Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Abdulrazak Mohamed Ahmed
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Dyslipidemia Among Type 2 Diabetes Mellitus Patients Attending Aden Abdulle
Hospital in Mogadishu Somalia.
Article · November 2021
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are available, but insulin must be stored in refrigerators – which many people do not have. Moreover,
many Somali diabetics develop serious or even fatal complications because they fail to follow medical
advice or treatment plans. Because many of the type 1 diabetes patients have died due to complications,
aid workers have found that most diabetic patients who seek hospital treatment have T2DM. Diabetic
patients without complications can be treated at the hospitals, whereas complex cases with
complications cannot be treated in any of the country’s hospitals. Those who can afford it therefore
seek treatment outside of the country (interview with international organisation in Nairobi, 5 November
2013). Proper education and instruction in how to manage diabetes, is beneficial for diabetics in their
daily lives. Nevertheless, even highly educated individuals with good knowledge of their own
condition faces the same challenges as other diabetics in Somalia: an almost non-existent public
healthcare system, unreliable access to medicines, lack of technical equipment, and expenses that many
was have difficulty paying, even those with a stable income. The price of insulin at points of sale in
Mogadishu (and other cities) is unknown; Land info has no information on whether devices for
measuring glucose levels are available for private individuals. In preparation for surgical procedures,
usually an amputation, which is a frequent complication for many diabetics, patients may need to be
stabilized with insulin. When a patient is discharged from hospital, he or she is not given any medicine
for daily use. This must be purchased at a market or from a pharmacy (Yusuf S, Reddy S, et al., 2016).
According to the latest WHO data published in 2017 Diabetes mellitus deaths in Somalia reached 1019
or 0.81% of total deaths. The age adjusted death rate is 22.70 per 100,000 of population ranks Somalia
109 in the world. Proportional mortality for diabetes patients is 1% of total deaths of all ages (WHO,
2016).A healthy diet, regular physical activity, maintaining normal body weight and avoiding tobacco
use can prevent or delay the onset of type 2 diabetes (WHO, 2002). Cardiovascular disease in Diabetes
is caused by multiple co-morbid conditions; key of which is Dyslipidemia. Other cardiovascular
diseases that include coronary heart diseases, stroke, and peripheral vascular diseases account for the
majority of deaths in diabetic patients (Fausi, 2006). It is noted that most people with diabetes do not
die of causes uniquely related to diabetes, but to cardiovascular complications that are caused by risk
factors including dyslipidemia. Dyslipidemia is defined as an abnormal lipid profile characterized by
high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), low high-density
lipoprotein cholesterol (HDL-C) and high triglycerides (TG). For diabetic patients the targets are: LDL
<100mg/dl (2.6mmol/l), HDL > 40mg/dl (1.02mmol/l) and TG <150mg/dl (1.7mmol/l) (NCEP, 2002).
Coronary artery disease, especially myocardial infarction (MI) is also among the leading causes of
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morbidity and mortality worldwide (Robert T, DOdesini AR, and Lepore G., 2006). The World Health
Organization estimated that Dyslipidemia is associated with more than half of the global cases of
ischemic heart disease and more than 4 million deaths annually (Mwita et al., 2012). Dyslipidemia has
emerged as an important cardiovascular risk factor in sub-Saharan Africa. Research shows that high
cholesterol level (≥3.8 mmol/l) accounted for 59% of ischemic heart disease and 29% of ischemic
stroke burden in adults age 30 and over. Dyslipidemia, especially elevated cholesterol has been shown
to vary across regions in sub-Saharan Africa (Belue R, Okoror TA, Iwelunmor, 2009). The frequency
of diabetes mellitus in Somalia faces unique challenges in combating the disease including lack of
funding for non-communicable diseases, lack of availability of studies and guidelines specific to the
population, lack of availability of medications, differences in urban and rural patients, and inequity
between public and private sector health care. Because of these challenges, diabetes has a greater
impact on morbidity and mortality related to the disease in sub-Saharan Africa, especially in Somalia
than any other region in the world. In order to address these unacceptably poor trends, contextualized
strategies for the prevention, identification, management, and financing of diabetes care within this
population must be developed (Boutayeb et al. 2012; IDF 2013).
