Diabetes

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Preparedness for Diabetes and Cardiovascular diseases service delivery in health facilities in Mangochi district, Malawi
(Kamuzu University of Health Sciences, 16-06-21) Lutala, Prosper
Type of the study: A mixed- methods. Problem statement: Diabetes and hypertension are steadily increasing in Sub-Sahara Africa and Malawi. However, preparedness and readiness in dealing with noncommunicable diseases (NCDs) were reported weak and inappropriate in several settings in Africa, including Malawi. Current level of availability and preparedness in the management of NCDs in general in few domains (NCDs’ referrals and community activities) s and perceptions of providers regarding NCDs services in Mangochi, as also perceptions of providers regarding NCDs services’ availability and preparedness remain unknown in Mangochi. Therefore, need for this study. Objectives: This study aim is to assess the preparedness through readiness of health facilities for diabetes and cardiovascular (CVDs) services in public and private health facilities in Mangochi district, Malawi. Specific objectives are: assess basic supplies for diagnostic, management, treatment, referral and community management of diabetes and cardiovascular diseases in health facilities in Mangochi district; to assess availability and preparedness of staff in managing diabetes and hypertension in health facilities in Mangochi district; to assess the perceptions of staff about the availability and readiness of diabetes’s and cardiovascular diseases’ services in health facilities in Mangochi district; and to identify factors associated with the preparedness of health facilities in Mangochi district for the outpatient’s management of diabetes and cardiovascular diseases Methodology: The study will be carried out in private and public health facilities in Mangochi. It will cover the period between March to September 2021. The sample will be selected among all the forty-two health facilities in Mangochi and their respective in-charges, and knowledgeable clinician, nurse and health surveillance assistant . Multistage Random sampling will be done for health centers, purposeful selection for the four hospitals and systematic sampling of in-charge in 16-Jun-2021 5 Study protocol Version 4 (June 5, 2021) selected facilities. Sample size: a computed sample of 32 facilities with for each, his in-charge and others staff needed. A local validated service availability and readiness assessment (SARA) self-administered questionnaire including a checklist will be carried out by a trained research assistant (quantitative), while a semi-structured interview will guide collection of qualitative data. Quantitative part will use simple descriptive statistics (means, percentages, chi-square and test-t of student for continuous and categorical, respectively; logistic regression for associations); and content analyses will be conducted to identify key themes for the qualitative data. Ethical considerations: Informed consent, confidentiality, anonymity, authorization from district and ethical clearance from COMREC. Expected findings: they are human resource by cadre and training, equipment, availability of guidelines, medicines and commodities, diagnostics, and education materials and states, referrals, community NCDs activities; perceptions of staff. determinants availability. Dissemination: Feedback to the facilities involved, study report to COMREC, College library, National Health Sciences Research Committee (through the COMREC Secretariat) presented as a policy brief, journal articles in peer-reviewed journals, and University of Malawi Research and Publication Committees.
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Point of Care Retinopathy Screening Study (PARROTS)
(Kamuzu University of Health Sciences, 2020-06-05) Burgess, Philip
Type of study A pilot of point of care cross-sectional (POC) screening for diabetic retinopathy (DR) delivered by ophthalmic clinical officers (OCOs) and optometrists will be undertaken at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. This study will investigate both the accuracy of the screening test and acceptability of the system of POC screening to patients and health care workers. The Problem Malawi has an adult population prevalence of diabetes of approximately 5% and a high prevalence of sight threatening diabetic retinopathy (STDR) in persons attending diabetes clinics. Visual loss from diabetes is preventable and treatable. Early detection is key but European style screening programmes would not be cost-effective or sustainable in Malawi. Low-cost fundus cameras used together with novel automated grading software could provide the means to provide effective point-of-care screening by health workers. Recent work in 2018/2019 has been undertaken to assess the quality of retinal photographs produced by 2 portable fundus cameras and to investigate the accuracy of an automated grading algorithm used together with a hand-held fundus camera for detection of DR. Automated grading addresses the problems of recruiting, training and cost for human grading of retinal photographs. A POC result overcomes the problem of communicating results at a distance. The planned next stage of this project is described below. Objectives Broad Objectives 1. To determine whether new and low cost portable screening cameras alongside a grading algorithm for diabetic retinopathy will benefit patients with diabetes Specific objectives 1. To investigate the accuracy of an automated grading algorithm used together with a low-cost fundus camera for detection DR which imminently threatens vision in 2 settings: a Central Hospital and a District Hospital. 2. To investigate the acceptability to patients of a system of POC DR screening using an automated grading algorithm used together with a low-cost fundus camera. 3. To investigate the acceptability to health care workers of a system of POC DR screening using an automated grading algorithm used together with a low-cost fundus camera This is a prospective pilot study of a screening intervention based at 2 sites. People living with diabetes (PLWD) attending a diabetes clinic at each site (n=246) will be recruited. DR screening with POC automated grading will be delivered by OCOs and optometrists. Digital fundus photography of 2 standard fields (disc-centred and macula-centred) will be performed through dilated pupils using 2 hand-held fundus cameras (Volk Pictor Plus and Volk InView). Photographs will be analysed using Eye Star automated grading software. Screen positive cases (DR which imminently threatens vision: LDES level 50+ and exudates within 500um of the central fovea) will be referred to a tertiary referral centre: Lions Sight First Eye Unit at Queen Elizabeth Central Hospital, Blantyre for assessment and, if necessary, treatment. All screen positive subjects will be examined by an ophthalmologist (PK) to determine the positive predictive value. A proportion of screen negative subjects will be examined by an ophthalmologist to determine the negative