Prevalence of diabetes mellitus and other Cardiovascular risk factors in Kibera slum
Background Diabetes is a global health problem affecting 197 million people worldwide and over 10 million in Sub Saharan Africa. According to the World Health Organization (WHO), it has been postulated that prevalence of non-communicable diseases will outstrip that of communicable diseases by 2020. The developing countries are however, experiencing a double burddri of disease as they still have to cope with both the communicable and non communicable diseases. The increase in non communicable diseases is as a result of demographic changes; increasing urbanization and associated changes in risk factor levels e.g. tobacco smoking, obesity and physical inactivity. The paucity of data on prevalence of diabetes mellitus in the community was the rationale for this study. Main objective: Determine the prevalence of diabetes and other cardiovascular risk factors in an urban community setting. Research Design: Cross sectional community survey. Methodology Cluster sampling of households in eight villages of the Kibera slum with target population of adults 18 years or older who were residents for more than three months . with a calculated sample size of 2000 using a prevalence of 10.7% . Outcome variables: 1. Demographic 2. Clinical: obesity parameters i.e. BMI, waist circumference, waist hip ratio. 3. Laboratory profiles: RBS, FBS, Lipid profile, highly sensitive C reactive protein. Data collection: Questionnaires, physical examination, laboratory parameters. Data analysis: Descriptive statistics Results A total of 2200 individuals were screened of whom 2061 were enrolled into the study. The population was generally young with 53.9% of the study population being in the 25- 44 years age group and only 5.2% being 55 years or older. The diabetes prevalence was 3.2% (95% CI 2.5-4.1 %) and when the prevalence was calculated for those older than 40 years the prevalence increased to 9.2% (95% CI 6.9-12.1%). Just above half (53%) of the patients with diabetes were newly diagnosed. The diabetics were found to be more of females with an M: F of 1: 1.3. There was a high proportion of overweight and obesity in the overall study population of 45% and this increased in the diabetic, population to 67.2% using BMI measurements. The proportion of those engaging in tobacco smoking and alcohol consumption in the diabetic population was13.8% and 23.7% respectively. The duration of smoking and mean pack year history was statistically significant in the diabetic population compared to the non diabetic population. Alcohol ingestion was not statistically significant. Both the overall study population and diabetic population participated in: high levels of physical activity either work and travel related. Only 10.6% of the overall study population had had their blood sugar evaluated in their lifetime. In the diabetic : population , 96% of the patients were found to have desirable total cholesterol of less than 5.17mmol/l with 94% having a low HDL of <1.05mmolll, 88% having normal triglycerides of less than 1.8mmolll and 66% having a LDL of less than 3.4mmol/1. When highly sensitive C reactive protein was analyzed, 33% of the patients were excluded due to levels more than 5mg/dl. Of the remaining diabetes patients, 39.4% had levels in ; the high risk category of cardiovascular outcomes. 4.5% were in the risk!category while 22.7% were in the Jow risk group with levels of below 2 md/gl Conclusion The prevalence of diabetes mellitus in adults in Kibera slum is 3.2% and associated cardiovascular risk factors were found to be common despite a high level of physical activity in the Kibera slums.