This study examines the prevalence of, and risk factors for, diabetic retinopathy in Asian Indian, Chinese, and Creole Mauritians in whom there is an increasing prevalence of non-insulin-dependent diabetes mellitus (NIDDM). As part of a population-based survey on the Indian Ocean island of Mauritius in 1992, glucose tolerance was classified using a 75-g oral glucose tolerance test on 6,553 persons. Subjects with newly diagnosed (n = 358) or known diabetes (n = 388), and a random sample of one in four subjects with impaired glucose tolerance (n = 165), had stereoscopic 45 degrees retinal photographs taken of three fields in the right eye after mydriasis. Photographs were graded according to a modified version of the Airlie House criteria. The prevalence of nonproliferative and proliferative retinopathy was: 14.5% and 0.3%, respectively, in newly diagnosed diabetic subjects; 42.0% and 2.3%, respectively, in known diabetic subjects; and 9.1% and 0%, respectively, in persons with impaired glucose tolerance. Muslim Indians had the lowest prevalence of retinopathy (10.8% and 34.0% for new and known diabetes, respectively), but after adjusting for other factors, this was significantly different only to Creoles (18.8% and 53.8%, respectively). Univariate analysis revealed significant differences between diabetic subjects with and without retinopathy in mean age, body mass index, fasting and 2-hour plasma glucose levels, systolic and diastolic blood pressure, fasting triglycerides, serum creatinine, and urinary albumin levels. For known diabetes, mean duration of diabetes and the proportion using insulin were also greater in those with retinopathy. Multivariate analysis using logistic regression confirmed that increasing duration of diabetes, fasting plasma glucose, systolic blood pressure, and urinary albumin concentration, and decreasing body mass index, were independently associated with retinopathy. The high prevalence of diabetic retinopathy observed in all major ethnic groups in Mauritius portends a serious public health problem, given the relative recency of the NIDDM epidemic in that country and the limited resources for laser photocoagulation. Strategies to minimize this problem among those already known to have diabetes should include strict control of plasma glucose and blood pressure.

The incidence of LEAs in diabetic Nauruans was higher than in other populations after adjusting for age and duration. Given the apparent success of the Nauruan footcare program in reducing amputation rates, other populations with high rates of NIDDM and LEAs should consider population-wide prevention strategies.

Disasters exact a heavy toll globally. However, the degree to which we can accurately quantify their impact, in particular mortality, remains challenging. It is critical to ensure that disaster data reliably reflects the scale, type, and distribution of disaster impacts given the role of data in: (1) risk assessments; (2) developing disaster risk management programs; (3) determining the resources for response to emergencies; (4) the types of action undertaken in planning for prevention and preparedness; and (5) identifying research gaps. The Sendai Framework for Disaster Risk Reduction 2015-2030s seven global disaster-impact reduction targets represent the first international attempt to systematically measure the effectiveness of disaster-impact reduction as a means of better informing policy with evidence. Target A of the Sendai Framework aims to ''substantially reduce global disaster mortality by 2030, aiming to lower the average per 100,000 global mortality rate in the decade 2020-2030 compared to the period 2005-2015.'' This article provides an overview of the complexities associated with defining, reporting, and interpreting disaster mortality data used for gauging success in meeting Target A, acknowledging different challenges for different types of hazard events and subsequent disasters. It concludes with suggestions of how to address these challenges to inform the public health utility of monitoring through the Sendai Framework.

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