Browsing by Author "Lwabukuna, Warles C."

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    Clinical predictors of imminent diabetic foot ulcer among diabetes mellitus patients in Dar es salaam and Zanzibar
    (IOSR Journal of Dental and Medical Sciences, 2024-05) Lwabukuna, Warles C.; Mgonda, Yassin M.
    Background: Diabetic foot ulcer (DFU) is a lesion that involves breakage in the skin with loss of epithelium that extends to the dermis and deeper layers involving muscle and bone which tend to develop due to factors associated with diabetes; hyperglycemia, presence of calluses, foot deformities, peripheral neuropathy, and vasculopathy. The management of diabetic foot ulcers requires a multidisciplinary approach; and is burdensome on the health care systems due to its chronic nature and potential complications. Diabetic foot ulcer has caused financial distress to the government in treating diabetic foot ulcer and its consequences; such as lower limb amputation which is irreversible, costly, and devastating to the quality of life of the patients, since diabetic foot ulcer patients have a low work productivity which in turn causes them to remain unemployed. DFU leads to increased morbidity and mortality due to complications like sepsis. Identification of the clinical predictors of imminent diabetic foot ulcer among diabetes mellitus patients is pivotal for the prevention and prompt identification of diabetic foot ulcer. This study aimed to identify and outline the clinical predictors of imminent diabetic foot ulcer among diabetes mellitus patients in Dar es Salaam and Zanzibar. Hence, identifying the clinical predictors of imminent diabetic foot ulcer such as; peripheral neuropathy for example which usually goes unnoticed because of its oblivious nature will therefore have no room for excuse and further prevent the development of diabetic foot ulcer. Correspondingly it allows health care systems to distribute access to health care rather than focusing on treating DFU significantly. It will also enable the government’s economic burden placed on managing DFU to temper down. The quality of life of patients will improve in terms of physical, mental, and social health hence, reducing morbidity and mortality. Methods: a descriptive cross-sectional study was conducted among diabetes mellitus patients attending diabetic clinics in Dar es Salaam and Zanzibar. Questionnaires were used to collect demographic data and clinical characteristics of study participants. Random blood glucose and skin scrape tests were done using standard methods. Results: A total of 202 participants (72 males and 130 females) were studied. The overall mean age of the study participants was 55.3± 16.7 years with a range of (13-83 years). The majority of the participants resided in Dar es Salaam, with 164 (81.2%) individuals, while 38 (18.8%) were from Zanzibar. Out of the 202 study participants, the proportion of diabetic foot ulcer was 40.6%, with the clinical predictors of imminent diabetic foot ulcer; peripheral neuropathy (47%), calluses (43.1%), hyperglycemia (34.2%) foot deformities (20.8%) and peripheral vasculopathy (10.4%). Conclusion: findings from this study provide evidence for the existence of clinical predictors of imminent diabetic foot ulcer among diabetes mellitus patients in which peripheral neuropathy, calluses, hyperglycemia, foot deformities, and peripheral vasculopathy predominate.
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    Early clinical markers of metabolic syndrome among secondary school adolescents in Dar es Salaam region 2019.
    (Hubert Kairuki Memorial University, 2021) Lwabukuna, Warles C.
    Background: Metabolic syndrome is one of the non-communicable disorders which have recently gained attention worldwide. This is due to its association with chronic diseases such as coronary artery disease, type 2 diabetes mellitus, cerebro-vascular disease and chronic kidney disease. Contrary to earlier thoughts, metabolic syndrome is no longer rare among children and adolescents due to the fact that the components that constitute this syndrome are increasingly reported in this population. Obesity and dyslipidemia seem to be the most common occurring components. Others include hypertension and hyperglycemia (impaired fasting blood glucose). Insulin resistance has remained the key underlying pathophysiology of the syndrome. Though pharmacologic agents are available to treat the different components of the syndrome, early detection of the components and timely preventive intervention is the only strategy that is less costly and more effective. Broad objective: To determine the prevalence of early clinical markers of metabolic syndrome among secondary school adolescents in Dar es Salaam. Methods: This is a descriptive cross-sectional study conducted among secondary schools in Dar es Salaam region. Special structured questionnaires were used to get demographic data. Blood pressure and anthropometric measurements (body weight, height and waist circumference) were taken by using standardized methods. Fasting blood samples were collected to measure blood glucose, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglyceride. For this study, the International Diabetes Federation (IDF) criteria were used to describe the early clinical markers of metabolic syndrome. Results: A sample of 217 adolescents (69 males and 148 females) was studied. Out of 217 participants; 162(74.7%) and 55(25.3%) were young (14-17 years) and elder (18-19 years) adolescents respectively. Participants from public and private schools were 104(47.9%) and 113(52.1%) respectively. Out of 217 study participants; 94 participants (43.3%) had at least one clinical marker for metabolic syndrome. The most prevalent clinical markers were central obesity (22.1%), dyslipedemia (low levels of high density lipoprotein (18%)) and impaired fasting blood glucose (hyperglycemia) (13%), while hypertension was the least prevalent clinical marker. The prevalence of metabolic syndrome was found to be 1.4%. Conclusion: Findings from this study provide evidence for the existence of early clinical markers of metabolic syndrome among adolescents in which central obesity, dyslipedemia and impaired fasting blood glucose (hyperglycemia) dominate with central obesity occurring significantly in young adolescents (10-17 years). Recommendations: It is strongly recommended that various measures against obesity and dyslipedemia should be taken early to rescue adolescents from these conditions. Such measures may include encouraging physical activity and healthy diet like unsaturated fats, soluble fibers, complex sugars, fruits and vegetables
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    Early clinical markers of metabolic syndrome among secondary school adolescents in Dar es Salaam, Tanzania.