Methods
Study design and setting
This was a cross sectional study conducted at Aden Abdulle Hospital in Mogadishu Somalia. Aden
Abdulle Hospital is located the south-central Benadir region of Somalia especially Digfer Rd KM5,
Lamiyaraha Bula Hubey, Wadajir District, Mogadishu, Somalia.
Aden Abdulle Hospital (AAH) is a non-governmental facility which endeavors to promote the health of
the population by providing accessible, affordable, and appropriate quality inpatient and outpatient
services. AAH motto is embedded in our mantra “caring that feels right” an important driving force in
the provision of our services to the community. Aden Abdulle Hospital is located in KM5 Wadajir
District, Mogadishu-Somalia. The hospital was established on the 9th September, 2007 in a city that
desperately needed medical care, AAH began as a small clinic but has over the years grown into a mid-
sized referral hospital with several specialists. Aden Abdulle hospital envisions a society that enjoys
affordable access to quality health services centered on five core values: quality; affordability; respect
for human life; responsiveness; and accountability.
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Recruitment of participants
The study population was adult diabetes patients attending the AA Hospital. Inclusion criteria were
adults over 35 years of age who had confirmed diabetes. Exclusion criterion was all patients diagnosed
with diabetes mellitus before the age of 35.
Data collection
Data was collected from July 2018 to December 2019 at the AAH. Data collected from all participants
who met the inclusion criteria included socio-demographic; age, sex, level of education,
occupation/employment status, monthly income and residence. Clinical data collected include blood
pressure (BP), fasting blood sugar (FBS) weight and height. Other clinical data recorded were duration
since DM diagnosis, personal and family history of cardiac disease. Behavioral/ practice data included
physical activity levels, Clinic attendance, alcohol consumption, cigarette smoking, adherence to
medication and dietary advice were also collected. Laboratory investigations were done at Aden
Abdulle Hospital (AAH) to determine fasting lipid profile. All participants were given a unique code
number alongside their questionnaire for easy identification and tracking on the clinical and laboratory
results. Data was entered and analyzed into a SPSS. Data cleaning was done at the end of data
collection analysis.
Statistical analyses
• Dependent variable: was Dyslipidemia which was defined as; Total cholesterol >5.2mmol/dl
(200mg/dl), and or increased LDL cholesterol >2.6mmol/L (130mg/dl), and or decreased HDL
cholesterol 1.7mmol/l (150mg/dl).
• Independent variables: were age, sex, level of education, employment status, monthly income,
marital status, residence, BP, FBS, BMI, physical activity, sedentary behavior, clinic attendance,
alcohol consumption, cigarette smoking, family and personal cardiac history. Analyses were done using
SPSS version 20. Descriptive statistics were done to describe distribution of Dyslipidemia against all
variables. Univariate analysis was done to assess for association with Dyslipidemia, and factors found
to be associated by the way of p ≤ 0.05 were subjected to multivariate analysis. Using backward
elimination criteria, those variables that attained p <0.05 on the multivariate logistic regression were
considered statistically significant. Comparisons of occurrence of Dyslipidemia were done between
males and females.
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Discussion
Participants’ characteristics
Socio-demographic and economic characteristics:
The mean age of the participants was 52 years (sd =+32), The majority (54%) were male, had attained
non formal education, (31.7%) were of middle social-economic status, as 60% earned a monthly
income of 200-399 USD, and lived in urban areas (46.7%) (Table 1).
Table 1: Socio-demographic and economic characteristics of T2DM patients in AA Hospital in
Mogadishu Somalia.