predictive value. The acceptability of the intervention will be assessed by qualitative methods. All patients and health care workers will be invited to complete a questionnaire. A sub-group of patients (n=28) and health care workers (n=10) will be interviewed. A separate sub-group of patients will be invited to participate in focus groups (n=20). The impact of distance, gender, and risk perception on acceptability of the POC DR screening to patients will be assessed. The study will be undertaken in a sequential manner: phase 1 at Queen Elizabeth Central Hospital; phase 2 at Chiradzulu District Hospital. After phase 1 of the study, a planned interim analysis will be undertaken, and any necessary changes made to the screening model. Expected results The results are expected to demonstrate the effectiveness of screening for sight threatening diabetic retinopathy using handheld cameras in a LMIC hospital setting. Results will also establish acceptability for patients and health care staff. Data from this pilot study will inform future large studies of this intervention. If the expected results are seen, implementing diabetic retinopathy screening at a district level would be sought. Approval would be sought for deployment of the fundus cameras and grading system at a national level, from the appropriate governing body. Dissemination of results The findings of the study will be disseminated through presentation at national and international meetings and through peer reviewed publication. The Committee of Medical Research and Ethics Committee (COMREC) will be notified of the findings in the first instance. Findings from the study will inform a phased introduction of diabetic retinopathy screening throughout Malawi.
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Assessing the burden of Diabetes Mellitus (DM) and risk factors among Blantyre city based Non-Governmental Organisation (NGO) drivers
(Kamuzu University of Health Sciences, 2020-06-05) Mtila, Yusuf
Type of Study The study is a cross-sectional study that will adopt the World Health Organization (WHO) STEPS survey design for NCD risk factors assessment with particular interest on Diabetes. Problem The prevalence of Diabetes Mellitus (DM) in Malawi was determined at 5.6% among adults aged 25-64 years by national wide STEPS survey in 2009. Sedentary life style which is a characteristic of driving population has been associated with increasing prevalence of Diabetes Mellitus. Studies on determinants and distribution of DM among different groups of driving populations including taxi drivers, bus drivers and truck drivers have been conducted. The results from the studies have informed effective programming on DM response interventions amongst the target populations. Currently epidemiology of DM among Non-Governmental Organization drivers in particularly is not known and documented. Knowledge on prevalence of DM and their associated risk factors among NGO drivers in Blantyre city will inform evidence-based interventions that specifically respond to diabetes burden among them. Objectives The main objective of the study is to assess the prevalence and risk factors of Diabetes Mellitus among NGO drivers in Blantyre city. Specific objectives include: Assess prevalence of lifestyle and behavior risk factors, Medical/ physiological risk factors and prevalence of DM among NGO drivers. Methodology A sample of 91 NGO drivers from Blantyre city will be interviewed, assessed on behavior, physical and biomedical risk factors. Two enumerators and two certified providers will be temporally employed to facilitate data collection process. The enumerators will be interviewing NGO drivers on background information, behavior risk factors using a questionnaire. The interviewees together with their partly filled questionnaires will next be directed to providers (Nurse/Clinician) for presence of DM, physical and biomedical factors assessment. All interviews will be recorded, entered into STATA 16 and hard copies filed in a file cabinet. Data will be processed and analyzed using STATA. Expected Findings It is expected that there will be significant associations between behavior, physical, physiological risk factors to prevalence of DM in Blantyre city-based NGO drivers. Dissemination of Findings Findings from the study will be shared with relevant authorities in Blantyre city council, CONGOMA, Ministry of Health and COMREC to reflect on the recommendations of the study. It is expected that findings from the study will be used by Malawi government for reference on development of comprehensive national NCDI /Diabetes policy.
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Assessing diabetic lifestyle knowledge, attitude and practice and their associated factors in type II diabetic patients attending medical clinic at Nkhoma Mission Hospital
(Kamuzu University of Health Sciences, 2020-09-16) Chisepo, Patrick
The problem: Lifestyle Modification involves altering long-term habits, typically of eating and physical activity and maintaining the new behaviour for months or years.(3) Lifestyle Modification is known to treat or reverse a number of Non-communicable diseases(NCD) and plays an important role in the management of diabetes toward achieving good glycaemic control, as well as preventing or delaying micro-vascular complications in patients with type II diabetes. Though we give patient education and counselling at Nkhoma medical clinic regarding Lifestyle Modification, little is known about patients’ intention, attitude, and actual practice of these activities. This study will help us to identify patients’ stated intentions and attitude factors that relate to lifestyle behaviors. Understanding these motivating thought processes will help us better relate to counseling individual patients, as well as improve diabetes education and empowerment programs. 7.2 Study design: We will carry out a descriptive quantitative cross-section study 7.3 Objective: The study aims to assess patients’ intention, attitude and behaviour towards Lifestyle Modification among patients with type II diabetes. Specifically will assess level of the patients’ intentions to engage in Lifestyle Modification, factors that are associated with Intentions to engage in Lifestyle Modification and factors predictive of Lifestyle Modification. 7.4 Methodology: This will be a descriptive cross-section study of diabetic patients attending outpatient medical clinic. It will use Diabetes Intention, Attitude and Behaviour questionnaire (DIAB-Q) to measure diabetes-related cognitions and behaviours for engaging in health lifestyle. A sample of 50 patients with type II diabetes will be enrolled using convenience sampling during the study period of two months; since the medical clinic at Nkhoma is done once a week on Tuesdays, it will mean the data collection will be done in 8 days over the 2 month period. The study will include type II patients 18 years and above who consent and have been known to have diabetes for at least 1 week. It will exclude those who are below 18 years and those who have had diabetes for less than 1 week.
