Screening tuberculosis patients for diabetes mellitus in a routine program setting in Kampala, Uganda: a cross-sectional study

Abstract

Background: Uganda is located in East Africa and is among the countries with the lowest income globally. The ten health centres in this project serve populations in the under-privileged communities of Kampala. The objective of the study was to implement diabetes mellitus (DM) screening among tuberculosis (TB) patients in a routine program setting with limited resources and high human immunodeficiency virus (HIV) prevalence. Methods: A descriptive cross-sectional observational study was conducted in ten health centres in Kampala, Uganda. As part of a project to implement DM screening in a routine setting, TB patients were screened for DM by trained health workers. A fasting blood glucose (FBG) value ≥7.0mmol/l was considered to indicate DM. For this study, aggregate data was collected and analysed using SPSS for Windows, version 13.0. Results: Among 4,590 TB patients registered, 4,016 (88.0%) were screened with random blood glucose (RBG). Of those with RBG ≥6.1mmol/l, 1,093 (83.3%) were screened with FBG. In total, 92 (2.3%) patients were diagnosed with DM and 66 (71.8%) of them were newly diagnosed. The proportion of TB patients screened with FBG in the health centres varied from 58.2% to 100%. The proportion of patients screened with FBG and the prevalence of DM were significantly higher in private health centres compared with public health centres. The health centres in peri-urban areas screened more patients with RBG than those in urban areas. These health centres without DM services screened a larger number of patients with RBG and FBG than those with DM services. Conclusions: It appears feasible to implement screening TB patients for DM in routine program settings with limited resources and high HIV prevalence. Its introduction requires close collaboration between TB and DM services. The challenges identified need government attention and certain institutional and service-related factors need to be better managed at times

Acceptability and feasibility of tuberculosis and diabetes mellitus bidirectional screening and joint treatment services in Malawi: a cross-sectional study and a policy document review

“…Furthermore, the study reported that stigma due to TB disease, weak collaborative working culture among TB and DM clinics and financial challenges were among the barriers identified to be affecting implementation of effective integration of healthcare services. 48 On the other hand, a cross-sectional study that was conducted in Uganda 43 found that TB screening for DM in routine care was feasible, however, political will and programming issues were to be improved.…”

Low prevalence of diabetes mellitus in TB patients and the community in urban Uganda

“…10 The prevalence of diabetes in our health facility cases (3.8%) is also consistent with a larger study of TB patients in an outpatient setting in Kampala which found a 2.3% prevalence of diabetes. 11 Notably, studies of hospitalized patients from Uganda 7 and elsewhere in sub-Saharan Africa 12 have reported a much higher prevalence of diabetes -but these estimates may not reflect the burden of diabetes in the underlying community. While our estimate of overall diabetes prevalence is consistent with other studies in Uganda, our results may not reflect the contribution of diabetes to TB in Uganda as a whole, due to the young age distribution in the study population and the younger average age of individuals with prevalent compared to notified TB.…”