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Bale BI, Zeppieri M, Idogen OS, Okechukwu CI, Ojo OE, Femi DA, Lawal AA, Adedeji SJ, Manikavasagar P, Akingbola A, Aborode AT, Musa M. Seeing the unseen: The low treatment rate of eye emergencies in Africa. World J Methodol 2025; 15:102477. [DOI: 10.5662/wjm.v15.i3.102477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 01/11/2025] [Accepted: 01/21/2025] [Indexed: 03/06/2025] Open
Abstract
BACKGROUND Emergency medical care is essential in preventing morbidity and mortality, especially when interventions are time-sensitive and require immediate access to supplies and trained personnel.
AIM To assess the treatment rates of eye emergencies in Africa. Ocular emergencies are particularly delicate due to the eye’s intricate structure and the necessity for its refractive components to remain transparent.
METHODS This review examines the low treatment rates of eye emergencies in Africa, drawing on 96 records extracted from the PubMed database using predetermined search criteria.
RESULTS The epidemiology of ocular injuries, as detailed in the studies, reveals significant relationships between the incidence and prevalence of eye injuries and factors such as age, gender, and occupation. The causes of eye emergencies range from accidents to gender-based violence and insect or animal attacks. Management approaches reported in the review include both surgical and non-surgical interventions, from medication to evisceration or enucleation of the eye. Preventive measures emphasize eye health education and the use of protective eyewear and facial protection. However, inadequate healthcare infrastructure and personnel, cultural and geographical barriers, and socioeconomic and behavioral factors hinder the effective prevention, service uptake, and management of eye emergencies.
CONCLUSION The authors recommend developing eye health policies, enhancing community engagement, improving healthcare personnel training and retention, and increasing funding for eye care programs as solutions to address the low treatment rate of eye emergencies in Africa.
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Affiliation(s)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | | | | | | | | | | | | | - Pirakalai Manikavasagar
- Public Health for Eye Care, London School for Hygiene and Tropical Medicine, London CB21TN, United Kingdom
| | - Adewunmi Akingbola
- Department of Public Health, University of Cambridge, Cambridge CB2 1TN, Cambridgeshire, United Kingdom
| | | | - Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
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Zulu N, Piotie PN, Webb EM, Maphenduka WG, Cook S, Rheeder P. Screening for diabetic retinopathy at a health centre in South Africa: A cross-sectional study. J Public Health Afr 2025; 16:681. [PMID: 39968353 PMCID: PMC11830854 DOI: 10.4102/jphia.v16i1.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 11/20/2024] [Indexed: 02/20/2025] Open
Abstract
Background In South Africa, screening for diabetic retinopathy (DR) is non-existent at the primary healthcare (PHC) level because of the absence of a screening programme. This leads to preventable vision loss. Aim To describe the clinical characteristics and outcomes of eye screenings and subsequent referrals. Setting Laudium Community Health Centre (CHC), a PHC facility in Tshwane. Methods We conducted a cross-sectional study from February 2022 to August 2022. Individuals with diabetes were screened for eye complications using visual acuity testing, intraocular pressure measurement, and fundoscopy with a non-mydriatic digital fundus camera. Fundus images were analysed by an optometrist and an artificial intelligence (AI) programme. Demographic and clinical data were collected. Results A total of 120 participants were included, with the majority (60.7%) from Laudium CHC. Most participants (64.2%) were on oral agents, and 66.7% were women. The mean haemoglobin A1c (HbA1c) was 8.3%, with a median diabetes duration of 8 years. Artificial intelligence detected more glaucoma cases (17.5% vs 9.2%) and DR (23.3% vs 15.8%) compared to the optometrist. In contrast, the optometrist identified more cases of macula pathology (29.2% vs 19.2%). Participants (n = 79) were referred to an ophthalmologist for diagnosis confirmation and management. Conclusion The study revealed that while DR was not highly prevalent among PHC patients with diabetes, there was a significant referral rate for other ocular complications. Artificial intelligence can enhance early detection and improve efficiency. Contribution The findings underscore the need to integrate diabetes eye screening programmes into PHC services for people living with diabetes.
