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- ItemRestrictedAssessing prevalence of diabetes for patients who are on Hydrochlorothiazide and Propranolol in Blantyre(Kamuzu University of Health Sciences, 2021-03-17) Shaba, Alice; Harrison, ChikondiHypertension 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
- ItemRestrictedAssessment of lipid profile patterns of diabetic patients at Kamuzu Central Hospital(Kamuzu University of Health Sciences, 2021-03-04) Filisa, Florence AnnaStudy 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.
- ItemRestrictedAssessment 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 VenancioStudy 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.
- ItemRestrictedComorbidity of depression with diabetes in noncommunicable diseases clinics in southern Malawi(Kamuzu University of Health Sciences, 2021-03-17) Udedi, Micheal MphatsoType 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.
- ItemRestrictedEvaluation of gestation Diabetes Mellitus at Zomba Central Antenatal Hospital Clinic(Kamuzu University of Health Sciences, 2021-01-13) Chimwaza, NelsonGestational 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.