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Evaluation of gestation Diabetes Mellitus at Zomba Central Antenatal Hospital Clinic
(Kamuzu University of Health Sciences, 2021-01-13) Chimwaza, Nelson
Gestational Diabetes Mellitus (GDM) was earlier defined as “hyperglycemia first recognized during pregnancy” and has more recently been described by the American Diabetes Association as diabetes diagnosed during pregnancy that is not clearly overt diabetes. GDM is associated with a wide range of adverse outcomes for women and their babies. Having GDM can increase the risk of high blood pressure during pregnancy. It can also increase the risk of having a large baby that needs to be delivered by cesarean section. Therefore results of this research can help in development of policies, management of antenatal mothers and used as basis for other studies. The objective of the study is to evaluate the prevalence rate of GDM and determine risk factors. This will be a cross sectional prospective study where by 300 participants shall be randomly selected through convenience sampling method. Women of 24-28 weeks gestation who pass the inclusion and exclusion criteria and have given their written consent shall be included in the study and their height, weight and age shall be recorded. Thereafter 75-g Oral Glucose Tolerance Test shall be performed in the morning after an overnight fast of at least 8 hours. The diagnosis of GDM is made if at least two of the following is met or exceeded i) fasting: 95 mg/dl ii) 1 hour: 180 mg/dl iii) 2 hour: 155 mg/dl. After centrifuging the blood sample in an anticoagulant tube, plasma shall be put in a BS 360 E Chemistry Analyzer to test for the client’s plasma glucose level. We expect a low GDM prevalence rate and association between GDM and maternal obesity as well as age. To compare the proportion of GDM across the age groups, Body Mass Index and gravida Chi Square test shall be used. Results of the research shall be available to College of Medicine Research Ethics Committee, Zomba Central Hospital and college of medicine library. Ethical clearance for this research project shall be sought from College of Medicine Research Ethics Committee.
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Assessment of quality of life among patients with type II diabetes mellitus at Kamuzu Central Hospital in Lilongwe, Malawi
(Kamuzu University of Health Sciences, 2021-01-13) Chisalunda, Alinafe Venancio
Study type This is a convergent mixed methods study with both quantitative and qualitative methods. Quantitatively, a cross section descriptive study design will be employed. For qualitative data, a phenomenological approach will be used The Problem to be studied Diabetes mellitus is a complex and chronic disease with multiple complications leading to increased mortality and poor quality of life. Unfortunately, Majority of guidelines on diabetes care focus on the medical aspects of initial management without addressing other needs e.g. psychological well-being. This results in poor outcomes in diabetes patient management and hence poor quality of life. Current studies have found that health related quality of life is instrumental to the delivery of care and it is recognized as being an inclusive term that assesses both self-reported mental and physical functioning of an individual. However health related quality of life assessment is not incorporated in diabetes management in Malawi. Furthermore, no study on assessment of quality of life among type II diabetes mellitus patients has been conducted in Malawi. Objectives The main objective of this study is to assess the quality of life among patients with type II diabetes mellitus receiving treatment at Kamuzu Central Hospital in Lilongwe, Malawi. The specific objectives are to describe physical, psychological and social challenges faced by patients with type II diabetes mellitus and to determine ways of addressing the challenges to improve quality of life. Methodology This will be a convergent mixed methods study in which both qualitative and quantitative data will be collected. Quantitatively, cross section design will be employed and data will be collected using the Modified Diabetes Quality of Life (MDQoL) -17 questionnaire. Phenomenological approach will be used for qualitative data and will be collected through in-depth interviews with patients and guardians using an interview guide. The interviews will be tape recorded. Diary method and emotional mapping will also be used to capture qualitative data. Demographic characteristics for example age and gender will be collected as well as duration of diabetes history, body weight and presence or absence of complications. The common diabetes complications are; nephropathy, retinopathy, erectile dysfunction, peripheral neuropathy, heart problems for example coronary artery disease, myocardial infarction, congestive heart failure and peripheral vascular disease. These variables will be collected using a demographic data form. Quality of life values as given by the MDQoL-17 questionnaire will also be collected. This questionnaire has 17 diabetic specific questions that are classified into 8 concepts. These concepts are; physical, social functioning, role limitations due to personal and emotional problems, psychological impact, energy/fatigue, bodily pain and general health perceptions. After data collection, STATA software will be used for analysis. Furthermore, multiple regression model will be employed to draw conclusions from the quantitative data. Analysis for qualitative data will be done manually using thematic content analysis. Expected findings and dissemination It is expected that the results of this study will reveal: physical, psychological and social challenges that diabetes patients encounter. It will further identify precipitating factors to these problems and come up with evidence-based policies to help solve the problems. Furthermore, the results will act as an eye opener to incorporate health related quality of life assessment in diabetes management. Results from this study will be disseminated at College of Medicine Research Ethics Committee (COMREC), at the students’ research dissemination conference in the health systems and policy department at College of Medicine, College of Medicine Research Dissemination Conference, and Kamuzu Central hospital as well as published in the Malawi Medical Journal (MMJ). A copy of the dissertation will also be submitted to College of Medicine’s Library.
