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I-anemia phakathi kwabantu abadala abanesifo seswekile abaya kwisibhedlele esiqhelekileyo kwimpuma ye-Ethiopia: isifundo esinqamlezileyo
Teshome Tujuba, 1 Behailu Hawulte Ayele, 2 Sagni Girma Fage, 3 Fitsum Weldegebreal41, Medical Laboratory, Guelmsau General Hospital, Guelmsau City, Ethiopia 2 School of Public Health, Faculty of Health and Medicine, Haramaya University, Harala State, Ethiopia; 3 School of Nursing and Midwifery, Faculty of Health and Medicine, Haramaya University, Ethiopia; 4 Faculty of Health and Medicine, Haramaya University, Harar City, Ethiopia News Agency: Sagni Girma Fage, Faculty of Health and Medical Sciences, Haral University, Ethiopia, Harar, Ethiopia POBox 235 Email giruu06@gmail.com Background: Although anemia is a common disease among diabetic patients, there is very little evidence of anemia in this part of the population in Ethiopia, especially in the research environment. Therefore, the purpose of this study was to evaluate the degree of anemia and related factors in adult diabetic patients treated in a general hospital in eastern Ethiopia. Methods: A cross-sectional study of health basics was conducted on 325 randomly selected adult diabetic patients. Follow-up clinic at the Gramsoe General Hospital in eastern Ethiopia. Use pre-tested structured questionnaires to collect data through interviews and then perform physical and laboratory measurements. Then enter the data into EpiData version 3.1, and use STATA version 16.0 for analysis. Fit a binary logistic regression model to identify factors related to anemia. When p-value<0.05, all statistical tests are declared significant. Results: The degree of anemia in adult diabetic patients was 30.2% (95% confidence interval (CI): 25.4%-35.4%). Men (36%) have higher anemia than women (20.5%). Male (adjusted odds ratio (AOR) = 2.1, 95% CI: 1.2, 3.8), DM ≥ 5 years (AOR = 1.9, 95% CI: 1.0, 3.7), comorbidities (AOR = 1.9, 95) %CI : 1.0, 3.7) and suffering from diabetic complications (AOR = 2.3, 95% CI: 1.3, 4.2) were significantly associated with anemia. Conclusion: Anemia is a moderate to moderate public health problem among adult DM patients in the study subjects. Male gender, the duration of DM, the presence of DM complications, and DM comorbidities are factors related to anemia. Therefore, routine screening and appropriate management should be designed for men, DM patients with long DM duration, and anemia patients with complications and comorbidities, so as to improve the quality of life of patients. Early diagnosis and regular monitoring of diabetes may also help minimize complications. Keywords: Anemia, Diabetes, General Hospital, Eastern Ethiopia
I-anemia ibhekisela ekunciphiseni kwenani leeseli ezibomvu zegazi ezijikelezayo (RBC) kunye / okanye ukunciphisa umthamo wokuthwala i-oxygen ngenxa yoko, enganelanga ukuhlangabezana neemfuno ze-physiological zomzimba womntu.I-1,2 Ichaphazela amazwe asakhulayo kunye namazwe aphuhlileyo, kwimpilo yabantu, uphuhliso lwentlalo kunye noqoqosho.3 Kukho malunga ne-1.62 yeebhiliyoni zabantu abane-anemia emhlabeni, ibalwa kwi-24.8% yabemi behlabathi.4
I-Diabetes mellitus (DM) sisifo semetabolism, esiye sahlulahlulwe ngokohlobo lwe-I_juvenile okanye isifo seswekile esixhomekeke kwi-insulin kunye nohlobo lwe-II_isifo seswekile esingaxhomekekanga kwi-insulin.5 Kwizigulane ezinesifo seswekile, i-anemia ibangelwa ikakhulu kukudumba, iziyobisi, ukunqongophala kwesondlo, isifo sezintso, ukuhamba nezifo ezizimelayo, i-6,7 yokunciphisa i-erythropoietin ekuveliseni i-erythropoietin, ukunqongophala kwe-iron ngokupheleleyo okanye ukusebenza, kunye nokusinda kweeseli ezibomvu zegazi.8,9 Ngoko ke, i-anemia ixhaphakile kwizigulane zesifo seswekile.I-10,11 Kubantu abadala, ukuxhaphaka kwe-anemia yi-24% phakathi kwabasetyhini abaneminyaka yobudala (i-15-49 iminyaka) kunye ne-15% phakathi kwamadoda aneminyaka eyi-15-49.12
Kwizigulane ezine-DM, ngakumbi abo banesifo esicacileyo sezintso okanye ukungaphumeleli kwezintso, ukuxhaphaka kwe-anemia malunga ne-2 ukuya ku-3 amaxesha aphezulu ngaphezu kwezigulane ezingenayo i-DM.I-13,14 I-anemia kunye nesifo sikashukela, njenge-nephropathy, i-retinopathy, i-neuropathy, ukuphulukiswa kwesilonda esibi, kunye nesifo se-macrovascular [15,16], sinempembelelo embi kumgangatho wobomi bezigulane.I-17-19 Nangona ezi zibakala, iingxelo zophando zibonisa ukuba abaninzi i-25% yezigulane zesifo sikashukela azikwazi ukuqaphela i-anemia.20,21
Ukuqatshelwa kwangaphambili kunye nokunyangwa kwe-anemia kwizigulane ze-DM kunokunceda ukunciphisa ukugula nokufa, kunye nokuphucula umgangatho wobomi babo.22 Nangona kunjalo, ngokubanzi, ukuvavanywa kwe-anemia kwizigulane zesifo sikashukela e-Ethiopia kuphantsi kakhulu, kwaye okwangoku, akukho uphando olufanelekileyo.Oku kuyinyani ngakumbi kwindawo yophononongo.Ke ngoko, olu phononongo lujolise ekuqikeleleni iqondo le-anemia kwizigulana ezinesifo seswekile kwiSibhedlele esiPhakathi sase-Gramsoe empuma ye-Ethiopia kwaye sijonge izinto ezinxulumene nayo.
