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©IDOSR PUBLICATIONS
International Digital Organization for Scientific Research ISSN: 2579-0811
IDOSR JOURNAL OF BIOCHEMISTRY, BIOTECHNOLOGY AND ALLIED FIELDS 8(3): 38-47, 2023.
https://doi.org/10.59298/IDOSR/JBBAF/23/14.5311

Assessment of Diabetes Mellitus Prevalence and Associated

Complications among Patients at Jinja Regional Referral Hospital

Al-Busaidy Swalah Suleiman Salim

Faculty of Clinical Medicine and Dentistry Kampala International University Western

Campus Uganda.

ABSTRACT
In recent years, Africa has witnessed a notable shift in its disease landscape from acute
infectious conditions to chronic non-communicable diseases like diabetes. The economic
impact of diabetes and its complications has become a significant concern, affecting
individuals, families, healthcare systems, and national economies through direct medical
costs and productivity loss. Uganda, in particular, has observed a rising prevalence of
diabetes, with the Uganda Diabetes Association reporting a 1.4% prevalence, accounting for
approximately 500,000 individuals affected. This surge in diabetes presents a dual challenge
as both a public health issue and an economic burden, necessitating vigilant monitoring and
stringent management. Recognizing its profound public health implications in terms of
morbidity, mortality, and cost, a comprehensive investigation into the prevalence and
complications of diabetes mellitus was conducted at Jinja Regional Referral Hospital (JRRH).
Using a retrospective facility-based cross-sectional study design encompassing qualitative
and quantitative approaches, this research reviewed 784 patient records admitted to JRRH
from January 2018 to December 2018. The findings revealed a notably high prevalence of
diabetes mellitus at 8.2%. Noteworthy gender disparities were observed, with a higher
prevalence among males (12%) than females (6%) within the studied population. Moreover,
urban dwellers exhibited a higher susceptibility to diabetes compared to rural counterparts,
and the risk was observed to escalate with age. Complications associated with diabetes
mellitus were alarmingly prevalent, reaching 89.23%, predominantly characterized by
microvascular complications, accounting for 56.90%. Despite the severity of complications,
the case fatality rate stood at 1.54%, lower than the documented 4%, possibly influenced by
a spectrum of contributing factors both positive and negative. The study underscores the
urgency for increased focus on diabetes care in Jinja, emphasizing the imperative for further
research, robust health education initiatives, and enhanced funding allocation toward
managing this escalating health concern.
Keywords: Diabetes Mellitus, Diseases, Public Health, Complications, Males and Females.

INTRODUCTION
With the lifestyle change that accompanies DM has been classified into Type I and
improvement in earning, the prevalence of Type II based on several metabolic and
Diabetes Mellitus (DM) (especially type 2 clinical criteria, but one thing that is
DM) has increased in tandem due to an common for both types is chronic
increase in the number of people, hyperglycaemia and the metabolic
especially in Africa, who lead a more derangements that accompany it [7, 8]. The
sedentary, high-calorie-intake life [1=3]. chronic hyperglycaemia of diabetes is
Diabetes is a group of metabolic diseases associated with long-term damage,
characterized by hyperglycaemia resulting dysfunction, and failure of different
from defects in insulin secretion, insulin organs, especially the eyes, kidneys,
action, or both [4-6]. For clinical purposes, nerves, heart, and blood vessels [9, 10].

