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Survey on Acute and Chronic Complications in Children and Adolescents With Type 1 Diabetes at Muhimbili National Hospital in Dar es Salaam, Tanzania

¹ Department of Pediatrics, University of Chieti, Chieti, Italy
² Department of Pediatrics and Child Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
³ Department of Internal Medicine, Hindu Mandal Hospital, Dar es Salaam, Tanzania
⁴ Department of Biostatistics and Epidemiology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
⁵ Department of Ophthalmology, Muhimbili National Hospital, Dar es Salaam, Tanzania

Address correspondence and reprint requests to Edna S. Majaliwa, Department of Pediatrics, University of Chieti, Via dei Vestini 15, 66100 Chieti, Italy. E-mail: dr_esma{at}yahoo.com

OBJECTIVE—The purpose of this study was to assess glycemic control and complications of type 1 diabetes in children and adolescents in Tanzania.

RESEARCH DESIGN AND METHODS—This demographic and clinical survey included 99 children aged between 5 and 18 years attending Muhimbili National Hospital Clinic for Diabetes. A structured questionnaire was used for evaluating socioeconomic data and for estimation of the prevalence of acute complications occurring over the last 6 months. The prevalences of retinopathy and diabetic nephropathy were determined by fundus ophthalmoscopy and by microalbuminuria, respectively.

RESULTS—All of these children were treated with a conventional insulin regimen. The mean ± SD duration of diabetes was 4.76 ± 3.58 years. Only 1 child (1%) had good glycemic control (A1C <7.5%), 60 children (60.6%) had moderate glycemic control (A1C 7.5–10%), 14 children (14.1%) had poor glycemic control (A1C >10–12.5%), and 24 children (24.2%) had very poor glycemic control (A1C >12.5%). At onset of diabetes, 75% of children presented with diabetic ketoacidosis (DKA); 89 children (89.80%) had at least one episode of DKA, and 55 children (55.67%) had symptomatic hypoglycemic episodes. Microalbuminuria was present in 29 (29.3%) and retinopathy in 22 (22.68%) children.

CONCLUSIONS—Although there are some methodological limitations, this survey highlights the difficulties of achieving good metabolic control and the high prevalence of acute and chronic complications in Tanzanian children with type 1 diabetes. These results clearly show that major efforts are needed to improve quality of care in children with type 1 diabetes in Tanzania.

Abbreviations: DKA, diabetic ketoacidosis

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