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I-anemia phakathi kwabantu abadala abanesifo sikashukela abaya esibhedlela esijwayelekile empumalanga ye-Ethiopia: isifundo esihlukanisayo
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 isho ukwehla kwenani lamangqamuzana egazi abomvu ajikelezayo (RBC) kanye/noma ukuncipha kwamandla okuthwala umoya-mpilo njengomphumela, okunganele ukuhlangabezana nezidingo zomzimba womuntu.1,2 Kuthinta amazwe asathuthuka nathuthukile, kwezempilo yabantu, intuthuko yezenhlalakahle nezomnotho.3 Kukhona cishe abantu abayizigidi eziyizinkulungwane eziyi-1.62 abane-anemia emhlabeni, okubalelwa ku-24.8% wabantu bomhlaba.4
Isifo sikashukela i-mellitus (DM) yisifo sikashukela esincike ku-insulin, esicishe sihlukaniswe sibe uhlobo lwe-I_juvenile noma isifo sikashukela esincike ku-insulin kanye nohlobo lwesifo sikashukela esingancikile ku-insulin.5 Ezigulini ezinesifo sikashukela, i-anemia ngokuyinhloko ibangelwa ukuvuvukala, izidakamizwa, ukuntula ukudla okunomsoco, isifo sezinso, izifo ezihambisana nokuzivikela komzimba, ukuncipha okulinganiselwe kwe-erythropoietin 6,7, ukuntuleka kwe-iron ngokuphelele noma ukusebenza, kanye nokusinda kwamangqamuzana abomvu egazi kuyafinyela.8,9 Ngakho-ke, i-anemia ivamile ezigulini ezinesifo sikashukela.10,11 Kubantu abadala, ukusabalala kwe-anemia kungama-24% kwabesifazane abaneminyaka yobudala yokuzala (iminyaka engu-15-49) kanye no-15% phakathi kwabesilisa abaneminyaka engu-15-49.12
Ezigulini ezine-DM, ikakhulukazi lezo ezinesifo esisobala sezinso noma ukwehluleka kwezinso, ukwanda kwe-anemia cishe kuphindwe izikhathi ezi-2 kuya kwezi-3 kuneziguli ezingenayo i-DM.I-13,14 I-anemia nesifo sikashukela, njenge-nephropathy, i-retinopathy, i-neuropathy, ukuphulukiswa kwesilonda esibi, kanye nesifo se-macrovascular [15,16], kunomthelela omubi ezingeni lempilo yeziguli.I-17-19 Naphezu kwala maqiniso, imibiko yocwaningo ibonisa ukuthi abaningi abangaba ngu-25% beziguli ezinesifo sikashukela abasakwazi ukubona i-anemia.20,21
Ukuqashelwa kusenesikhathi kanye nokwelashwa kwe-anemia ezigulini ze-DM kungasiza ekunciphiseni ukugula nokufa, futhi kuthuthukise izinga lempilo yazo.22 Nokho, sekukonke, ukuhlolwa kwe-anemia ezigulini ezinesifo sikashukela e-Ethiopia kuphansi kakhulu, futhi kuze kube manje, alukho ucwaningo olufanele.Lokhu kuyiqiniso ikakhulukazi endaweni yocwaningo.Ngakho-ke, lolu cwaningo luhlose ukulinganisa izinga le-anemia ezigulini ezinesifo sikashukela esibhedlela i-Gramsoe General Hospital empumalanga ye-Ethiopia nokunquma izici ezihlobene nayo.
Ucwaningo lwenziwe esibhedlela i-Glymso General Hospital (GGH) esisedolobheni lase-Glymso, esifundeni sase-Habro, esifundazweni sase-Oromiya, eMpumalanga ye-Ethiopia.Isibhedlela sisendaweni eqhele ngamakhilomitha angama-390 empumalanga ye-Addis Ababa, inhloko-dolobha yase-Ethiopia.23 Ngokombiko weHhovisi Lezempilo lase-Habro Woreda, i-GGH iyisikhungo sokudlulisela kubantu abalinganiselwa ezigidini eziyi-1.4 endaweni ezungezile.Ihlinzeka ngezinsizakalo zokunakekelwa kwezempilo ezigulini ezingaphezu kuka-90,000 eminyangweni nasemitholampilo yayo ehlukene minyaka yonke.I-Diabetes Clinic ingelinye lamayunithi ochwepheshe ahlinzeka ngezinsizakalo ezigulini ezinesifo sikashukela ezingaba ngu-660.I-Habro District itholakala endaweni ephakeme ngamamitha ayi-1800-2000.
Ucwaningo olusekelwe esibhedlela lwenziwe kusukela ngomhla ka-9 Juni 2020 kuya ku-Agasti 10, 2020. Abahlanganyeli abafanelekayo abantu abadala (≥ iminyaka engu-18) iziguli ezinesifo sikashukela ezilandelwa ku-GGH.Iziguli ezinesifo sikashukela esikhulile ezithole ukumpontshelwa igazi ezinyangeni ezi-3 ezedlule, iziguli ezikhulelwe noma ezisanda kubeletha noma ezigula ngengqondo, iziguli ezihlinzwe noma zopha nganoma yisiphi isizathu, kanye neziguli ezithole ukwelashwa kwezinambuzane zamathumbu azifakiwe. .Funda.