Table 1: Socio-demographic and economic characteristics of T2DM patients in AA Hospital in
Mogadishu Somalia
Socio demographic variables Frequency Percentage
Age Category
< = 45
36 30
> 45 84 70
Gender
Male 65 54
Female 55 46
Level of education
Primary & lower
Secondary & higher
54
66
45
55
Quantitative information Mean ± Sd
Age 52+32 years
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Clinical Characteristics
Prevalence of Dyslipidemia and other CVD risk factors:
Among all participants (22.5%) had Dyslipidemia, (59%) had been diagnosed with diabetes mellitus
within the past 5 years, had hypertension (31%). Overweight and obesity was noted in 59%;. Despite
the significant history of cardiac disease in 51% of the participants, and high rates of multiple CVD
risk factors in the study, 63% reported only fair or poor medications’ adherence (Table 2a).
Behavior and Practices
Majority (42.5%) of the participants not having received dietary advice on the management of their
illness. 33.3% sometimes were getting dietary advice they had received, However, only 24.2% were
getting regular dietary advice. Fortunately, only a minority smoked tobacco (17.5%). Additionally,
37.5% achieved physical activity one to two hours a day, over one quartile of the participants also spent
more than 2 hours on sedentary behavior. Almost two third of the patients always strictly takes
medication, takes the right amount of medicine, takes medication as prescribed by the doctor.
Insufficient physical activity was significantly associated with dyslipidemia. This concurs with
previous findings that showed a strong dose-response association between exercise-intense and lipid
(Lean S, 2012). In previous study intense physical activity was found to be associated with improved
lipids. Sedentary life style has been found to be associated with most cardiovascular risk factors.
BMI was also significantly associated with dyslipidemia. The corporate with previous study that
showed excess weight to be associated with increased prevalence of dyslipidemia and metabolic
syndrome. Obesity is also well known determinant of dyslipidemia.
This study was carried out at the outpatient department (OPD) of Aden Abdulle Hospital in
Mogadishu, Somalia to determine the proportion of dyslipidemia and its associated risk factors among
T2DM patients attending AA Hospital in Mogadishu Somalia.
Our results found that the proportion of dyslipidemia was a bit higher among the 45 to 54
years age group in compare to the other groups. A recent study found that highest rate of
dyslipidemia among 30-39 age group of man and 40-49 years age group of women, which is
similar to our finding (Ozder, 2014). It was also found that dyslipidemia was higher (31.7%)
among the participants those do not have formal education. Although recently published paper from
China has mentioned that dyslipidemia was positively associated with level of education (Yan et
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al., 2016). In terms of income, we have found that majority of the dyslipidemic patients were middle-
or higher-income group. It is might be due to less physical activity which we have found later that
72% of the participants had no regular physical exercise. It has been supported by previous study
conducted among Chinese population (Yan et al., 2016). We have found that the highest proportion of
dyslipidemia among the over-weight (52.5%) group. Several previous studies among Asian population
have found the similar results (Fung et al., 2019) In our study, hypertensive group had more
dyslipidemia (59.0%) in compare to non-hypertensive group, and also among the diabetic group
(55.0%) in compare to non-diabetic group. A serum lipid concentration among the Asian populations
is.