    (Tanzania Journal of Health Research, 2021) Lwabukuna, Warles C.; Mgonda, Yassin M.
    Background:Metabolic syndrome is defined by the presence of three of four disorders; hypertension, obesity, dyslipidemia and diabetes mellitus type 2. The presence of any one or two of these constitutes early markers of the syndrome. It occurs in children and adolescents but its magnitude has not been determined consistently in many countries including Tanzania. Detection of early clinical markers is effective preventive strategy. The aim of this study was to determine the prevalence of early clinical markers of metabolic syndrome among secondary school adolescents in Dar es Salaam. Methods:A descriptive cross-sectional study was conducted among secondary schools in Dar es Salaam. Structured questionnaires were used to record demographic data. Blood pressure and anthropometric measurements were taken using standard methods. Fasting blood samples were collected for blood glucose, total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride. The International Diabetes Federation (IDF) criteria were utilized. Results:A total of 217 adolescents were enrolled; of these males and females were 32% (69) and 68% (148) respectively. Of these; 75% (162) were young adolescents (14-17years). Participants from public and private schools were 48% (104) and 52% (113) respectively.Early clinical markers of metabolic syndrome were detected in 43% (94) with at least oneclinical marker and 9% (19) with two markers. The prevalence of full-blown metabolic syndrome was 1.4% (3). Overall, the clinical markers included; dyslipidemia 30% (64), central obesity 22% (48), hyperglycemia 13% (29) and hypertension 2% (4). Prevalence of central obesity was 26% (42) among young adolescents and 11% (6) among elderly adolescents and the differencewas significant (p value= 0.02). Conclusion:Early clinical markers of metabolic syndrome exist among Dar es Salaam secondary school adolescents with dyslipidemia being the commonest marker while central obesity wasmuch common among young adolescents. School programs for screening students for detection of early markers of metabolic syndrome are needed.
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    Malnutrition and associated factors among adults starting on antiretroviral therapy at PASADA Hospital in Temeke District, Tanzania
    (Tanzania Journal of Health Research, 2018) Kabalimu, Titus K.; Sungwa, Edson.; Lwabukuna, Warles C.
    Background: Malnutrition is known to play a significant role in HIV/AIDS progression. Severe malnutrition has been previously found to be associated with early mortality among people living with HIV/AIDS (PLHIV) undergoing anti-retroviral therapy (ART) in Sub-Saharan Africa. The objective of this study was to determine the prevalence and factors associated with malnutrition among adult PLHIV attending care and treatment centre (CTC) in Temeke District, Tanzania. Methods: The cross-sectional descriptive study involved consecutive eligible patients attending the CTC for initiating in ART, between January and April, 2014. All participants who agreed to sign a consent form were enrolled. The participants had undergone baseline workup for ART initiation (by CTC), which included blood tests for liver and renal function tests, and CD4+ cell count, using calibrated instruments and standard techniques. In all patients the weight and height were measured to calculate the body mass index (BMI), denoting the nutritional status. This parameter was recorded in the study instrument together with the CD4+ count for each patient. A structured questionnaire was used to obtain more information, namely demographic and lifestyle data. Results: A total of 125 patients were included in this study. The prevalence of malnutrition among participants was 19.4%. Those with severe malnutrition comprised of 9%. Significant association was noted between malnutrition and irregular income (OR= 3.8, CI: 1.2-11.5) and also inability to get at least two meals a day (OR= 3.4, CI: 1.2-9.2). Severe malnutrition was significantly associated with the CD4+ counts of <200 cells/mm (OR =7.6; CI: 1.7-34.6). Conclusion: About 19% of participants were malnourished at the time of initiation of ART and among them 9% were severely malnourished. The most important risks for malnutrition were found to be irregular income and inability to get adequate feeding. This calls for routine nutritional assessment at CTCs prior to initiation of ART so as to identify those who need immediate intervention, including those with severe malnutrition.
