Work

High prevalence in Malawi of sight‐threatening retinopathy and visual impairment caused by diabetes: identification of population‐specific targets for intervention

Year: 2014

Type: article

Abstract: AIMS: To report the prevalence of all grades of diabetic retinopathy and associations with demographic, clinical and biochemical variables in people with diabetes in Southern Malawi. METHODS: We report baseline data from a 24-month prospective cohort study. Subjects were systematically sampled from two hospital-based, primary care diabetes clinics. Visual acuity, glycaemic control, systolic blood pressure, HIV status, urine albumin-creatinine ratio, and haemoglobin and serum lipid levels were assessed. Retinopathy was graded at an accredited reading centre using modified Wisconsin grading of four-field mydriatic photographs. RESULTS: A total of 357 subjects were studied. Of these, 13.4% subjects were HIV-positive and 15.1% had anaemia. The overall prevalence rates of any retinopathy, sight-threatening diabetic retinopathy and proliferative retinopathy were 50.1% (95% CI 44.9-55.3), 29.4% (95% CI 24.7-34.1) and 7.3% (95% CI 4.6-10.0), respectively. In multivariate logistic analysis the presence of sight-threatening retinopathy was associated with duration of diabetes (odds ratio 1.11, 95% CI 1.05-1.17), HbA1c (odds ratio 1.31, 95% CI 1.13-1.50), systolic blood pressure (odds ratio 1.03, 95% CI 1.01-1.04), haemoglobin (odds ratio 0.98, 95% CI 0.96-0.99) and LDL cholesterol (odds ratio 1.63, 95% CI 1.18-2.25). No significant association with HIV status was observed. In all, 3.6 and 1.4% of people in our study cohort had visual acuity worse than 6/18 and 6/60 in the better eye, respectively. CONCLUSIONS: The present study found a prevalence of sight-threatening retinopathy in diabetes clinics in one Sub-Saharan African country of approximately four times that reported in recent European studies and a prevalence of proliferative retinopathy approximately 10 times higher. The association of sight-threatening retinopathy with lower haemoglobin level is a new finding. Our results highlight the urgent need for provision of services for retinopathy detection and management to avoid a large burden of vision loss.

Source: Diabetic Medicine

DOI: 10.1111/dme.12492

Authors: P. I. Burgess, T. J. Allain, M. García‐Fiñana, N. A. V. Beare, G. Msukwa, S. P. Harding

Institutions: University of Liverpool, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Royal Liverpool University Hospital

Language: English

Topic: Retinal Diseases and Treatments

Subfield: Ophthalmology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $2,921