Table 2a: Association between dyslipidemia and other clinical characteristics among gender
Participants
characteristics
Unit(s) N. (%)
N=120
Male
N=65 (54%)
Female
N=55 (46%)
P value
Dyslipidemia Present 27 (22.5%) 13 (10.83%) 14 (11.67%)
0.476
Absent 93 (77.5%) 52 (43.3%) 41 (34.2%)
Blood pressure Normal (Non
hypertensive)
83 (69.2%)
43 (36%) 40 (33%)
0.437
Elevated
(hypertensive)
37 (30.8%)
22 (18.3%) 15 (12.5%)
Family history
of cardiac
diseases
Yes 32 (26.7%)
20 (16.7%) 12 (10%)
0.021
No 44 (36.7%) 21 (17.5%) 23 (19.2%)
I don’t know 44 (36.7%) 24 (20%) 20 (16.7%)
Obesity Yes 27 (22.5%) 13 (10.8%) 14 (11.6%)
0.476
No 93 (77.5%) 52 (43.3%) 41 (34.2%)
Duration of
diabetes
< 2 years 45 (37.5%) 18 (15%) 27 (22.5%) 0.017
2-5 years 26 (21.7%) 12 (10%) 14 (11.7%)
5-9 years 29 (24.2%) 21 (17.5%) 8 (6.7%)
10+ 20 (16.7%) 14 (11.7%) 6 (5%)
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Regularly
received
treatment for
diabetes
81 (67.5%) 48 (40%) 33 (27.5%) P value
0.107
39 (32.5%) 17 (14.2%) 22 (18.3)
Table-2b: Association between socio-demographic and clinical factors among dyslipidemia
Demo-graphic factor Dyslipidemia Chi square (P
value)
Present Absent
Age Category
<=45
>45
7
20
29
64
0.254
Gender
Male
Female
13
14
52
41
0.476
Education
Non formal education
Primary
Secondary
Higher secondary
Bachelor and higher
10
2
6
3
6
28
24
14
6
21
0.745
Clinical Factor
Blood pressure
Non hypertensive
Hypertensive
21
6
62
31
0.271
Family history of cardiac
diseases
Yes
No
I don’t Know
5
16
6
27
28
38
0.021
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Duration of diabetes
< 2 years
2-5 years
5-9 Years
10 years
13
6
4
4
32
20
25
16
0.495
Regularly received
treatment for diabetes
18
9
63
30 0.916
Table-3: Simple & multiple logistic regressions
Demographic
Variables
UOR (95% CI) P-value UOR (95% CI) P-value
Age category
< 45
> 45
0.148, 4.996 0.322 0.565, 1.429 0.651
Gender
Male
Female
0.443, 2.757 0.831 0.318, 1.867 0.564
Education 0.762, 1.339 0.946 0.392, 3.986 0.007
Clinical factor
Blood pressure 0.641, 4.779 0.275 .641, 4.779 0.00
Family history of
cardiac diseases
0.236, 3.083 0.026 0.324, 4.241 0.00
Obesity 0.877, 1.138 0.988 0.247, 1.043 0.738
Duration of
diabetes
0.864, 1.930 0.213 0.456, 5.793 0.013
Regularly received
treatment for
diabetes
0.383, 2.368 0.916 0.383, 2.368 0.002
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Conclusions
The study found a high prevalence of dyslipidemia among T2DM patients attending CDM clinics in
Turbo sub-county. This is high earlier on after diagnosis of DM despite good physical activity.
Occupation, BMI, FBS and insufficient physical activity are important predictors of dyslipidemia. The
alarming burden means that there is need for patient education and practice plan on importance of diet
observation, clinical attendance, physical exercises and weight reduction especially to those in
occupations that do not involve much physical activity (business persons). There is need to prioritize
research driven control and management of dyslipidemia, diabetes and related CVD risk factors. This
should be done at both national level and county level with government and society playing the role.
Recommendation
As a good proportion of diabetes patients (22.5%) are suffering from dyslipidemia, all DM patients
need to be checked for lipid profile soon after diagnosis of diabetes mellitus.
1. Attending physicians should arrange counseling of all DM patients for physical activity, Diet
control, weight control, and complains of medical advice.
2. Further study needs to be done with larger sample size targeting identified risk factors.
Acknowledgements
At first, we would like to thank Almighty Allah, the most Gracious and most Merciful for enabling me
to successfully completing my research work.
We would like to express our sincerely thanks and gratitude to the authority of the respective
Bangladesh University of Health Sciences (BUHS) for their tremendous support during this study. We
are ever grateful to Aden Abdulle Hospital authority for providing the endless support during data
collection phase for this study, without that, this study may not be possible. Lastly, we are thankful to
the study participants for their valuable time and patience during the whole study period.
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12. Ahmed et al. / European Journal of Medicine and Veterinary Sciences-Novus, 01(01), 010006EJMVS
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Please cite this article as: Ahmed et al., 2021 .European Journal of Medicine and Veterinary Sciences, EJMVS-
NOVUS, 01(01), 2021 010006EJMVS
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