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Assessment of lipid profile patterns of diabetic patients at Kamuzu Central Hospital
(Kamuzu University of Health Sciences, 2021-03-04) Filisa, Florence Anna
Study type: This is a descriptive cross-sectional study assessing lipid profile patterns of diabetic patients at Kamuzu Central Hospital. The problem: The burden of diabetes continues to increase globally and in Malawi with a prevalence of 9.3 and 5.6% respectively. Diabetes is a known high risk factor for Atherosclerotic cardiovascular disease ASCVD. The elevated risk of ASCVD in diabetic patients is a product of lipid abnormalities (dyslipidaemias) typical in people with diabetes. Insulin resistance in diabetes has been shown to contribute to the pathophysiology of dyslipidaemia in diabetes. Dyslipidaemia is a modifiable risk factor for ASCVD and can be managed by lowering the lipid blood levels through low lipid diet, exercises and statin therapy, thereby reducing the risk for developing adverse complications such as stroke in diabetics. The screening and monitoring of dyslipidaemia is recommended for people with diabetes to assess the risk and manage the condition effectively. Assessment of lipid profile patterns and its relationship to other risk factors to ASCVD can help suggest individual specific management of diabetic dyslipidaemia. The individualised patient management approach ensures success in patient lipid control. This would in turn reduce the ASCV-related morbidity and mortality in diabetic patients. Despite the recommendations, Malawi is still lagging behind in lipid profile screening and monitoring for diabetic patients. This may be due to various health system challenges that hinder availability and consistent provision of this essential service. Current clinical practice at Kamuzu Central hospital includes a 10mg/day prescription of statin to all diabetes patients. This is done without a lipid test, despite the facility having these tests available. Underutilization of these relevant tests by the diabetic clinic requires further investigation. Furthermore, due to the limited lipid profile data in Malawi, the study aims to assess the lipid patterns and related risk factors associated with dyslipidaemia among patients being treated for diabetes at Kamuzu Central Hospital. Study objectives: The main aim of the study is to describe the prevalence, biochemical characteristic and risk factors associated with dyslipidemia in diabetic patients aged 18-72 years attending the diabetic clinic at KCH. The specific objectives are to 1. Determine lipid profiles of the adult diabetic participants attending the diabetic clinic. 2. Calculate the prevalence of dyslipidemia in the study participants using HbA1c. 3. Determine blood HbA1c levels of study participants. 4. Determine the relationship between dyslipidemia and other variables such as age, sex, body mass index and HbA1c. Methodology: This will be a descriptive cross-sectional quantitative study. The study population will be diabetic patients aged 18-72years attending the KCH diabetic clinic. The sample size will be 388 participants. The sample size was calculated using the Conchran formula, based on an expected prevalence of dyslipidaemia of 40% in this patient population, with a power of 80% and 5% standard error and 5% attrition). A self-developed data collection tool (attached in Appedix) will be used to collect participant information including socio-demographic data (age and sex), information on cardiovascular risk factor such as smoking and alcohol consumption, and medication history will also be collected. We will perform anthropometric measures and collect vital signs. Weight and height scales will be used to obtain participants weight (kg) and height (m) readings. These readings will be documented on the same self-developed data collection too. BMI will be calculated using the weight and height readings using the formula: weight divide by square root of the height. Two blood samples will be collected, one in EDTA tube for HBA1c tests and another in red topped plane tubes for biochemical lipid profile testing. Whole blood will be used to measure HBA1c using the NycoCard. Serum will be used to measure lipid levels. Results will be captured in the data tool developed as well. Data will then be entered in Microsoft Excel sheet. SPSS and Stata will be used for data analysis. Descriptive statistics will be presented in a table to describe the general characteristics of the participants. Chi square test and Fischers test will be used analyse categorical and independent variables respectively. Stratification of data will be applied to handle confounders such as smoking and age. The t-test will be used to test the differences between two means. Correlations between the variables will be tested using Pearson‟s Product or Spearman‟s test of correlation depending on data normality. In all cases, a pvalue ≤0.05 will be considered significant. Possible Constraints A possible constraint to this study could be Covid-19 pandemic. Due to the special risk this pandemic has on individuals with diabetes, we assumed patient turnout at the clinics would decline. However, at KCH, the patient turnout at the clinic has not been significantly affected. So, we envisage that enrolling patients in the study will not be affected. During the study activities, we will ensure that all Covd-19 preventive measures are strictly adhered to throughout the course of the study. Clinic staff will monitor and ensure social distancing, wearing of masks as well as hand washing for clinic staff and patients. Nurses will hand sanitize before and after attending to each patient to ensure a Covid-19 safety for our clinic patients. Expected Findings and Dissemination: The results will aid in providing information on whether maintenance of the 10mg/day statin therapy for all diabetics being practiced at KCH is justifiable and adequate or there should be adjusted based on individual patient lipid results and additional risk factors. The results once analysed will subsequently be published in an international scientific journal and copies will be presented to the following: The College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library, The Health Sciences Research Committee (through the COMREC Secretariat), The University Research and Publication Committee (URPC) (through the COMREC Secretariat). Results will also be presented to KCH during monthly ground rounds. A copy will also be shared with the Malawi Ministry of Health NCD commission.
