School of Public Health, College of Health Sciences, University of Nairobi, PO BOX 19676-00202, KNH, Nairobi, Kenya.
BMC Public Health. 2013 Apr 20;13:371. doi: 10.1186/1471-2458-13-371.
Urban slum populations in Africa continue to grow faster than national populations. Health strategies that focus on non-communicable diseases (NCD) in this segment of the population are generally lacking. We determined the prevalence of diabetes and associated cardiovascular disease (CVD) risk factors correlates in Kibera, Nairobi's largest slum.
We conducted a population-based household survey utilising cluster sampling with probability proportional to size. Households were selected using a random walk method and consenting residents aged 18 years and above were recruited. The WHO STEPS instrument was administered. A random capillary blood sugar (RCBS) was obtained; known persons with diabetes and subjects with a RCBS >11.1 had an 8 hours fasting blood sugar (FBS) drawn. Diabetes was defined as a RCBS of ≥ 11.1 mmol/l and a FBS of ≥ 7.0 mmol/l, or a prior diagnosis or receiving diabetes drug treatment.
Out of 2061 enrolled; 50.9% were males, mean age was 33.4 years and 87% had a minimum of primary education. Only 10.6% had ever had a blood sugar measurement. Age adjusted prevalence of diabetes was 5.3% (95% CI 4.2-6.4) and prevalence increased with age peaking at 10.5% (95% CI 6.8-14.3%) in the 45-54 year age category. Diabetes mellitus (DM) correlates were: 13.1% smoking, 74.9% alcohol consumption, 75.7% high level of physical activity; 16.3% obese and 29% overweight with higher rates in women.Among persons with diabetes the odds of obesity, elevated waist circumference and hypertension were three, two and three fold respectively compared to those without diabetes. Cardiovascular risk factors among subjects with diabetes were high and mirrored that of the entire sample; however they had a significantly higher use of tobacco.
This previously unstudied urban slum has a high prevalence of DM yet low screening rates. Key correlates include cigarette smoking and high alcohol consumption. However high levels of physical activity were also reported. Findings have important implications for NCD prevention and care. For this rapidly growing youthful urban slum population policy makers need to focus their attention on strategies that address not just communicable diseases but non communicable diseases as well.
非洲城市贫民窟人口的增长速度继续超过全国人口。针对这部分人群的非传染性疾病（NCD）健康策略通常是缺乏的。我们在肯尼亚内罗毕最大的贫民窟基贝拉（Kibera）确定了糖尿病的流行情况以及相关的心血管疾病（CVD）危险因素。
我们利用集群抽样进行了一项基于人群的家庭调查，采用与大小成比例的概率抽样。使用随机漫步法选择家庭，招募 18 岁及以上同意的居民。采用世界卫生组织 STEPS 工具进行调查。抽取随机毛细血管血糖（RCBS）；已知的糖尿病患者和 RCBS 大于 11.1 的患者，抽取 8 小时空腹血糖（FBS）。糖尿病定义为 RCBS 大于等于 11.1mmol/L 和 FBS 大于等于 7.0mmol/L，或有先前的诊断或正在接受糖尿病药物治疗。
在 2061 名登记的参与者中，50.9%为男性，平均年龄为 33.4 岁，87%接受过最低程度的小学教育。只有 10.6%的人曾经测量过血糖。年龄调整后的糖尿病患病率为 5.3%（95%CI 4.2-6.4），患病率随年龄增长而增加，在 45-54 岁年龄组中达到峰值，为 10.5%（95%CI 6.8-14.3%）。糖尿病的相关因素有：13.1%的人吸烟，74.9%的人饮酒，75.7%的人进行高强度的体力活动；16.3%的人肥胖，29%的人体重超重，女性的肥胖率和超重率更高。在患有糖尿病的人群中，肥胖、腰围增大和高血压的几率分别是非糖尿病患者的三倍、两倍和三倍。与整个样本相比，糖尿病患者的心血管危险因素较高，但他们使用烟草的频率显著更高。
这个以前未被研究的城市贫民窟地区糖尿病患病率很高，但筛查率很低。关键的相关因素包括吸烟和大量饮酒。然而，也有报道称该地区的体力活动水平较高。研究结果对非传染性疾病的预防和护理具有重要意义。对于这个快速增长的年轻城市贫民窟人口，政策制定者需要将注意力集中在不仅解决传染病问题，而且解决非传染性疾病问题的策略上。