Uphononongo lwenziwe kwiSibhedlele esiPhakathi seGlymso (GGH) esisedolophini yaseGlymso, kwiSithili saseHabro, kwiLizwe lase-Oromiya, eMpuma Ethiopia.Isibhedlele simi malunga neekhilomitha ezingama-390 kwimpuma ye-Addis Ababa, ikomkhulu lase-Ethiopia.23 Ngokwengxelo ye-Ofisi yezeMpilo ye-Habro Woreda, i-GGH liziko lokudlulisela abantu abaqikelelwa kwi-1.4 yezigidi kwindawo engqongileyo.Ibonelela ngeenkonzo zempilo kwizigulane ezingaphezu kwama-90,000 kumasebe ayo ahlukeneyo kunye neekliniki minyaka le.Ikliniki yeSifo seswekile yenye yeeyunithi zobungcali ezibonelela ngeenkonzo kubaguli abanesifo seswekile abamalunga nama-660.ISithili saseHabro sibekwe kwindawo ephakamileyo ye-1800-2000 yeemitha.
Uphononongo olusekwe esibhedlele olusekwe kwi-cross-sectional lwenziwe ukusuka kwi-9 kaJuni ngo-2020 ukuya kumhla we-10 ku-Agasti 2020. Abathathi-nxaxheba abafanelekileyo ngabantu abadala (≥18 iminyaka) izigulane zeswekile ezilandelwa kwi-GGH.Izigulana zabantu abadala abanesifo seswekile eziye zatofelwa igazi kwiinyanga ezi-3 ezidlulileyo, izigulane ezikhulelweyo okanye ezisandul’ ukuzalwa okanye ezigula ngengqondo, izigulane ezenze utyando okanye zopha nangasiphi na isizathu, kunye nezigulane ezifumene unyango lwe-intestinal parasite azibandakanyi. .Funda.
Ubungakanani besampula bunqunywe ngokusebenzisa i-formula eyodwa yomlinganiselo wabemi kwaye isekelwe kwiingcamango ezilandelayo: i-95% yexesha lokuzithemba, i-5% yephutha le-5%, kunye nokuxhaphaka kwe-anemia yezigulane ze-diabetes kwi-Dessie Referral Hospital e-Northeast Ethiopia (p = 26.7)%).I-24 Emva kokongeza i-10% kubantu abangaphenduliyo, ubungakanani besampulu yokugqibela yi-331.
Izigulana ezingama-660 ezinesifo seswekile ziye zalandelwa ngenkuthalo kwikliniki yesifo seswekile kwi-GGH.Yahlula inani lilonke lezigulane ezinesifo seswekile (660) ngobungakanani besampulu yokugqibela (331) ukuze ufumane iisampulu ezimbini ngamaxesha.Ngokusebenzisa irejista yezigulane zesifo seswekile ezifumana iinkonzo zokulandela isifo seswekile esibhedlele njengesakhelo sesampulu, sasebenzisa i-sampling random yenkqubo ecwangcisiweyo yokubandakanya zonke ezinye izigulane kwisifundo.Nika umthathi-nxaxheba ngamnye wophando ngenombolo yesazisi eyodwa ukuphepha ukuphindaphinda, kwimeko apho isigulane sinye siphinda sivele ngexesha lophononongo ukuze kulandelelwe olunye.