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Comorbidity of depression with diabetes in noncommunicable diseases clinics in southern Malawi
(Kamuzu University of Health Sciences, 2021-03-17) Udedi, Micheal Mphatso
Type of study: Cross-sectional study design will be used in this project. Problem: This research project will focus on prevalence and detection of depression in the context of non-communicable diseases. Malawi, like many low- and middle income countries, is faced with the growing challenge of non-communicable diseases (NCDs). Depression is one of the shared risk factors for physical NCDs however there is currently no routine practice to identify and manage mental illnesses in the physical NCDs clinics in Malawi. Broad Objective: We aim at estimating the prevalence of depression among patients with type 2 diabetes mellitus attending to NCDs clinics in the two districts of southern Malawi. Methodology: The project will be a cross sectional study and will involve validated Chichewa version of the PHQ-9. A minimum calculated sample size of 323 participants will be recruited consecutively at the NCDs clinics of Mwanza and Blantyre districts. The permission to conduct the study has been sought from the heads of the facilities where the study will be conducted. The ethical approval will be sought from the College of Medicine Review and Ethics Committee (COMREC) and informed consent will be sought from the study participants before administering the questionnaire. All filled questionnaires will be handled by the research assistants and the PI and will be kept in a safe place before and after data entry. The computers for data entry will be protected by passwords. Data will be analyzed statistically using a statistical package for social sciences. Patients’ characteristics by age, sex and condition will be described using frequency tables. Expected findings: This study might uncover the prevalence and detection of depression in NCDs clinics in the district of southern Malawi. The findings of this study therefore may be relevant in advocating for the integration of depression management into NCDs clinics in Malawi. Dissemination: The findings from this research project will be accessible by academicians and researchers through the College of Medicine library. Furthermore, the findings will be submitted to the COMREC secretariat, the University Research and Publication Committee (URPC) through COMREC secretariat and the National Health Sciences Research Committee (NHSRC). The results will be shared through presentations at national and international research or policy conferences as well as submission to peer reviewed publications. The results will be shared with the participating health facilities and furthermore the results will also be shared with policy makers and other local stakeholders in form of policy briefs as part of evidence on prevalence and detection of depression in NCD clinics in Malawi.
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Assessing prevalence of diabetes for patients who are on Hydrochlorothiazide and Propranolol in Blantyre
(Kamuzu University of Health Sciences, 2021-03-17) Shaba, Alice; Harrison, Chikondi
Hypertension and diabetes are the most common co-morbidities which are increasingly becoming a great public health risk to most developing countries including Malawi. This is attributed to physical inactivity, urbanization, obesity and nutritional transitions. Hypertension is managed by different drug classes which include; diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors, and beta blockers. The use of diuretics and beta blockers has been associated with a new onset of diabetes. This quantitative cross sectional study aims at assessing the prevalence of diabetes for patients who are on hydrochlorothiazide (HCTZ) and propranolol in Blantyre. The objectives of the study include identifying hypertensive patients who are on HCTZ and propranolol; determining prevalence of diabetes in these patients; and lastly determining blood sugar control. This study will be conducted at Queen Elizabeth Central Hospital in Blantyre with 177 sample size. Study population will be both male and female hypertensive adults who have been on HCTZ and propranolol for a year. It is expected that there will be high prevalence of diabetes among hypertensive patients who are on HCTZ and propranolol. Also there will be high percentage of diabetes patients having their blood sugar not controlled. Results of the study will be presented to College of Medicine and possibly published in peer reviewed medical journal
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Herbal medicine use among diabetic and hypertension patients in Mangochi: Prevalence, determinants and use pattern
(Kamuzu University of Health Sciences, 2021-08-02) Mwalwanda, Stanley
This is a cross sectional study involving all adult diabetic and hypertensive patients in NCD Clinic. Problem statement: There is fast growing use of herbal medicine in NCD however there is lack of baseline scientific data on quality, safety and efficacy in Africa, even in Malawi therefore a need to add to Malawi local baseline data on the use of traditional medicine in NCD. OBJECTIVES: Broad objective: 1. To assess the prevalence, determinants and pattern of herbal medicine use among hypertension and diabetes patients in rural and urban settings of Mangochi Specific objectives: 1. To estimate the prevalence of traditional medicine usage among hypertension and diabetes type two patients in Mangochi, 2. to assess the types, formulation, category of herbal medicine used by Hypertension and diabetic patients at Mangochi and monkeybay hospitals. 3. to assess the concurrence use of traditional medicine and conventional medicine by Hypertension and diabetic patients at Mangochi and monkeybay hospitals. 4. to investigate the reasons for using traditional medicine by Hypertension and diabetic patients at Mangochi and monkeybay hospitals. Methodology: The research will be conducted at Mangochi District Hospital and Monkey bay community hospital, purposeful selection for the two hospitals. The sample size will be selected among over thirty years’ adults diagnosed with HTN/DM2 >1yr and Systematic random sampling technique will be employed to recruit the study participants. Sample size; a computed sample of two facilities was computed to be 286 participants. A validated questionnaire used in similar settings will be adjusted, the study will cover the period between 5th October to 5th December 2021. Data analysis: will use descriptive analysis(mean, chi square). Ethical Consideration: Authorization from the district research committee and anonomity of data and ethical clearance will be sort from COMREC. 02-Aug-2021Expected findings: : At the end of this study, we are going to have: the prevalence of traditional medicines in patients with hypertension and diabetes; different types, categories, and formulations of herbal medicines used; the frequency of use among participants, and the reasons of using traditional medicines by patients. Dissemination: The research findings will be disseminated at the local dissemination college of medicine (COMREC) as well as published in a research journal and furthermore, results will be reported to all research regulatory authorities and Malawi poisonous and pharmacy board with recommendations to the Malawi ministry of health.