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Affiliation(s)
- Ntokozo Zulu
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Patrick Ngassa Piotie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- University of Pretoria Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Elizabeth M. Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- University of Pretoria Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Wezi G. Maphenduka
- Department of Ophthalmology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Steve Cook
- The Eye Centre, East London, South Africa
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Walter Sisulu University, East London, South Africa
| | - Paul Rheeder
- University of Pretoria Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Kwon JW, Lee K, Kim SW, Park J, Hong JJ, Che JH, Seok SH. Therapeutic potential of histamine H 4 receptor antagonist as a preventive treatment for diabetic retinopathy in mice. Sci Rep 2024; 14:22664. [PMID: 39349555 PMCID: PMC11443088 DOI: 10.1038/s41598-024-72166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/04/2024] [Indexed: 10/02/2024] Open
Abstract
Diabetic retinopathy (DR) is a prevalent complication of diabetes, often resulting in vision loss and blindness. Existing treatments primarily aim to control blood sugar levels and inhibit angiogenesis. However, current therapies for DR, such as anti-VEGF and laser photocoagulation, are frequently invasive, and can cause adverse side effects. Consequently, there is a critical need for new preventive therapeutics to address DR more effectively. This study aimed to examine the therapeutic potential of a histamine H4 receptor (HRH4) antagonist as a preventive treatment for DR in mice. A mouse model of DR was established by intraperitoneally injecting 200 mg/kg of streptozotocin (STZ). Immune cell infiltration into the retina of mice with STZ-induced diabetes was measured using fluorescence-activated cell sorting (FACS) 12 weeks after STZ injection. The preventive effects of the HRH4 antagonist on inflammation and pathological retinal vessel leakage were determined in a mouse model of DR. Infiltration of HRH4-expressing macrophages increased in the retina of mice with STZ-induced DR. The HRH4 antagonist prevented macrophage infiltration and retinal vascular leakage to prevent STZ-induced DR in mice without causing any retinal toxicity. The infiltration of macrophages increased in the retina of mice with STZ-induced diabetes through HRH4, indicating that HRH4 is potentially a novel preventative therapeutic target in DR. These findings suggest that targeting HRH4 is a promising strategy for the prevention and treatment of DR.
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Affiliation(s)
- Jung Won Kwon
- Macrophage Lab, Department of Microbiology and ImmunologyInstitute of Endemic Disease, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kihwang Lee
- Department of Pediatric Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Wha Kim
- Macrophage Lab, Department of Microbiology and ImmunologyInstitute of Endemic Disease, Seoul National University College of Medicine, Seoul, Republic of Korea
- College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon, Republic of Korea
| | - Jisu Park
- Macrophage Lab, Department of Microbiology and ImmunologyInstitute of Endemic Disease, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Joo Hong
- National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju, Republic of Korea
- KRIBB School of Bioscience, Korea University of Science and Technology (UST), Daejeon, Republic of Korea
| | - Jeong-Hwan Che
- Biomedical Center for Animal Resource Development and Institute for Experimental Animals, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Seung Hyeok Seok
- Macrophage Lab, Department of Microbiology and ImmunologyInstitute of Endemic Disease, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Maluleke KD, Ntimana CB, Mashaba RG, Seakamela KP, Maimela E. Associated factors of diabetic retinopathy in type 1 and 2 diabetes in Limpopo province in South Africa. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1319840. [PMID: 38770017 PMCID: PMC11104328 DOI: 10.3389/fcdhc.2024.1319840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/15/2024] [Indexed: 05/22/2024]
Abstract