Ukuqokelela idatha malunga nokuguquguquka kwe-sociodemographic, ukusetyenziswa kotywala, ukutshaya, kunye neempawu zokutya ngokusebenzisa i-questionnaire ecwangcisiweyo eguqulelwe kwi-step-by-step indlela ye-WHO yokubeka iliso kwisifo esingapheliyo.25 Ukusetyenziswa kweti nekofu, ukusebenzisa imibhobho yamanzi, iphepha lemibuzo lokuhlafuna likaCarter, ucwangciso-ntsapho, kunye nembali yokuba sexesheni kwafunyanwa ngokuphonononga uncwadi olwahlukeneyo.I-questionnaire ye-26-30 yabhalwa ngesiNgesi kwaye yaguqulelwa kulwimi lwendawo (Afaan Oromoo), kwaye emva koko yaguqulelwa kwisiNgesi ziingcali zeelwimi ezahlukeneyo ukujonga ukuhambelana.Fumana idatha yeklinikhi efana nobude besifo seswekile, uhlobo lwesifo seswekile, iingxaki zesifo seswekile, kunye nokuzila ukutya kweglucose yegazi kwiirekhodi zonyango zesigulane.Idatha yaqokelelwa ngabongikazi ababini abaqeqeshiweyo kunye negcisa laselabhoratri, kwaye lijongwe yinkosi yesidanga sempilo yoluntu.
Ukulinganisa uxinzelelo lwegazi (BP) usebenzisa imitha yoxinzelelo lwegazi yedijithali (Heuer) eqinisekiswa rhoqo.Phambi kokulinganisa uxinzelelo lwegazi, umntu ebengakhange asele naziphi na iziselo ezishushu, njengeti, ikofu okanye icuba elitshayayo, iCaterpillar ehlafunwayo, okanye enze umthambo ngamandla kwimizuzu engama-30 edlulileyo.Emva kokuba isifundo siphumle ubuncinane imizuzu emihlanu kwaye sirekhode umyinge wokufundwa kweBP, imilinganiselo emithathu ezimeleyo ithathwe kwingalo yasekhohlo.Imilinganiselo yesibini neyesithathu ithathwe kwimizuzu emihlanu kunye neshumi emva kwemilinganiselo yokuqala neyesibini, ngokulandelanayo.Uxinzelelo lwegazi luchazwa njengezigulane ezine-BP≥140 okanye i-DBP≥90mmHg) okanye abo baye bafumanisa kwangaphambili ukuba bathatha iziyobisi ze-antihypertensive.31,32
Ukumisela imeko yesondlo nge-index mass body (BMI), silinganise ubude kunye nobunzima besigulane.Xa umthathi-nxaxheba ngamnye emi ngokuthe tye eludongeni, izithende zabo zathinta udonga kunye, azizange zigqoke izicathulo, zigcine iintloko zabo zithe tye, kwaye zilinganisa ukuphakama kwazo ngerula kwaye zirekhode i-0.1 cm esondeleyo.Sebenzisa isikali sedijithali esiphawulwe 0-130 kg ukulinganisa ubunzima bakho.Phambi komlinganiselo ngamnye, linganisa isikali ukuya kwinqanaba elinguziro.Ukulinganisa ubunzima bomthathi-nxaxheba ngelixa enxibe iimpahla ezilula kwaye kungekho zihlangu, kwaye urekhode i-0.1 kg esondeleyo.33,34 Isalathisi sobunzima bomzimba (BMI) sibalwa ngokwahlula ubunzima bomzimba (kg) ngobude (m).Emva koko isimo sesondlo sichazwa ngokuthi: ukuba i-BMI <18.5, i-underweight;ukuba i-BMI = 18.5-24.9, ingaphantsi;ukuba i-BMI = 25-29.9, i-overweight;ukuba BMI ≥30.35,36, ukutyeba
Kufutshane ne-midpoint phakathi komda ongezantsi weembambo ezilula kunye nomphezulu wesiphelo, sebenzisa umlinganiselo we-tape ongeyena-elastic ukulinganisa umjikelezo wesinqe kwaye urekhode kwi-0.1 cm ekufutshane.Ukutyeba okuphakathi kuchazwa njengomjikelezo wesinqe kumadoda ≥ 94 cm, kunye nomda wesangqa esinqeni kubasetyhini ≥ 80 cm.30,36 Ngexesha loqeqesho, izigulane ezili-10 zabantu abadala ezinesifo seswekile ziye zafumana impazamo yokulinganisa ubuchwephesha (%TEM) ukuze kuncitshiswe iimpazamo zomlinganiselo weanthropometric.Iimpazamo eziboniweyo zomlinganiselo wobugcisa ngaphakathi naphakathi kwabakhi-mkhanyo zingaphantsi kwe-1.5% kwaye zingaphantsi kwe-2%, ngokulandelelanayo.