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Improving self-management skills among adults living with insulin-treated diabetes in rural Lilongwe, Malawi: A pilot study
(Kamuzu University of Health Sciences, 2021-11-11) Nkambule, Ellen; Msiska, Gladys
Title of the study: Improving self-management skills among adults living with insulin-treated diabetes in Rural Lilongwe, Malawi: A pilot study. Type of study Mixed methods study approach that will employ both quantitative and qualitative research methods. Problem statement This pilot study is a follow up of a qualitative study which explored the experiences of insulin treated diabetic patients in rural Lilongwe which revealed problems which rural-based diabetic patients experience. The study revealed compromised self-management and persistent ill health and this set the impetus for this pilot study. Objectives of the study Broad objective The aim of this pilot intervention study to investigate the impact of selected evidence-based intervention on the utilization of self-management practices among insulin-treated patients in Lilongwe rural.” Specific objectives 1. Assess knowledge on diabetes self-management practices among rural-based insulin treated diabetes patients 2. Evaluate the impact of the interventions on glycaemic control among the rural-based insulin-treated diabetic patients through regular monitoring of blood sugar using glucometers. 3. Explore post-intervention experiences of rural-based insulin-treated diabetic patients. Methodology Research design: This pilot study will employ mixed methods research research design and it will be conducted in three phases namely the pre-intervention, intervention and post-intervention phases. The pre-intervention phase will employ a survey design inorder to assess the knowledge of the participants and their compliance to the recommended self-management practices. The intervention phase will employ a prospective, single-arm, longitudinal study. The post intervention phase will have both quantitative and qualitative strands. The quantitative strand will employ a survey design while the qualitative strand will employ exploratory descriptive qualitative design. Study setting: Kamuzu Central Hospital, Malawi. Target population: Adult insulin-dependent diabetic clients attending Diabetic clinic. Sampling: This study will use convinient sampling to recruit participants. Sample size: The study will use a sample of 10 participants. Data collection: Self administeredquestionaire and face-to-face in-depth interviews. Data analysis: Quantitative data will be analysed through SPSS, while qualitative data will be analysed manually using thematic analysis. Ethical considerations: Ethical approval for the study will be sought from the College of Medicine Research and Ethics Committee (COMREC). Informed consent will be sought from the individual study participants and participation will be voluntary. Privacy and confidentiality of participants will be observed. Expected findings: The study will offer opportunities for rural-based insulin-treated diabetic patients to be strengthened in self-management practices Dissemination of the results: The findings will be disseminated at conferences both locally and internationally and will also be published in peer reviewed Nursing and Midwifery Journals.
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Clinical qharacteristics, quality of care and outcomes of patients presenting with diabetes ketoacidosis at Kamuzu Central Hospital
(Kamuzu University of Health Sciences, 2021-11-11) Mwabutwa, Emmanuel
Type of Research This will be a cross-sectional study. Problem Diabetes Ketoacidosis is a serious and life threatening complication of diabetes. There is need to understand the clinical characteristics, in-hospital management quality and patient outcomes in view of the increasing numbers of patients being diagnosed and admitted with diabetes at Kamuzu Central Hospital. Study Objectives Broad objectives The primary objective of this study is to describe the clinical characteristics, precipitating factors, management and outcomes of patients with diabetes ketoacidosis at Kamuzu Central Hospital. Specific objectives To describe the proportion of patients with of suboptimal insulin therapy (poor insulin compliance /storage/technique of injection) as a precipitant to DKA To establish clinical characteristics of patients presenting with DKA To analyze point of care on patients with DKA determine time to resolution of DKA, quality of care and outcomes of patients with DKA Data Collection, management and analysis Patients will be recruited from adult medical wards at Kamuzu Central Hospital. A standard questionnaire will be used to collect data. Health passports, patient case files will be reviewed to gather information on patients’ comorbidities and drugs. Collected data will be entered into an electronic database and statistical analysis will be performed using STATA 15.1 software. Descriptive statistics will be used to summarize frequencies and proportions. Chi squared testing will be used to compare categorical variables and t-testing will be used for continuous variables. Research Ethics A written informed consent will be sought from all study participants and confidentiality will be ensured by the study team by following good clinical practice guidelines. Research ethics approval will be sought from the College of Medicine’s research and ethics committee. Expected findings and dissemination We expect to highlight the common clinical characteristics, quality of in-hospital management and outcomes of patients admitted with diabetes ketoacidosis at Kamuzu Central Hospital.