Background Diabetic retinopathy (DR) is the major cause of vision impairment or blindness in individuals who have diabetes. It has accounted for 2.6% of all cases of blindness, and 1.9% of all cases of vision impairments globally. There is a lack of data on the prevalence of diabetic retinopathy and its associated factors amongst diabetic rural populations. Hence, the current study aimed to determine factors associated with diabetic retinopathy (DR) among diabetes mellitus (DM) patients undergoing diabetic therapy. Methods The study was cross-sectional in design and the participants were selected using convenient sampling. STATA version 15 software was used for data analysis. Chi-square was used to compare proportions. Logistic regression was used to determine the relationship between DR and associated risk factors. Results The prevalence of DR was 35.3%, of which 32% were mild and 3.4% were moderate non-proliferative DR (NPDR). Females were more unemployed than males (32.1% versus 16.8%, p=0.0058). Males were found to drink alcohol (21.8% versus 1.9%, p<0.001) and smoke cigarettes (4% versus 0.3%, p=0.0034) more than females. Being aged ≥ 55 years (OR: 2.7, 95% CI: 1.6-4.4), with matric qualification (OR: 0.6; 95% CI: 0.4-1.0); employed (OR: 1.4, 95% CI: 1.2-1.6); having high systolic blood pressure (OR=1.4, 95%CI=1.1-1.7) were the independent determinants of DR. Conclusions The prevalence of diabetic retinopathy was 34%. DR was determined by high systolic blood pressure, old age, and employment. Although not statistically significant, gender, hyperglycemic state, poor glycemic control, smoking, and increased body mass index (BMI) were associated with increased risk of developing DR.
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Affiliation(s)
| | - Cairo Bruce Ntimana
- Dikgale Mamabolo Mothiba (DIMAMO) Population Health Research Centre, University of Limpopo, Polokwane, South Africa
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Charumbira MY, Berner K, Louw QA. Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15636. [PMID: 36497710 PMCID: PMC9735592 DOI: 10.3390/ijerph192315636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 05/05/2023]
Abstract
A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.
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Affiliation(s)
- Maria Y. Charumbira
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, South Africa
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Abdool Z, Naidoo K, Visser L. Implementation and evaluation of a team approach to managing diabetes mellitus and diabetic retinopathy in the South African district health system. AFRICAN VISION AND EYE HEALTH 2021. [DOI: 10.4102/aveh.v80i1.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Diabetic retinopathy (DR) screening programmes have been developed and implemented in different countries based on availability of resources. Most protocols developed for DR have been solely dedicated to DR screening without involving systemic screening.Aim: To implement and evaluate a DR screening model utilising a team of healthcare practitioners (HCPs) to manage diabetes mellitus (DM) to reduce DR progression.Setting: Primary healthcare clinics and Voortrekker hospital in Waterberg district of Limpopo province.Methods: A cross-sectional study was conducted, in which a total of 107 patients with DM from seven clinics consented to participation. A proposed DR screening model was implemented where patients with DM were screened for systemic complications at clinics and referred to Voortrekker district hospital for retinal photography. Questionnaire responses evaluated the success of the screening process and operational challenges.Results: From the study population, 32 (29.1%) were male and 75 (70.1%) were female. The mean age of patients was 63.7 years with a mean weight of 80.69 kg. The mean duration of DM was 9.26 years and the mean haemoglobin A1c (HbA1c) level was 9.7%. From the 47 patients who had visual acuity less than 6/9, 74.5% had refractive error. About 10% (9.4%) had DR or diabetic macular oedema (DME) and 38.3% had other lesions. Referral to an ophthalmologist was necessary in 36.5% of cases.Conclusion: The implementation of a team approach to co-manage DM and DR utilising the developed protocol improved the quality of care for patients with DM in the district health system.