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Over the past couple of years, the disease increasing urbanization and population
burden in Africa has steadily shifted from aging, diabetes will pose an even greater
acute infectious conditions to chronic non- threat. It is expected that by 2040 there
communicable diseases, Diabetes being will be 34.2 million adults in the region
one of them. Diabetes has long ceased to living with diabetes, more than double the
be a disease of the obese, old affluent number in 2015 [19]. Uganda still has to
Westerner; it has crept into the young grapple with poor and inadequate diabetes
African population and the affected age care, especially in rural areas [21]. What
group gets younger by the day [11, 12]. As makes the situation in Uganda even direr is
a result of the increased prevalence of the fact that regular blood pressure
diabetes, complications also have become monitoring is only done in about 56% of
more common and physician has to deal the diabetics and only a few (26.7%)
with diabetes complications more now achieve the recommended target of <
than ever before. Possible complications 140/90 mmHg, only 11,5% go for the
include heart attack, stroke, kidney failure, recommended annual eye check-up, 2.2%
leg amputation, vision loss and nerve for the annual foot exam, 4.5% annual
damage [13, 14]. In pregnancy, poorly dental check-up, 13.9% have their
controlled diabetes increases the risk of lipid/cholesterol check-up done and only
foetal death and other complications [15]. about 32% have their annual kidney
Diabetes and its complications cause function assessment done [22]. This might
significant economic loss to people with be so from the high cost incurred in
diabetes and their families, and to health managing diabetes. This makes diabetes in
systems and national economies through Uganda both a public health and an
direct medical costs and loss of work and economic problem that needs close and
wages [16, 17]. In Sub-Saharan Africa, the adequate monitoring with stringent
disease burden of DM has increased management if Uganda is to progress at the
steadily over the past few decades or so same pace as other countries in the
[18]. An estimated 14.2 (9.5–29.4) million developed world toward the achievement
people aged 20–79 have diabetes in the of the Sustainable Development Goals
sub-Saharan Africa (SSA) region, (SDGs) of 2030. Given the increased public
representing a regional prevalence of 2.1– health importance, morbidity, and
6.7 %. SSA has the highest proportion of mortality burden, plus the cost
undiagnosed cases of diabetes; over two- implications of DM and its complications
thirds (66.7 %) of people with diabetes are in African countries, a study into its
unaware of their status. The majority of prevalence and complications was
people with diabetes (58.8 %) live in cities, warranted and the researcher conducted
even though the population in the region such a study at Jinja Regional Referral
(61.3 %) is predominantly rural. With Hospital (JRRH), Uganda.
METHODOLOGY
Study Design Inclusion Criteria
A retrospective facility-based cross- All files of Patients admitted and treated in
sectional study design was used which the medical wards of JRRH within the time
applied both qualitative and quantitative scope of the study were used for the study.
approaches. Exclusion Criteria
Area of Study All files of patients admitted and treated in
The study was conducted at Jinja Regional the medical wards of JRRH within the time
Referral Hospital. scope of the study but whose data was
Study Population unclear and unverifiable were excluded.
The study population was all patients Sample Size Determination
admitted in the male and female medical Being a retrospective cross-sectional
wards of Jinja Regional Referral Hospital study, which involved the review of patient
within the time scope of the study. records all the files of patients admitted to
the medical wards of JRRH and attended to
between January 2018 to December 2018
were used in the study.

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Sampling Procedures bivariate and multivariate analytical
Convenient sequential enrolment was used methods being employed.
for the study whereby all patients’ records Quality Control
falling within the time scope of the study Data obtained from the participants’ files
were collected and used. were scrutinized for consistency and
Data Collection Methods and where any uncertainties arose
Management clarifications were sought from the staff at
Data was collected chiefly through record the internal medicine department and
review. Medical records of patients that diabetic clinic where necessary to compare
had been chosen by the sampling records. Files whose diagnoses were found
procedure above were reviewed and not to be clear and could not be clarified or
biodata, diagnosis, complications and verified were excluded from the study.
outcomes of treatment were useful for this Ethical Considerations
study. Data collected was tallied, Clearance was obtained from Kampala
tabulated, and charted in a way that International University-Western Campus
reflected the study objectives. faculty of Clinical Medicine & Dentistry
Data Analysis through IREC and an introductory letter
Data was entered into Microsoft Excel 2016 was obtained which was presented to the
professional spreadsheets and analyzed administration of FPRRH. The researcher
using SPSS version 17.0. Data analysis was affirmed the use of the information
done as per the objective; descriptive obtained from the patient’s records for
statistics in the form of percentages, purposes meant only for the research and
charts, tables and graphs with univariate, did not divulge the said information to any
unauthorized parties.
RESULTS
Social–demographic factors contributing to the prevalence of diabetes mellitus and its
complications at Jinja Regional Referral Hospital
Table 1: Showing Socio-demographic characteristics of respondents (N = 784)
Characteristic of patients Frequency Percentage
Male 314 40%
Sex
Female 470 60%
Below 45 years 502 64.03%
Age
45 years and above 282 36.97%
Basoga 470 51.80%
Tribe
Others 314 20.06%
Rural 659 84.06%
Residence
Urban 125 15.94%