Amagcisa aselabhoratri aqokelele malunga neemililitha ezimbini (2 mL) zeisampulu zegazi kubo bonke abathathi-nxaxheba zaza zazifaka kwityhubhu yovavanyo ene-tripotassium ethylenediaminetetraacetic acid (EDTA K3) anticoagulant ukumiselwa kwehemoglobin.Hlanganisa ngokufanelekileyo igazi eliqokelelweyo kwaye usebenzise i-Sysmex XN-550 ye-hematology analyzer ukuze uhlalutye.Umlinganiselo we-hemoglobin wahlengahlengiswa ngokunciphisa ukuphakama kwabo bonke abathathi-nxaxheba ngokususa i-0.8 g / dl kunye nesimo sokutshaya ngokukhupha i-0.03 g / dl.Emva koko uchaze i-anemia njengenqanaba le-hemoglobin yabasetyhini <12g/dl kunye nendoda <13g/dl.Ubunzima be-anemia buhlukaniswe: amanqanaba e-hemoglobin yamadoda kunye nabasetyhini yi-11-12.9 g / dl kunye ne-11-11.9 g / dl, ngokulandelanayo, i-anemia encinci, ngelixa amanqanaba e-hemoglobin ye-anemia ephakathi kunye ne-anemia enzima yi-8-10.9 g/dl, ngokulandelanayo dl kunye <8 mg/dl.Indoda nenkazana
Qokelela iimililitha ezintlanu (5 mL) zegazi le-venous kwityhubhu yovavanyo ngaphandle kwe-anticoagulant ukumisela i-creatinine kunye ne-urea.Igazi elipheleleyo ngaphandle kwe-anticoagulant lixutywe imizuzu engama-20-30 kunye ne-centrifuged kwi-3000 rpm imizuzu emi-5 ukuhlula i-serum.Emva koko, i-Mindray BS-200E (i-China Mindray Biomedical Electronics Co., Ltd.) i-chemistry analyzer yekliniki yayisetyenziselwa ukugqiba i-serum creatinine kunye nomxholo we-urea nge-acid picrine kunye neendlela ze-enzymatic.37 Sebenzisa ireyithi yokucocwa kwecreatinine ukuqikelela izinga lokuhluza iglomerular.Sebenzisa i-Chronic Kidney Disease (CKD) Ratio (GFR), echazwa njenge-CKD-EPI Cockroft-Gault formula echazwe ngokwe-1.73 square metres.
Amanqanaba eglucose egazini lokuzila ukutya (ubuncinci iiyure ezisi-8) alinganiswa ngeminwe yeminwe kusetyenziswa imitha yeglucose yegazi elinganiswe iglucose yegazi.38 Ukuba inqanaba le-glucose yegazi lokuzila li-<80 okanye> 130mg/dl, ke ikhowudi ayilawulwanga ukulawula i-glucose yegazi.Lawula xa ixabiso le-glucose yegazi lokuzila liphakathi kwe-80-130mg/dl 39
Abathathi-nxaxheba bophononongo banikwe intonga ecocekileyo yokufaka iplanga kunye nekomityi yeplastiki ecocekileyo, eyomileyo, engavuziyo enenombolo yesiriyali yomfundi kuyo ukuze ihlolwe i-fecal parasite.Bayalele ukuba beze nesampuli yesitulo esitsha seegram ezimbini (malunga nobhontsi).Emva kokubona iintshulube (amaqanda kunye/okanye imibungu) kusetyenziswa iindlela zokuxhoma ngokuthe ngqo ezimanzi, iisampulu zajongwa kwimizuzu engama-30 yokuqokelelwa kwesampulu.Iisampulu ezisele zigcinwe kwi-tube yokuvavanya equkethe i-10 mL ye-10% ye-formalin ukuphucula izinga lokubona i-parasites, kwaye emva kokunyangwa nge-teknoloji ye-concentration ye-formalin-ether ye-precipitation, i-Olympus Microscope yayisetyenziselwa ukuhlolwa.