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Akuffo KO, Asare AK, Sewpaul R, Dukhi N, Kumah DB, Agyei-Manu E, Addo EK, Reddy P. Eye care utilization among diabetics in the South African National Health and Nutrition Examination Survey (SANHANES-1): a cross-sectional study. BMC Res Notes 2020; 13:407. [PMID: 32867822 PMCID: PMC7457475 DOI: 10.1186/s13104-020-05245-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Diabetes is a chronic disease of uncontrolled blood sugar levels. People with diabetes are at an increased risk of developing visual impairment and other diabetes-related visual complications. The study aims to determine the eyecare utilization pattern and its associated determinants among diabetics in the South African National Health and Nutrition Examination Survey (SANHANES-1). RESULTS The mean age of participants was 56.2 years and 66.6% were females. The prevalence of eyecare utilization among participants was 49.0% and this differed significantly by age groups (p = 0.024) and the number of years since diabetes diagnosis (p < 0.001). After statistical adjustments, older age (55-64 years OR = 4.18, p = 0.003 and ≥ 65 years OR = 4.78, p = 0.002), having health insurance (OR = 6.32, p = 0.002), and having had diabetes for 6-10 years (OR = 4.23, p = 0.005) were significantly associated with eye care utilization. About half of people diagnosed with diabetes in South Africa have had an eye examination since diabetes diagnosis, which is disturbingly low given the impact of diabetes complications on eye health. Government policies must be directed at ensuring access to affordable health insurance and eye health education on diabetes.
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Affiliation(s)
- Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Akosua Kesewah Asare
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ronel Sewpaul
- Health & Wellbeing, Human and Social Capabilities, Human Sciences Research Council, Cape Town, South Africa
| | - Natisha Dukhi
- Health & Wellbeing, Human and Social Capabilities, Human Sciences Research Council, Cape Town, South Africa
| | - David Ben Kumah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eldad Agyei-Manu
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Usher Institute for Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Emmanuel Kofi Addo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Ophthalmology and Visual Sciences, Moran Eye Centre, University of Utah, Salt Lake City, Utah, USA.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, USA
| | - Priscilla Reddy
- Health & Wellbeing, Human and Social Capabilities, Human Sciences Research Council, Cape Town, South Africa.,Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
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Godman B, Basu D, Pillay Y, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Okwen PM, Niba LL, Nonvignon J, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Distiller LA, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia A, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future. Front Pharmacol 2020; 11:108. [PMID: 32265688 PMCID: PMC7098994 DOI: 10.3389/fphar.2020.00108] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health, National Department of Health, Pretoria, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Gaborone, Botswana
| | - Patrick Mbah Okwen
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Larry A Distiller
- Centre for Diabetes & Endocrinology (Pty) Ltd, Johannesburg, South Africa
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Department Of Health, Shayandima, South Africa
| | - Jeffrey Wing
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.,Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.,Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | | | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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9
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Misra A, Gopalan H, Jayawardena R, Hills AP, Soares M, Reza-Albarrán AA, Ramaiya KL. Diabetes in developing countries. J Diabetes 2019; 11:522-539. [PMID: 30864190 DOI: 10.1111/1753-0407.12913] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 12/24/2022] Open
Abstract
There has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro- and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.
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Affiliation(s)
- Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Hema Gopalan
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
| | | | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Mario Soares
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Alfredo A Reza-Albarrán
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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10
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Aleman-Flores R, Mompeo-Corredera B. Glial Cells and Retinal Nerve Fibers Morphology in the Optic Nerves of Streptozotocin-induced Hyperglycemic Rats. J Ophthalmic Vis Res 2018; 13:433-438. [PMID: 30479713 PMCID: PMC6210862 DOI: 10.4103/jovr.jovr_130_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study analyzes the structures of optic nerve elements, i.e., glial cells and nerve fibers, in an STZ-induced hyperglycemic animal model. Morphological changes in glial elements of the optic nerve in hyperglycemic and normoglycemic animals were compared. Methods: Transmission electron microscopy, histochemistry, immunohistochemistry, and morphometry were used in this study. Results: Hyperglycemia increased the numbers of inner mesaxons and axons with degenerative profiles. Furthermore, it led to both an increase in the amount of debris and in the numbers of secondary lysosomic vesicles in glial cytoplasm. Hyperglycemia also led to a decrease in glial fibrillary acidic protein expression and an increase in periodic acid-Schiff-positive deposits in the optic nerves of hyperglycemic animals. Conclusion: We conclude that the damage to the structural elements observed in our animal models contributes to the pathogenesis of optic neuropathy in the early stages of diabetes.
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