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High prevalence in Malawi of sight‐threatening retinopathy and visual impairment caused by diabetes: identification of population‐specific targets for intervention
Author(s) -
Burgess P. I.,
Allain T. J.,
GarcíaFiñana M.,
Beare N. A. V.,
Msukwa G.,
Harding S. P.
Publication year - 2014
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12492
Subject(s) - medicine , odds ratio , retinopathy , diabetes mellitus , diabetic retinopathy , prospective cohort study , population , cohort , cohort study , endocrinology , environmental health
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), HbA 1c (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.