Sahadew N, Pillay S, Singaram V S
Clinical and Professional Practice, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
Department of Internal Medicine, King Edward VIII Hospital, Durban, South Africa.
S Afr Med J. 2022 Nov 1;112(11):855-859. doi: 10.7196/SAMJ.2022.v112i11.16546.
The growing burden of diabetes has long been under the radar in developing countries such as South Africa (SA). In recent years, there has been an unprecedented and exponential increase in recorded and undiagnosed diabetes mellitus (DM) cases. Unreliable data collection, overburdened health systems and poor infrastructure have all proved to be barriers to achieving optimum disease management. The District Health Information System (DHIS) serves as the data collection tool for the SA public healthcare sector. It is used in all nine SA provinces to gather data without individual patient identifiers.
To analyse and compare the DM data collected by the DHIS in the Western Cape (WC), Eastern Cape (EC), KwaZulu-Natal (KZN) and Gauteng provinces of SA.
An audit of diabetes-related data from the DHIS for 2016 was conducted. The data were then analysed using Excel. Time-series and cross-sectional analyses were made possible using pivot tables. Graphics were designed using Thinkcell software.
Of the four provinces surveyed, Gauteng recorded the highest incidence of DM, 67% higher than the reported global DM incidence estimate, while the WC had the lowest incidence. A similar pattern was also noted regarding the incidence of DM in people aged <18 years, with Gauteng having the highest and WC the lowest prevalence results. When comparing the number of DM-related consultations conducted in each province, the metropolitan districts were highlighted as hotspots of activity for DM care. This study found a moderate inversely proportional relationship between the incidence of DM in all provinces and education deprivation (p<0.05). Among the provinces that collected data on screening (excluding EC), KZN recorded the highest number of diabetic screenings.
Metropolitan areas were highlighted as areas to be targeted, further reinforcing the current connection observed between urbanisation and DM in SA. The presence and recording of screening efforts is an excellent step in the right direction for the SA public healthcare sector and the DHIS. With improved interprovincial co-ordination regarding standardisation of the criteria and specifications of data collection fields, and enhanced training for data officers and primary collection agents, good quality and rich data is a very close possibility.
糖尿病负担日益加重，长期以来在南非（SA）等发展中国家未受到足够关注。近年来，已记录和未确诊的糖尿病（DM）病例出现了前所未有的指数级增长。不可靠的数据收集、不堪重负的卫生系统和薄弱的基础设施都已证明是实现最佳疾病管理的障碍。地区卫生信息系统（DHIS）是南非公共医疗部门的数据收集工具。它在南非所有九个省份使用，收集的数据不包含个人患者标识符。
分析和比较南非西开普省（WC）、东开普省（EC）、夸祖鲁 - 纳塔尔省（KZN）和豪登省通过DHIS收集的糖尿病数据。
对2016年DHIS中与糖尿病相关的数据进行了审核。然后使用Excel对数据进行分析。通过数据透视表进行时间序列和横断面分析。使用Thinkcell软件设计图表。
在所调查的四个省份中，豪登省记录的糖尿病发病率最高，比报告的全球糖尿病发病率估计值高67%，而西开普省发病率最低。18岁以下人群的糖尿病发病率也呈现类似模式，豪登省患病率最高，西开普省最低。比较每个省份进行的与糖尿病相关的会诊次数时，大都市地区被突出显示为糖尿病护理的活动热点。本研究发现所有省份的糖尿病发病率与教育剥夺之间存在适度的反比关系（p<0.05）。在收集筛查数据的省份中（不包括东开普省），夸祖鲁 - 纳塔尔省记录的糖尿病筛查次数最多。
大都市地区被突出显示为需要重点关注的区域，进一步强化了目前在南非观察到的城市化与糖尿病之间的联系。筛查工作的开展和记录对南非公共医疗部门和DHIS来说是朝着正确方向迈出的出色一步。通过改进关于数据收集字段标准和规范的省际协调，并加强对数据官员和主要收集人员的培训，获得高质量和丰富的数据是非常有可能的。