Sebenzisa i-lancet engasebenziyo ukuqokelela iisampulu zegazi le-capillary eminweni ukufumanisa isifo seengcongconi.Lungiselela ifilimu yegazi elincinci kwiglasi efanayo ecocekileyo ngaphandle kwegrisi, kwaye umoya womile.Izilayidi zangcoliswa nge-10% ye-Giemsa malunga nemizuzu eli-10, kwaye iintlobo ze-malariya parasites zahlolwa.Xa iindawo zamandla aphezulu ezili-100 zavavanywa phantsi kwenjongo yokuntywiliselwa kweoli, isilayidi sagqalwa njengesibi.40
Uqeqesho lweentsuku ezimbini malunga nezixhobo zokuqokelelwa kwedatha kunye neendlela zanikwa abaqokeleli zinkcukacha kunye nabaphathi.Ngaphambi kokuba iSibhedlele Jikelele seChiro siqokelele idatha yangempela yezigulane ze-30 zesifo sikashukela, i-questionnaire yavavanywa kwangaphambili kwaye ukuguqulwa okufunekayo kwenziwa ngokufanelekileyo.Umlinganiso obonakalayo ubekwe emgangathweni yimpazamo yobugcisa enxulumeneyo yomlinganiselo (%TEM).Ukongezelela, iinkqubo zokusebenza ezisemgangathweni zilandelwa kuzo zonke iisampuli zokuqokelela iisampuli zebhubhoratri, ukugcinwa, uhlalutyo kunye neenkqubo zokurekhoda.
Imvume yokuziphatha ifunyenwe kwi-Institutional Health Research Ethics Review Committee (IHRERC) yeSikole seMpilo sangaphambili kunye neMithi yase-Am Valley University (IHRERC 115/2020).Ikholeji ikhuphe ileta esemthethweni yokuxhasa i-GGH kwaye yafumana imvume kwintloko yesibhedlele.Ngaphambi kokuqokelela idatha, fumana imvume enolwazi, ngokuzithandela, ebhaliweyo kunye nesayinwe kumthathi-nxaxheba ngamnye wophando.Abathathi-nxaxheba baxelelwa ukuba yonke idatha eqokelelwe kubo iya kugcinwa iyimfihlo ngokusetyenziswa kweekhowudi, kwaye akukho zichongi zomntu ziya kusetyenziswa, kwaye ziya kusetyenziswa kuphela kwiinjongo zophando.Olu phando lwenziwe ngokuhambelana ne "Declaration of Helsinki".
Khangela ingqibelelo yedatha eqokelelweyo, faka ikhowudi kwaye ufake i-EpiData inguqulo 3.1, kwaye emva koko uthumele kwi-STATA version 16.0 yolawulo lwedatha kunye nohlalutyo.Sebenzisa iipesenti, ulungelelwaniso, i-avareji, kunye nezitenxo eziqhelekileyo ukuchaza idatha.Emva kokulungelelanisa izinga le-hemoglobin ngokwesimo sokutshaya sabathathi-nxaxheba kunye nokuphakama kwendawo, isimo se-anemia sinqunywe ngokwemigangatho entsha yokuhlelwa kwe-WHO.Linganisa imodeli yohlengahlengiso yezinto ezimbini eziguquguqukayo ukuze uchonge izinto eziguquguqukayo zohlahlelo lokugqibela lokuhlengahlengiswa kwezinto ezininzi.Kwi-bivariate logistic regression, ii-variables ezine-p-value ≤ 0.25 zithathwa njengabaviwa be-multivariate logistic regression.Ukuseka imodeli ye-multivariate logistic regression ukuchonga izinto ezingahambelani ne-anemia.Sebenzisa i-odds ratio kunye ne-95% yexesha lokuzithemba ukulinganisa amandla ombutho.Inqanaba lokubaluleka kweenkcukacha-manani labhengezwa njengexabiso le-p <0.05.
Kolu phononongo, izigulane ezingama-325 zabantu abadala zeDM zithathe inxaxheba kwintlanganiso, kwaye izinga lokuphendula lalingama-98.2%.Uninzi lwabathathi-nxaxheba;amadoda asuka ezilalini 203 (62.5%), 247 (76%), 204 (62.8%) kunye 279 (85.5%) ngamadoda atshatileyo, kwaye uhlanga lwabo Oromo.Iminyaka yobudala yabathathi-nxaxheba yayiyiminyaka eyi-40, kwaye i-interquartile range (IQR) yayiyiminyaka eyi-20.Malunga ne-62% yabathathi-nxaxheba abazange bayifumane imfundo esesikweni, kwaye i-52.6% yabathathi-nxaxheba ngamafama aqeqeshiweyo (Uluhlu loku-1).