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    Pattern of kidney disease among adult Hypertensive patients attending cardiac clinics in Dar es Salaam, Tanzania
    (IOSR Journal of Dental and Medical Sciences, 2024-07-11) Lwabukuna, Warles C.; Mgonda, Yassin M.
    Background: Hypertension is a worldwide public health challenge. Over the years it has become one of the leading cause of kidney disease. This is due to closely interlinked pathophysiological states such that sustained hypertension impairs kidney function. Progressive decline in kidney function conversely leads to worsening hypertension. Early detection of indicators of kidney disease among hypertensive individuals and timely preventive intervention are the key strategies to prevent development of kidney disease among hypertensive patients. Objective: The aim of this study was to determine the pattern of kidney disease among adult hypertensive patients in Dar es Salaam. Method: A descriptive cross-sectional study was conducted. Questionnaires were applied for social-demographic data. Blood pressure, body weight and height were measured using standardized methods. Blood sample was collected to measure serum creatinine and estimated GFR using CKD EPI2021, while urine was collected for biochemical analysis, dipstick method and albumin creatinine ratio. Results: A total of 400 hypertensive patients were enrolled in this study, 287 (72%) were females; 249(62%) had primary education, 232(58%) were unemployed, 240 (60%) had history of hypertension less than 10 years, 346(86.5%) had no history of alcohol consumption and 380(95%) had no history of cigarette smoking. Furthermore 240(60%) and 211(52.8%) had a blood pressure of ≥140 mmHg for systolic and ≥90 mmHg for diastolic respectively. BMI of ≥25kg/m2 was found among 236(59%). Reduced eGFR (<60Ml/Min/1.73M 2) and micro albuminuria were observed among 119 (30%) and 179(61.5%) respectively. Conclusion: Acute Kidney Injury, Nephrotic Syndrome and End Stage Renal Disease were found to be the main kidney diseases among hypertensive patients, while higher systolic blood pressure, advanced age, long standing hypertension and unemployment being significant risk factors for decreased eGFR. Keywords: Kidney disease, Hypertensive patients, Cardiac clinics
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    Profile of fasting blood glucose among secondary school students in Dar Es Salaam Region: A cross- sectional study
    (IOSR Journal of Dental and Medical Sciences, 2024-05-04) Lwabukuna, Warles C.; Ngemera, J.
    Introduction: Of recent eras, there has been a dramatic increase in type 2 diabetes mellitus among children and adolescents. Female gender, childhood hypertension, overweight and obesity have been reported as the main risk factors for pre-diabetes and diabetes among children and adolescents. Screening children and adolescents for type 2 diabetes mellitus helps earlier detection and interventions for the disease. Objective: The aim of this study was to determine the profile of fasting blood glucose among secondary school students in Dar es Salaam. Methods: This was a descriptive cross-sectional study among secondary schools in Dar es Salaam. Structured questionnaires were used to obtain demographic information. Anthropometric measurements were taken using standard methods. Fasting blood samples were collected for blood glucose. The American Diabetic Association and International Diabetic Federation criteria were utilized. Results: A total of 217 participants were enrolled; 32% (69) were males and 68% (148) were females, 75% (162) were in 14-17years age group. Students from private and public schools were 52% (113) and 48% (104) respectively. Fasting blood glucose levels were distributed as follows; normal level 87 %( 189), impaired/pre- diabetes 11.5 %( 25) and diabetes 1.4% (3). Impaired fasting blood glucose was significantly higher among students aged 18-19; 16.4% (9) with p-value 0.044. Similarly, diabetes was significantly higher among students within age group of 18-19 years 3.6% (2) than 14-17 age group counterparts. Prevalence of central obesity was 22% (48) which was higher among pre-diabetes 46% (22) and diabetes 6.1%(3) groups, and the difference was statistically significant (p value <0.001). Conclusion: Normal fasting blood glucose among secondary school students in Dar es Salaam is 6.7 fold of the abnormal with pre-diabetes being the commonest abnormality which is significantly prevalent among private schools and elder students with central obesity.