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Factors affecting glycemic control in patients attending peadiatric diabetic clinic at QECH
(Kamuzu University of Health Sciences, 2022-02-09) Mwasapi, Ireen; Mtonga, Chisomo; Mthyoka, Tamala; Mubisa, Hannah
1.0 Executive summary This is a quantitative cross-sectional study aimed at analyzing factors affecting glycemic control in patients attending pediatric diabetic clinic at Queen Elizabeth Central Hospital. The study will analyze factors affecting glycemic control and determine the proportion of patients with poor glycemic control. Patients will also be assessed for possible complications. Participants will be selected using convenient sampling method. Data will be collected using questionnaires and managed using Microsoft excel. Results will be presented at research dissemination at the end of research block at College of Medicine. The results will help improve management of diabetes patients and to prevent complications and other comorbidities. 2.0 Background Diabetes is a chronic non communicable disease which occurs when the pancreas produces insufficient insulin or when the body cannot effectively use the available insulin. Type 1 diabetes mellitus is an autoimmune disease which results from cellular mediated destruction of beta cells of the pancreas characterized by deficient insulin production. Type 1 diabetes mellitus (T1DM) is one of the most common chronic conditions in children, and it represents a global public health challenge There is an association between poor glycemic control and study level of patients, healthy eating habits and diabetes duration. Patients who have had diabetes for a longer duration betteglycemic control as compared to new onset diabetics(1).Additionally, there is poor glycemic control in African children especially adolescents. About 4% of children above 12 years of age have reasonable control compared to 78% of children less than 12 years(2). Body mass index, guardian education level and insulin type are some also factors associated with poor glycemic control(3). Furthermore, metabolic control is poor in type 1 diabetics population with overall poor adherence. Other factors associated with poor control were include older age, a caregiver other than the mother and poor adherence to Blood glucose monitoring(4). However, some studies have been done to find out ways of ensuring good glycemic control. Diabetic youth education camps have a positive impact on glycemic control(5).Additionally, diabetic education significantly reduces the risk of severe hypoglycemia, though better glycemic control cannot always be achieved(6). Poor glycemic control is associated with many acute complications. There is a high proportion of severe hypoglycemia and Diabetic Ketoacidosis (DKA) among patients attending diabetic clinic. There is also significant relationship between Diabetic Ketoacidosis (DKA) and mode of storage of insulin, most of the participants use the traditional storage method that is a clay pot with sand and water kept at the coolest place in their home. 97.56% of the participants had poor control of Type 1 diabetes mellitus with a mean HbA1c 0f 13.22%(7). Furthermore, inadequate knowledge on; diabetes complications; management of hyperglycemia; appropriate self-monitoring of blood glucose; differences in signs and symptoms of hyperglycemia and hypoglycemia and provision of psychological support contributes to poor glycemic control(8).
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Type 2 Diabetes Treatment Guidelines in Malawi: A Cross Section Survey for Type 2 Diabetes Remission
(Kamuzu University of Health Sciences, 2022-03-08) Mpinganjira, Obed; Chisenga, Bisayi
Study type: This is a cross-sectional study, intending to investigate the management of type 2 diabetes in Malawi. The problem: Worldwide, prevalence of non-communicable diseases (NCDs) is increasing and this includes diabetes mellitus. Some studies have indicated that type 2 diabetes is a chronic problem which requires strict adherence to its pharmacological intervention. However, most developing countries have a narrow choice of pharmacological drugs due to limited availability of most suitable drugs. This might lead to complications such as nephropathy and retinopathy, and even lower limb amputations. This indicates the need for regulated management of diabetes mellitus including periodical reviews of treatment options. Aim and Objectives: The main aim is to identify the gaps that exist in management of type 2 diabetes mellitus in Malawi. The specific objectives include describing the drugs used for diabetes type 2 treatment at diabetic clinic at QECH, to determine the commonly used measures for the management of type 2 diabetes, assessing how diabetes type 2 patients monitor their blood glucose and identifying the challenges faced by type 2 diabetes patients in managing their condition. Methodology: This is a qualitative cross section study that will look at the gaps which exist in management of diabetes mellitus type 2 in Malawi in relation to recommendations by international organizations. We will explore the case management of diabetes type 2 at diabetic clinic at QECH using questionnaire and case narrative management. The findings will be analyzed in relation to the recommendations provided by international organizations such as WHO and NHS. We aim to obtain the international recommendations for type 2 diabetes management by searching google scholar and gov.com websites. Expected Findings and Dissemination: Generated data will be analyzed and shared with Pharmacy department and other interested parties such as COMREC and QECH hospital. If resources enable us, we will publish the findings in a peer-reviewed journal.