Table 1 shows that the majority of the above. Most of the respondents were
respondents were female 470 (60%) Basoga (51.80%) compared to the rest of
compared to males who were 314(40%). other tribes who were 314 (20.06%).
Also, the study findings show that the Furthermore, the study shows that the
majority of the respondents 502 (64.03%) majority of the respondents 659 (84.06%)
were aged below 45 years whereas the least of the respondents were from rural areas
282 (36.97%) were aged 45 years and while 125 (15.94%) were from urban areas.

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Prevalence of Diabetes Mellitus

Table 2: Showing the prevalence of Diabetes Mellitus (N=65)
Characteristic of patients Frequency Percentage Prevalence

Male 38 58.46% 4.85%

Sex
Female 27 41.53% 3.44%
Total 65 100 8.29%
Below 45 Years 16 24.62%
Age
45 Years And Above 49 75.30%
Total 65 100
Basoga
Tribe
Baganda
Total
Rural 22 33.85% 3.34%
Residence
Urban 43 66.15% 34.4%
Total 65 100

65 respondents out of the total 784 had a diagnosis, the majority were above 45
diagnosis of diabetes. Out of the 65, 38 years. For the sake of convenience, the
were males and 27 were females. This gave researcher divided the subjects into two
an overall diabetes prevalence of 8.29%, age clusters; those below the age of 45
with the males contributing 4.85% and the years and those 45 years and above. The
females 3.44%. 12.00% of the total male 45-year mark was chosen based on the
population and 6.00% of the female recommendation by the American Diabetes
population were diabetic. The ages of the Association (ADA) that annual screening
total number of subjects fell between 18 for diabetes is done from this age onwards.
and 75 years while of the 65 with a DM

The proportion with a diagnosis of DM

Diagnosis of Diabetes 38, 12%
Other Diagnoses 276, 88%
n=314

Proportion with diagnosis Of DM

12%

Diagnosis of Diabetes
Other Diagnoses
88%

Figure 1: Showing proportion with diagnosis of DM

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The proportion of males and females two age clusters to try and find out the
with DM association between age and DM within the
The researcher then went ahead to population.
calculate the odds of being diabetic in the

Table 3: Showing odds of diabetes by age cluster (N = 784)

AGE CLUSTER With DM Without DM TOTALS

Below 45 years 16 486 502

45 years and above 49 233 282

TOTALS 65 719 784

In Table 3 above the odds of having years and above. In other words, below the
diabetes below the age of 45 years was age of 45, one was 0.16 times more likely
found to be 0.16 times the odds when 45 to be diabetic.

(n = 58)

Showing various DM complications of the

patients
37.94%
25
21.04%
20 25.86%
Neuropathy
15
Eye problems
10
Renal disease
3.43%
5 1.73%
Cardiovascular
0 Diabetic foot

Figure 2: showing various DM complications of patients

Table 2 shows complications on record who had diabetes were reported to have
that were directly attributed to DM: - some sort of complication related to DM.
neuropathy 22(37.94%), Eye problems Of these, 33 (56.90%) had microvascular
18(31.04%), Renal disease 15 (25.86%) complications while the rest (43.10%) had
cardiovascular disease 2 (3.43%) and macrovascular types as illustrated in the
Diabetic foot 1(1.73%). 58 (89.23%) of those figure below.

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Complications of Diabetes Mellitus

33, 43%

43, 57% Microvascular

Macrovascular

Figure 3: showing complications of diabetes mellitus

Diabetes-Related Deaths attributed to DM or its complications was

Over the 12 months of the study, one on record. This was from a total of 65 cases
(1.54%) death that could be directly with a diagnosis of DM. 19.

