Marshall, Sara
(2013)
Youth and Adolescents with Type 1 Diabetes in the Life for a Child Program in Rwanda, Africa.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
An estimated 285 million people had diabetes in 2010 of whom 480,000 were <14 years of age and most likely had type 1 diabetes (T1D). Each year, an additional 76,000 cases are diagnosed and incidence is increasing. Because there is no cure for T1D, this is an issue of great public health concern, particularly in developing countries, which will need to continue providing care for communicable diseases while addressing the rising incidence of chronic diseases.
To fully address the growing issue of T1D in developing countries, we need to better understand the true burden of the disease (incidence/prevalence), how it presents and progresses, and how to prevent early mortality. This dissertation represents the first attempt to describe these measures, in Rwandan youth and adolescents, with T1D and is based on collaboration with the Life For a Child program and the Association Rwandaise des Diabetiques.
Our data suggest that the rates of T1D in Rwanda are relatively low compared to African-Arabic countries, but similar to neighboring Tanzania. Incidence of recognized T1D has, however, increased over the last ten years, portending a larger issue in the near future. Additional efforts are needed to ensure proper and timely diagnosis, as it appears likely that cases are dying before diagnosis, or are being misdiagnosed, especially in those <5 years of age.
While the mortality rate in Rwanda was similar to several other African countries, it was significantly higher than rates seen in developed countries, and hypoglycemia was a major cause of death. We did, however, demonstrate that glycemic control could be improved in a country with limited resources, and confirmed that more frequent glucose monitoring is a potential intervention strategy.
Though these results are promising, it is clear that further research and interventions are needed to adequately address T1D in Rwanda. Additional efforts are needed to address the issue of balancing glycemic control and fear of hypoglycemia, especially in this population where food insecurity is common. Finally, additional strides need to be taken towards making this program more sustainable long-term, so that proper care may be available well into the future.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
27 September 2013 |
| Date Type: |
Publication |
| Defense Date: |
10 June 2013 |
| Approval Date: |
27 September 2013 |
| Submission Date: |
30 May 2013 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
170 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Diabetes
Youth
Africa |
| Date Deposited: |
27 Sep 2013 15:23 |
| Last Modified: |
19 Dec 2016 14:40 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/18825 |
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