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Prevalence of type 2 diabetes, risk factors and complications at Queen Elizabeth Central Hospita
(Kamuzu University of Health Sciences, 2022-08-17) Duncan, Bertha; Mpando, Macdonald
Executive summary: Type 2 diabetes, by far the most common type of diabetes, is on the rise globally at an alarming rate. It is rapidly escalating into a significant global public health catastrophe that poses a threat to the economies of all countries, particularly poor countries like Malawi. It was discovered to affect 382 million (7.7%) people in 2013 and is expected to reach 483 million (8.3%) by 2030. According to current forecasts, the total number of cases in the world could quadruple in the next two decades, resulting in a corresponding increase in the disease's human, social, and economic consequences. According to the Internal Diabetes Federal (IDF) data, poor and middle income nations account for almost 70% of current cases of type 2 diabetes. Type of study: This will be a cross-sectional descriptive and analytical study aimed at estimating the prevalence of type 2 diabetes mellitus and its risk factors and their association with diabetes complications Problem: Prevalence of type 2 diabetes mellitus, risk factors and complications at Queen Elizabeth Central Hospital. Objectives: Broad Objective  To investigate the prevalence of type 2 diabetes mellitus, risk factors and the associated complications. Specific Objectives  To determine the prevalence of type 2 diabetes mellitus  To investigate the association between risk factors and type 2 diabetes mellitus  To evaluate the number of people who report type 2 diabetes mellitus related complications. Methodology: This will be a cross-sectional study which will be conducted at QECH, diabetes clinic. Qualitative data will be collected using a questionnaire form a sample of 81 participants above 45 years old (because most diseases become prominent 10-15 years after diagnosis. Therefore, recruiting participants above 45 years of age will assist in the analysis of the complications.) Expected findings: The prevalence of Type 2 diabetes mellitus is expected to be high because of ageing (insulin resistance increases with ageing) and other related factors like occupational and environmental factors. There will be more diabetes related complications in people who have lived with diabetes for a longer period of time. Dissemination: The results will be disseminated through a presentation to the medical laboratory science (MLS) department. A copy of results will also be submitted to the college of medicine and research ethics committee (COMREC) for review and to the COM library for access by other scholars. A copy of dissertation will be submitted to the QECH diabetes clinic to keep them updated of the current prevalence of risk factors and their associated complications. Further dissemination will be done through local and international seminars and conferences. The results will also be published in an accredited peer reviewed journal.
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Prevalence of type 2 diabetes, risk factors and complications at Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2022-08-17) Duncan, Bertha
EXECUTIVE SUMMARY Type 2 diabetes, by far the most common type of diabetes, is on the rise globally at an alarming rate. It is rapidly escalating into a significant global public health catastrophe that poses a threat to the economies of all countries, particularly poor countries like Malawi. It was discovered to affect 382 million (7.7%) people in 2013 and is expected to reach 483 million (8.3%) by 2030. According to current forecasts, the total number of cases in the world could quadruple in the next two decades, resulting in a corresponding increase in the disease's human, social, and economic consequences. According to the Internal Diabetes Federal (IDF) data, poor and middle income nations account for almost 70% of current cases of type 2 diabetes. TYPE OF STUDY This will be a cross-sectional descriptive and analytical study aimed at estimating the prevalence of type 2 diabetes mellitus and its risk factors and their association with diabetes complications PROBLEM Prevalence of type 2 diabetes mellitus, risk factors and complications at Queen Elizabeth Central Hospital. OBJECTIVES I. Broad Objective  To investigate the prevalence of type 2 diabetes mellitus, risk factors and the associated complications. II. Specific Objectives  To determine the prevalence of type 2 diabetes mellitus  To investigate the association between risk factors and type 2 diabetes mellitus  To evaluate the number of people who report type 2 diabetes mellitus related complications. METHOLOGY This will be a cross-sectional study which will be conducted at QECH, diabetes clinic. Qualitative data will be collected using a questionnaire form a sample of 81 participants above 45 years old (because most diseases become prominent 10-15 years after diagnosis. Therefore, recruiting participants above 45 years of age will assist in the analysis of the complications.) EXPECTED FINDINGS The prevalence of Type 2 diabetes mellitus is expected to be high because of ageing (insulin resistance increases with ageing) and other related factors like occupational and environmental factors. There will be more diabetes related complications in people who have lived with diabetes for a longer period of time. DISSEMINATION The results will be disseminated through a presentation to the medical laboratory science (MLS) department. A copy of results will also be submitted to the college of medicine and research ethics committee (COMREC) for review and to the COM library for access by other scholars. A copy of dissertation will be submitted to the QECH diabetes clinic to keep them updated of the current prevalence of risk factors and their associated complications. Further dissemination will be done through local and international seminars and conferences. The results will also be published in an accredited peer reviewed journal.

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