DISCUSSION
Prevalence of Diabetes Mellitus importantly, study limitations
The prevalence of DM was high (8.2%), a encountered could also have affected the
large proportion of them being males final result; for one, missing records and
(4.855); higher than females (3.44%). More missing files could have impacted the final
of the males (12%) were diabetic than prevalence value making it higher or lower
females (6%) within the study population. than those from similar studies elsewhere.
The prevalence is close to the global The study, however, agreed with some
prevalence of 8.5% [23] and far better than findings of other previous studies. The
that of the Asian population of 60% [24]. prevalence of DM in males is higher than in
The findings are also similar to those in females. This agrees with existing
Eastern China of 8.0% but higher than 4.6% literature that males are at an increased
in Western China [25] and higher than the risk of DM than women [30]. What was also
standardized prevalence of 4.0% among apparent from the study is the fact that the
Chinese adults [26]. Of even more prevalence of DM was higher in urban folk
importance, it is lower than the overall compared to rural folk [30]. This could be
prevalence for Uganda and Tanzania in attributed to the different ‘modernized’
2015. The overall prevalence for the two lifestyles in the urban areas. High-caloric
countries was 10.1% (8.3% for Tanzania foods and a more sedentary lifestyle are
and 16.1% for rural Ugandans [27] It is seen in urban areas [31]. The risk of DM is
however slightly higher than the 7.4% also seen to increase with advancing age.
obtained for Eastern Uganda in 2013 [28], From the study, those 45 years and above
but a bit lower than the 9.0% obtained in had a prevalence of 75.38% compared to
Kasese District [29]. What the findings 24.62% for those below. The mean age of
emphasize is the regional variation that people with DM is 35 years and the
does exist as pertains to the prevalence of Ugandan Prevalence is 1.4% [30]. From our
DM which could be a result of several study, people with increased prevalence or
factors. For instance, variations in more at risk of DM are older and the
population dynamics, socio- prevalence of 8.2% is higher than the 1.4%
demographics, and lifestyles could be the in the previous study. This could either be
cause of these variations. Different study a result of many undiagnosed cases in the
designs and methodologies used could previous studies or that our study dealt
also result in these variations. More with those already diagnosed and the

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values were bound to be higher. People are Cardiovascular complications also
diagnosed later when complications have emerged as an important increasing
already set in [32]. complication of diabetes [32].
Complications of Diabetes Mellitus Deaths resulting from Diabetes Mellitus
The prevalence of DM complications was Only one (1.54%) death was attributable to
89.23%. Both macrovascular and DM and/or its complications. The case-
microvascular complications were fatality rate related to DM is placed at 4.0%
encountered in the study subjects. The [23]. Various factors could be attributed to
prevalence of macrovascular the lower fatality rate obtained in our
complications was 43.10% and that of study. On the positive end, it could mean
microvascular was 56.90%. All these three that diabetic care within the population
values were higher than those from has markedly improved; refuting previous
previous studies [32]. This could be Ugandan studies [21].
attributable to our patients having been In the negative, underdiagnosed and/or
diagnosed late and when they seek undiagnosed cases, poor health-seeking
healthcare, complications have already set behaviour and irregular checking of blood
in [33]. Of the total diabetic cases, 25.86% sugar levels cause people to remain
had renal disease, 31.04% had eye undiagnosed and die at home thus giving a
problems, 1.73% had foot complications, lower value than is true [22]. It could be a
37.94% had neuropathies and 3.43% had product of study limitations such as
cardiovascular complications. Neuropathy, incomplete/missing records and missing
eye problems, and renal disease were the files. Or it could be an indicator of a lack
most significant complications in our of adequate follow-up and loss of contact
population of diabetics [34]. with cases [21].
CONCLUSIONS
The prevalence of Diabetes Mellitus was (CMEs) for health workers particularly
high. Prevalence in males was higher than those involved in diabetes care to
in females; the risk of DM is higher in empower them with current trends and
males than females. Urban dwellers are developments. Make efforts towards
more at risk of DM compared to rural subsidizing or waiving DM care and
dwellers. The prevalence of complications treatment. Organize regular seminars and
was high among diabetics. The case- conferences on Diabetes management and
fatality rate of DM was lower than the progress reporting. Regular publications
available values. and journals on new trends management
Recommendations protocols and criteria concerning diabetes
Allocate more funding to Diabetes; and making these accessible to medical
research, education, care, screening personnel, the general population, and
drives, and campaigns. Organize seminars, patients alike.
for a, and continued medical education
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CITE AS: Al-Busaidy Swalah Suleiman Salim (2023). Assessment of Diabetes Mellitus
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