantswereofage25-34years(53.
2%),andathirdoftherespondentshadattainedsecondarylevelofeducation(35.
8%).
About1in5oftherespondentswereeitherselfemployed(22.
5%)orhousewives(20.
0%).
FurtherdescriptionofthesampleispresentedinTable1.
ImpairedglucoselevelordiabetesOfthetotalof1880subjectswhohadfastingbloodsugarmeasurementsdone,24(1.
3%)hadimpairedglu-coselevel(8males(33.
3%)and16females(66.
7%)while51(2.
7%)haddiabetes(13(25.
5%)malesand38(74.
5%)females).
Theagebysexstandardisedratesforcom-binedimpairedglucoselevelordiabetesformalesandfemalesconsideringLusaka'sagebysexpopulationwere4.
9%formalesand5.
6%forfemales.
Table2showsthedistributionofthecombinedpreva-lenceofimpairedglucoseordiabetesbyriskfactorsconsideredinthecurrentstudy.
Theprevalencevariedwithagewiththehighestprevalencebeingintheagegroup45+years.
Thehighestprevalencewasreportedamongparticipantswhowereobese.
ParticipantswithraisedcholesterolhadahigherprevalencethanNsakashalo-Senkweetal.
InternationalArchivesofMedicine2011,4:2http://www.
intarchmed.
com/content/4/1/2Page3of6thosewithnormallevelsofcholesterol.
Noclearpatternemergedfortheprevalenceamonglevelsofhypertension.
FactorsassociatedwithcombinedimpairedlevelsofglucoseordiabetesarepresentedinTable3.
Age,bodymassindex,waist-hipratio,hypertension,andcholes-terolweresignificantlyassociatedwithcombinedimpairedglucoselevelordiabetesinbivariateanalyses.
Inmultivariateanalysis,comparedtoparticipantsintheagegroup25-34years,olderparticipantsweremorelikelytohavecombinedimpairedglucoselevelordia-betes(AOR=2.
49(95%CI[1.
35,2.
92])for35-44yearsagegroup,andAOR=3.
80(95%CI[2.
00,7.
23])for45+yearsagegroup).
Onlymildhypertensionwasassociatedwithcombinedimpairedglucoselevelordiabetes(AOR=2.
57(95%CI[1.
44,4.
57])).
Nosignificantassociationswereobservedbetweenmoderateorseverehypertensionandcombinedimpairedglucoselevelordiabetes.
DiscussionThisisthefirststudytoreportresultsfromacompre-hensivegeneralpopulation-basedsurveyonthepreva-lencerateofimpairedglucoselevelordiabetesanditscorrelatesamongpersonsofage25yearsormoreinLusakaurbandistrict.
ThefindingsinthecurrentstudyformbaselineinformationtowhichinterventionstocontroldiabetesinLusakaurbandistrictcouldbemea-suredagainst.
Wefoundthattheprevalenceofdiabeteswas2.
1%amongmalesand3.
0%amongfemalesinthepresentstudy,andthatofimpairedglucoselevelwas1.
3%andTable1DemographiccharacteristicsforthesampledpopulationTotalMaleFemaleVariablen(%)n(%)n(%)Agegroup(years)25-341015(53.
2)337(53.
7)675(52.
9)35-44413(21.
6)135(21.
5)277(21.
7)45+481(25.
2)156(24.
8)323(25.
3)SexMale634(33.
0)--Female1288(67.
0)--EducationNone408(21.
5)76(12.
2)330(26.
0)Primary276(14.
5)61(9.
8)214(16.
9)Secondary679(35.
8)242(38.
8)435(34.
3)College/university534(28.
1)244(39.
2)290(22.
9)NB:numbersdonotaddupduetomissinginformation.
Table2DistributionofcombinedprevalenceofimpairedglucoselevelordiabetesbyriskfactorsconsideredinthecurrentstudyVariableTotaln(%)pvalueAgegroup(years)11510(*)Hypertension19.
57(3.
18,28.
83)HypertensionNormal11Mild4.
86(2.
76,8.
54)2.
57(1.
44,4.
57)Moderate2.
60(0.
96,7.
09)0.
98(0.
34,2.
83)Severe6.
77(3.
26,14.
02)1.
84(0.
75,4.
49)CholesterolNormal11Raised1.
85(1.
08,3.
19)1.
23(0.
67,2.
26)*notenoughdatainonecelltocomputetheestimateanditsconfidenceinterval.
Nsakashalo-Senkweetal.
InternationalArchivesofMedicine2011,4:2http://www.
intarchmed.
com/content/4/1/2Page5of6PossiblelimitationsThoughthestudydesignprovidesreliableandvalidinformation,thestudymayhavesomelimitations.
ThesurveywasdoneinLusakaurbandistrict,andhencetheresultscanonlybegeneralizedtothesampledpopula-tion.
Wedidnothavereliableinformationonthenum-berofhouseholdmembersofage25yearsorolderinordertoenableustocomputeresponserates.
Therefore,wecouldnotcomputeweightsthatcouldhavebeenusedintheanalysis.
Ourfindingsmaybebiasedtotheextentthatnon-respondentsdifferedfromthosethatpartici-patedinthesurvey.
However,weareunabletosuggestthedirectionofbias.
Someinformationontheimportantriskfactorsfordiabeteswaseithernotcollectedorinade-quatelycollected(suchasfamilyhistoryofdiabetesanddiet).
Weacknowledgelackofthisinformationasalim-itationtothestudythatmayhaveconfoundedourfind-ings.
Somestudyfactorsinoursurveywereobtainedthroughself-reports,andasinallsuchstudies,bothinad-vertentanddeliberatereportingisaconcern,moresothatweobtainedpersonalidentifiers.
Inspiteoftheabovelimitations,webelievethatourfindingsarecred-ibleastheycomparefavourablywiththoseobtainedintheZambiaDemographicandHealthSurvey.
ConclusionsTheprevalenceofdiabetesinLusakadistricthasnotreachedanalarminglevelanditisnowthatinterven-tionstargetingtheagegroups25-34yearsshouldbeputinplacetocurtailthespreadofdiabetes.
AcknowledgementsWegratefullythanktheNon-communicablediseases'steeringcommitteefordirectingtheentireresearchprocess;andtotheResearchassistantsfortheirtirelesseffortstosuccessfullycompletethesurvey.
WethankDrAggreyMweembaandDrGodfreyBiembafortheirinputintotheproposalwritingandpreparatoryworkofthestudy,respectively.
ThesurveywasfundedbytheMinistryofHealth,andtheWorldHealthOrganization.
Authordetails1DirectorateofPublicHealthandResearch,MinistryofHealth,Lusaka,Zambia.
2DepartmentofCommunityMedicine,SchoolofMedicine,UniversityofZambia,Lusaka,Zambia.
3DepartmentofPhysiology,SchoolofMedicine,UniversityofZambia,Lusaka,Zambia.
4WorldHealthOrganization,CountryOffice,Lusaka,Zambia.
Authors'contributionsMN-Scontributedtotheinterpretationofthefindings;SScontributedtothedesignofthestudy,trainingofresearchassistants,dataacquisition,dataanalysisandinterpretationofthefindings,andledthedraftingofthemanuscript;FMGcontributedtotrainingofinterviewers,dataacquisition,andinterpretationofthefindings;PScontributedtothedesignofthestudyandinterpretationofthefindings;VMcontributedtothedesignofthestudyandinterpretationofthefindings;OBcontributedtotheinterpretationofthefindings;Allauthorsreadandapprovedthefinalversionofthedocument.
CompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.
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