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Background: This cross-sectional study sought to establish the level of knowledge of diabetes among community members in rural and urban setups in Kenya and determine how this impacts on their attitude and practices towards diabetes. Methods: A face-to-face interview was done for selected respondents using a structured questionnaire for data collection. Results: 1982 respondents, 1151 (58.1%) female and 831 (41.9%) males aged between 13 and 65 years were interviewed. 539 (27.2%) of all the respondents had good knowledge of diabetes; of these 52% had tertiary education; 25% had secondary education while 14% and 9% had primary and no education, respectively. Only 971(49%) of the respondents had a positive attitude towards diabetes while 813 (41%) demonstrated good practices towards diabetes. Conclusion: This study indicates that the level of knowledge of diabetes in all regions in the country is very poor. It also indicates very poor attitudes and practices of the community towards diabetes. A comprehensive nationwide diabetes education programme is necessary to improve this situation.

BackgroundAlthough the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be done.MethodsTo ascertain recent use of medical services and medicines and other information about the impact of ill-health, we in 2008–2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs) and 1,770 matched comparison subjects (MCs) without diabetes in Cameroon, Mali, Tanzania and South Africa. We sampled DMs from diabetes registries and, in Cameroon and South Africa, from attendees at outpatient diabetes clinics. To recruit MCs, we asked subjects with diabetes to identify five persons living nearest to them who were of the same sex and approximate age. We estimated diabetes impact on medical services use by calculating ratios and differences between DMs and MCs, testing for statistical significance using two-stage multivariable hurdle models.FindingsDMs consumed 12.95 times more days of inpatient treatment, 7.54 times more outpatient visits, and 5.61 times more medications than MCs (all p<0.001). DMs used an estimated 3.44 inpatient days per person per year, made 10.72 outpatient visits per person per year (excluding traditional healers), and were taking an average of 2.49 prescribed medicines when interviewed.ConclusionsIn Sub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed diabetes is much greater than in industrialized countries and in China. Published calculations of the health-system impact of diabetes in Africa are dramatic underestimates. Although non-communicable diseases like diabetes are commonly thought to be minor problems for health systems and patients in Africa, our data demonstrate the opposite.

An audit was conducted of the degree of blood glucose control achieved during labour using a simple glucose/insulin infusion regimen. Records were examined of 40 pregnancies in 37 women over a 5-year period. Mean blood glucose was 5.2 +/- 2.2 (SD) mmol-1 7 h before delivery and 4.7 +/- 1.8 mmol-1 1 h before delivery. Four women experienced mild symptomatic hypoglycaemia before delivery and two during the 6 h after delivery. Seven neonates had blood glucose levels of 2.2 mmol-1 or less recorded at any time, but there was no relationship between neonatal hypoglycaemia and maternal hyperglycaemia during labour in the range of achieved maternal blood glucose levels. The mean HbA1 at booking was 8.4 +/- 1.2% (non-diabetic range 5.0-7.5%) and fell to a steady plateau from 12 weeks gestation to delivery averaging 7.5% (2SD above the non-diabetic mean). These data demonstrate the practical applicability of a simple regimen for control of blood glucose during labour in insulin-dependent diabetic women and suggest that less stringent aims of blood glucose control than originally adopted may be appropriate.