Distribution, incidence, prevalence and default of patients with diabetes mellitus accessing public healthcare in the 11 districts of KwaZulu-Natal, South Africa

Abstract

Developing, low-income countries not only confront the challenge of resource constraints, an ageing population and urbanisation, but also face the double burden of communicable diseases such as HIV/ AIDS, which is currently the African continent's leading cause of death, and diabetes mellitus. [1] According to global estimations, it is predicted that by the year 2030, developing countries will experience as much as a 69% increase in the number of adults diagnosed with diabetes. [2] Diabetes caused more than 68 thousand deaths in South Africa (SA) in 2013. [3] Census information for the year 2013 indicates that in KwaZulu-Natal (KZN), a subtropical province of SA with the country's second-largest population, diabetes was the fourth-largest cause of death. [4,5] More than any other continent, Africa suffers from the combined presence and effects of diabetes together with HIV/AIDS and tuberculosis (TB). The interactions between these conditions and their treatment pose many challenges. Patients with diabetes have been found to have an increased general risk of infection and a two to three times increased risk of developing TB. HIV has been found to promote recurrence of latent TB and drastically increases the progression to active disease. [6] Some antiretrovirals cause glucose intolerance, predisposing the HIV-positive patient to developing diabetes. Drug interactions between the medications used to treat diabetes and TB reduce each other's effectiveness, making it difficult to treat both conditions in one patient. [7] The International Diabetes Federation's 2013 Diabetes Atlas [3] indicates that SA is home to more than two and a half million diagnosed diabetics, and an approximate further million who are undiagnosed. It has been estimated that another 2.6 million South Africans have impaired glucose tolerance, an early metabolic Background. The global increase in the prevalence of diabetes mellitus is most marked in African countries. The District Health Information System (DHIS) is the primary data collection system of the Department of Health in KwaZulu-Natal Province (KZN), South Africa. Data are routinely collected at all public healthcare facilities in the province and are aggregated per facility. Objective. To investigate the distribution, incidence and prevalence of diabetes in the public healthcare sector of KZN. Methods. Data collected by the DHIS for all patients with diabetes in KZN from 1 January 2010 to 31 December 2014 inclusive were analysed. Additional open-source databases were accessed to enable further exploration of the data collected. Results. The study showed that the majority (38.7%) of patients with diabetes on the public sector register were from the district of eThekwini. Positive correlations were found between the prevalence of diabetes, the mortality rate and the number of defaulters (patients with diabetes who did not return for regular treatment). Conclusions. Provincial estimates of the prevalence of diabetes in this study were higher than the known national prevalence. This may be ...

A diabetes profile of the eight districts in the public health sector, Eastern Cape Province, South Africa

“…Quality data collection and vigorous analysis are required to improve the design of these control mechanisms to compensate for the challenges of poor infrastructure, access to healthcare, large patient loads and competing burdens of HIV and tuberculosis (TB). [2,7] HIV and TB are healthcare priorities for the National Department of Health (DoH). However, large urban areas and major cities face an increasing burden of disease and mortality owing to diabetes.…”

“…Studies sampling 2014 data from the KZN DHIS show an increase in the number of patients and a corresponding incidence in diabetes. [7,9] The IDF serves as a global authority on the growing epidemic of diabetes. To develop their biennial atlas, the IDF collects comprehensive data from as many countries as possible.…”

“…Changes in data collection fields and data interpretation are common in the DHIS, and progress is made annually to improve the quality of information they provide. [7,12] Outcome 2: Annual increase in new patients and incidence of diabetes Since 2014, a steady increase in the number of new patients and corresponding incidence in diabetes has been observed. This trend is similar to the global increase of the disease.…”

“…The coastal province of KZN, for example, collects supplementary data such as the number of patients on the register and those initiated on treatment. [7,9] To gain further insight into the effects of the disease, the KZN DHIS records the number of diabetesrelated amputation and defaulting patients. These additional collection fields can be used to determine patient compliance and prevalence of disabling complications to direct the design of healthcare initiatives.…”

A comparison of private and public sector intensive care unit infrastructure in South Africa

“…The eThekwini Health District has a high burden of patients with immunocompromising diseases such as HIV infection and diabetes mellitus, as well as a high burden of drug-resistant tuberculosis. [18,19] This combination of epidemics, together with an insufficient number of isolation rooms and isolation rooms without appropriate ventilation, increases the risk of transmission of infections in a health facility.…”