Itheyibhile yoku-1 yeempawu zentlalo yabantu abadala be-DM abanyangwa kwisibhedlele esisempuma ye-Ethiopia ngo-2020 (N = 325)
Phakathi kwabathathi-nxaxheba bophando, i-74 (22.8%) ichaze ukuba baye batshaya ubuncinane kanye kanye ebomini babo, xa kuthelekiswa ne-13 yabantu abatshayayo ngoku (4%).Ukongeza, abantu abayi-12 (3.7%) basela ngoku, kwaye i-64.3% yabathathi-nxaxheba kuphando yiti emnyama.Ngaphezu kwesinye kwisithathu (68.3%) sabathathi-nxaxheba bophando babike ukuba bahlala besela ikofu emva kokutya.Ikhulu elinamashumi amathathu anesithathu (96.3%) kunye nama-310 (95.4%) abathathi-nxaxheba batye iziqhamo nemifuno ngaphantsi kwezihlandlo ezintlanu ngeveki.Ngokumalunga nesimo sabo sesondlo, i-92 (28.3%) kunye ne-164 (50.5%) abathathi-nxaxheba babetyebile kwaye batyebe kakhulu (iThebhile 2).
Itheyibhile ye-2 Iimpawu zokuziphatha kunye nezondlo zezigulane ze-DM zabantu abadala eziphathwe kwiSibhedlele esiPhambili sase-Ethiopia ngo-2020 (N = 325)
Ngaphezulu kwe-170 (52.3%) izigulane ezinohlobo lwe-II DM zine-avareji ye-DM ubude beminyaka eyi-4.5 (SD±4.0).Phantse i-50% yezigulane ze-DM zithatha iziyobisi ze-hypoglycemic zomlomo (i-glibenclamide kunye / okanye i-metformin), kwaye phantse ikota yesithathu yabathathi-nxaxheba bathatha i-glucose yegazi engalawulwayo (Itheyibhile 3).Ngokumalunga ne-comorbidities, i-2% yabathathi-nxaxheba babeneengxaki.I-80 (24.6%) kunye ne-173 (53.2%) izigulane ezine-DM ngaphandle koxinzelelo lwegazi zine-anemia kunye ne-non-anemia ngokulandelanayo.Ngakolunye uhlangothi, phakathi kwezigulane zeDM ezifunyanwe ukuba zinexinzelelo lwegazi, i-189 (5.5%) kunye ne-54 (16.6%) yayine-anemia ngokulandelanayo.
Itheyibhile 3 Iimpawu zeklinikhi zabantu abadala be-DM abanyangwa kwisibhedlele esisempuma ye-Ethiopia ngo-2020 (N = 325)
Iqondo le-anemia kwizigulane zesifo sikashukela ngu-30.2% (95% CI: 25.4-35.4%), kunye nenqanaba le-hemoglobin eliphakathi ngu-13.2 ± 2.3g / dl (amadoda: 13.4 ± 2.3g / dl, amabhinqa: 12.9± 1.7g / dl).Ngokuphathelele ubunzima be-anemia kwizigulane ze-DM ezine-anemia, kwakukho iimeko ze-64 ze-anemia encinci (i-65.3%), iimeko ze-26 ze-anemia ephakathi (26.5%), kunye neemeko ze-8 ze-anemia enzima (8.2%).I-anemia emadodeni (36.0%) yayiphezulu kakhulu kunabasetyhini (20.5%) (p = 0.003) (Umfanekiso 1).Sifumene ukulungelelaniswa okubalulekileyo phakathi kobunzima be-anemia kunye nobude besifo sikashukela (r = 0.1556, p = 0.0049).Oku kuthetha ukuba njengoko ubude be-DM bukhula, ubunzima be-anemia buvame ukunyuka.
Umzobo we-1 inqanaba le-anemia ngesini kwizigulane ze-DM zabantu abadala eziphathwa kwisibhedlele esisempuma ye-Ethiopia ngo-2020 (N = 325)
Phakathi kwezigulane zeDM, i-64% yamadoda kunye ne-79.5% yabasetyhini abanayo i-anemia, ngelixa i-28.7% kunye ne-71.3% yabantu abahlafuna i-Khat ngoku bane-anemia.I-67% yezigulane ze-DM zabantu abadala abasebenzisa ikofu emva kokutya babengenayo i-anemic, kwaye i-32.9% yabo ifunyenwe i-anemia.Ngokuphathelele ubukho be-comorbidities, i-72.2% yezigulane ezine-DM ngaphandle kwe-comorbidities zine-anemia, kwaye i-36.3% yezigulane ezine-DM comorbidities zine-anemia.Izigulane ze-Diabetes ezineengxaki ze-DM zine-anemia ephezulu (47.4%) kunezo ezingenazo iingxaki ze-DM (24.9%) (iThebhile 4).
Itheyibhile 4 Izinto ezinxulumene ne-anemia phakathi kwezigulane ze-DM zabantu abadala eziphathwa kwisibhedlele esisempuma ye-Ethiopia ngo-2020 (N = 325)
Fit i-bivariate kunye ne-multivariate logistic regression models ukuze uhlolisise unxulumano phakathi kwe-anemia kunye neenguqu ezichazayo.Kuhlalutyo lwe-bivariate;ubudala, isini, isimo somtshato, ukuhlafuna iKhat, ikofu emva kokutya, i-comorbidities, iingxaki zesifo sikashukela, ubude be-DM kunye nesimo sesondlo (BMI) zihambelana kakhulu ne-anemia ngexabiso le-p <0.25, kwaye i-Multivariate i-logistic regression.
Kwi-multivariate logistic regression analysis, amadoda ane-DM ≥ iminyaka eyi-5 ubude, ubukho bezinto ezixinzelelekileyo kunye neengxaki ze-DM zidibene kakhulu ne-anemia.Izigulane ze-DM zabantu abadala zi-2.1 ngamaxesha amaninzi okuba ne-anemia kunabasetyhini (AOR = 2.1, 95% CI: 1.2, 3.8).Xa kuthelekiswa nezigulane ze-DM ngaphandle kwe-comorbidities, izigulane ze-DM ezine-comorbidities zi-1.9 amaxesha amaninzi okuba ne-anemia (AOR = 1.9, 95% CI: 1.0, 3.7).Xa kuthelekiswa nezigulane ezine-DM ubude beminyaka eyi-1-5, izigulane ze-DM ezinexesha elide le-DM ≥ iminyaka emi-5 zinamathuba angama-1.8 amathuba okuphuhlisa i-anemia (AOR = 1.8, 95% CI: 1.1, 3.3).Umngcipheko we-anemia kwizigulane ezineengxaki ze-DM yi-2.3 amaxesha abo osebenza nabo (AOR = 2.3, 95% CI: 1.3, 4.2) (Itheyibhile 4).
Olu pho nonongo luvavanye ubunzima be-anemia kunye nezinto ezinxulumene nazo kwizigulane ze-DM eziye zalandelwa kwi-diabetes kwi-Gelemso General Hospital.Iqondo le-anemia kwisifundo sangoku yi-30.2%.Ngokohlelo lwe-WHO lokubaluleka kwempilo yoluntu, kwindawo yophando, i-anemia yingxaki yempilo yoluntu ephakathi phakathi kwezigulane zabantu abadala abane-DM.Isini, ubude be-DM, ubukho beengxaki zeDM, kunye namadoda ane-DM comorbidities achongiwe njengezinto ezinxulumene ne-anemia.
Iqondo le-anemia kolu phononongo lifaniswa nelo leSibhedlele saseTopiya iDessie Referral [24], kodwa iphezulu kuneyeSibhedlele saseTopiya iFenote Selam [41] kwisifundo sendawo esiqhutywe eChina, 42 Australia, 43 kunye neIndiya [44] ]., Yeyiphi ephantsi kunezifundo eziqhutywe eThailand [45], Saudi Arabia [46] kunye neCameroon [47].Lo mahluko usenokuba ngenxa yomahluko weminyaka yabemi bophononongo.Umzekelo, ngokungafaniyo nophononongo lwangoku olungabandakanyi abantu abadala abangaphezu kweminyaka eyi-18 ubudala, uphononongo eThailand lwalubandakanya abantu abadala abangaphezu kweminyaka engama-60 ubudala, ngelixa uphononongo eCameroon lwalubandakanya abantu abadala abangaphezu kweminyaka engama-50 ubudala.Umahluko unokuthi ube ngenxa yokunciphisa umsebenzi wezintso, ukuvuvukala, ukunyanzeliswa komongo wethambo, kunye nokungondleki (ukwanda kweminyaka) 17.
Siyamangaliswa kukuba kuphononongo lwethu, i-anemia yamadoda ixhaphake kakhulu kunasetyhini.Oku kufunyaniswayo kuchasene nezinye iingxelo zophando [42,48], apho abafazi banokuthi bafumane i-anemia kunamadoda anesifo sikashukela.Isizathu esinokwenzeka salo mahluko kukuba amadoda kwisifundo sethu ayenemikhwa ephezulu yokuhlafuna i-Khat, enokubangela ukulahleka kwesidlo49, kwaye i-Khat iqulethe i-tannins-into enciphisa i-bioavailability ye-non-heme iron ekudleni.50 Esinye isizathu esinokwenzeka kukuba ukuthathwa okuphezulu kwekofu kunye neti emadodeni kolu phononongo kuthintele ukufunxwa kwentsimbi emathunjini.51-54
Sifumene ukuba izigulane ezine-DM ≥ iminyaka emi-5 ziyakwazi ukuphuhlisa i-anemia kunezigulane ezine-DM ezinekhosi ye-1-5 iminyaka.Oku kuhambelana nezifundo eziqhutywe kwiSibhedlele saseFenote Selam e-Ethiopia, i-41 Iraq 55 kunye ne-United Kingdom.17 Oku kunokuba ngenxa yokuvezwa ixesha elide kwi-hyperglycemia, ekhokelela ekwandeni kwee-cytokines ezivuthayo ezineempembelelo ze-anti-erythropoietin, ezikhokelela ekunciphiseni inani.Ukuncipha kokujikeleza kweeseli ezibomvu zegazi kukhokelela ekunciphiseni ukujikeleza kwe-hemoglobin.35
Ngokuhambelana nezifundo eziqhutywe eChina, i-anemia ye-13 kulolu cwaningo yayixhaphake kakhulu kwizigulane zeDM ezineengxaki.Ngokwebhayoloji, iingxaki zesifo seswekile zisenokonakalisa kakhulu iseli kunye nesakhiwo semithambo yegazi yezintso, ukudumba kwenkqubo, kunye nokufakwa kwe-erythropoietin release inhibitors kunokukhokelela kwi-anemia yesifo seswekile.56 I-Hypoxia inokuchaphazela i-gene expression, i-metabolism, i-capillary permeability kunye ne-cell survival 57. Ukunciphisa iiseli zegazi ezibomvu kunye neempawu zayo ze-antioxidant ezinxulumene ne-anemia nazo zingabangela ezinye iingxaki kwizigulane ze-diabetes58.
Ukongezelela, izigulane ze-DM ezine-comorbidities zithandwa kakhulu kwi-anemia kunezigulane ze-DM ngaphandle kwe-comorbidities.Oku kuthelekiswa nezifundo ezifanayo zangaphambili [35,59], ezinokuthi zibangelwa yimpembelelo ye-comorbidities (njenge-hypertension) ekhokelela kwiingxaki ze-cardiovascular, ngaloo ndlela yandisa umngcipheko we-anemia.60
Njengolunye lwezifundo ezimbalwa kakhulu ezisekwe kwilabhoratri eziqhutywe e-Ethiopia, izifo ezingapheliyo ezifana neDM ziye zaxhaphaka ngakumbi, nto leyo eyenza ukomelela kolu phando.Ngakolunye uhlangothi, olu phononongo luphando olulodwa olusekelwe esibhedlele kwaye alunakumela zonke izigulane ezine-DM okanye izigulane ezilandelwa kwamanye amaziko onyango.Ubume obunqamlezayo boyilo lophononongo esilusebenzisileyo aluvumeli ukusekwa kobudlelwane bexeshana phakathi kwe-anemia kunye nezinto.Izifundo zexesha elizayo zingadinga ukusebenzisa ulawulo lwamatyala, izifundo zeqela okanye ezinye izicwangciso zophando zokuqwalasela iimpawu kunye neempawu ze-anemia, i-RBC morphology, i-serum iron, i-vitamin B12, kunye namanqanaba e-folic acid.
Kwimeko yophando, i-anemia yingxaki yempilo yoluntu ephakathi phakathi kwezigulane zeDM yabantu abadala.Isini, ubude be-DM, ubukho beengxaki zeDM, kunye ne-comorbidities yayingamadoda kwaye ichongiwe njengezinto ezinxulumene ne-anemia.Ngoko ke, ukuhlolwa kwe-anemia yesiqhelo kunye nolawulo olufanelekileyo kwizigulane ze-DM ezinexesha elide le-DM, i-comorbidities kunye neengxaki kufuneka zenzelwe ukuphucula umgangatho wobomi bezigulane.Ukuxilongwa kwangoko kunye nokujongwa rhoqo kwe-DM kunokunceda ukunciphisa iingxaki.
Idatha exhasa iziphumo ezichazwe kwi-manuscript inokufumaneka kumbhali ohambelanayo ngokweemfuno ezifanelekileyo.
Sithanda ukubulela intloko yeSibhedlele esiPhambili saseGelemso, abasebenzi beKliniki yeSifo seswekile, abathathi-nxaxheba bokufunda, abaqokeleli bedatha kunye nabancedisi bophando.
Bonke ababhali baye benza igalelo elibalulekileyo kumsebenzi wengxelo, nokuba ngokwengqiqo, ukuyila uphando, ukubulawa, ukufumana idatha, ukuhlalutya kunye nokutolika, okanye kuzo zonke ezi nkalo;uthathe inxaxheba kuyilo, kuhlaziyo okanye kuphononongo olungqongqo lweli solotya;ekugqibeleni Yamkelwe inguqulelo ukuba ipapashwe;ufikelele kwisivumelwano kwijenali apho inqaku lingeniswe khona;kwaye bavumile ukuba noxanduva kuyo yonke imiba yomsebenzi.
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