Usayizi wesampula wanqunywa ngokusebenzisa ifomula yesilinganiso esisodwa sabantu futhi ngokusekelwe ekucabangeni okulandelayo: 95% isikhathi sokuzethemba, isilinganiso samaphutha angu-5%, kanye nokusabalala kwe-anemia yeziguli ezinesifo sikashukela esivela esibhedlela sase-Dessie Referral eNyakatho-mpumalanga ye-Ethiopia (p = 26.7) %).24 Ngemva kokungeza u-10% kwabangaphenduli, usayizi wokugcina wesampula ngu-331.
Iziguli ezinesifo sikashukela ezingama-660 zalandelelwa ngenkuthalo emtholampilo wesifo sikashukela e-GGH.Hlukanisa inani eliphelele leziguli ezinesifo sikashukela (660) ngosayizi wokugcina wesampula (331) ukuze uthole izikhawu ezimbili zamasampula.Ngokusebenzisa irejista yeziguli ezinesifo sikashukela ezithola izinsizakalo zokulandelela isifo sikashukela esibhedlela njengohlaka lwamasampula, sasebenzisa indlela ehlelekile yokusampula okungahleliwe ukuze kufakwe zonke ezinye iziguli ocwaningweni.Nikeza umhlanganyeli wocwaningo ngamunye ngenombolo kamazisi eyingqayizivele ukuze agweme ukuphindaphinda, uma kwenzeka isiguli esifanayo siphinde sivele phakathi nocwaningo ukuze silandelelwe.
Qoqa idatha eguquguqukayo ye-sociodemographic, ukusetshenziswa kotshwala, ukubhema, nezici zokudla ngokusebenzisa uhlu lwemibuzo oluhlelekile oluthathelwe endleleni yesinyathelo ngesinyathelo ye-WHO ye-Chronic disease monitoring factor.25 Ukusetshenziswa kwetiye nekhofi, ukusetshenziswa kombhobho wamanzi, uhlu lwemibuzo lokuhlafunwa kukaCarter, ukusetshenziswa kwezinto zokuvimbela inzalo, nomlando wokuya esikhathini kwatholakala ngokubukeza izincwadi ezihlukahlukene.Uhlu lwemibuzo lwama-26-30 lwabhalwa ngesiNgisi futhi lwahunyushelwa olimini lwendawo (Afaan Oromoo), lase lihunyushwa libuyiselwe esiNgisini ngochwepheshe abahlukene bezilimi ukuze kuhlolwe ukuvumelana.Thola idatha yomtholampilo efana nobude besikhathi sesifo sikashukela, uhlobo lwesifo sikashukela, izinkinga zesifo sikashukela, kanye namazinga kashukela egazini azila ukudla kumarekhodi ezokwelapha esiguli.Imininingwane yaqoqwa abahlengikazi ababili abangochwepheshe kanye nochwepheshe waselabhorethri, futhi bagadwa umpetha weziqu zezempilo yomphakathi.
Kala umfutho wegazi (BP) usebenzisa imitha yomfutho wegazi eyidijithali (Heuer) eqinisekiswa njalo.Ngaphambi kokulinganisa umfutho wegazi, ophathwayo wayengaphuzile noma iziphi iziphuzo ezishisayo, njengetiye, ikhofi noma ugwayi obhenyiwe, uCaterpillar ohlafunwayo, noma azivocavoce ngamandla emizuzwini engu-30 edlule.Ngemuva kokuthi isihloko siphumule okungenani imizuzu emihlanu futhi siqophe isilinganiso sokufundwa kwe-BP, izilinganiso ezintathu ezizimele zathathwa engalweni yangakwesokunxele.Izilinganiso zesibili nezesithathu zithathwe imizuzu emihlanu neyishumi ngemva kokulinganisa kokuqala nesesibili, ngokulandelana.I-Hypertension ichazwa njengeziguli ezine-BP≥140 noma i-DBP≥90mmHg) noma lezo okuye kwatholakala ukuthi zithatha izidakamizwa ze-antihypertensive.31,32
Ukuze sinqume isimo somsoco nge-body mass index (BMI), silinganise ubude nesisindo sesiguli.Lapho umhlanganyeli ngamunye emile eqondile odongeni, izithende zabo zazithinta udonga ndawonye, angagqoki izicathulo, agcina amakhanda abo aqondile, futhi akala ukuphakama kwawo ngerula futhi aqopha i-0.1 cm eseduze.Sebenzisa isikali sedijithali esimakwe 0-130 kg ukuze ulinganise isisindo sakho.Ngaphambi kwesilinganiso ngasinye, linganisa isikali sibe ileveli enguziro.Linganisa isisindo sombambi qhaza ngenkathi egqoke izingubo ezilula futhi engenazicathulo, futhi urekhode u-0.1 kg oseduze kakhulu.33,34 Inkomba yesisindo somzimba (BMI) ibalwa ngokuhlukanisa isisindo somzimba (kg) ngobude (m).Khona-ke isimo somsoco sichazwa ngokuthi: uma i-BMI <18.5, isisindo esingaphansi;uma i-BMI = 18.5–24.9, isisindo esingaphansi;uma i-BMI = 25–29.9, ukukhuluphala ngokweqile;uma i-BMI ≥30.35,36, ukukhuluphala
Eduze nendawo emaphakathi phakathi konqenqema olungezansi lwezimbambo ezilulayo kanye nangaphezulu ekugcineni, sebenzisa isilinganiso setheyiphu esinganwebeka ukuze ulinganise isiyingi sokhalo futhi urekhode ku-0.1 cm eseduze.Ukukhuluphala ngokweqile kuchazwa ngokuthi umkhawulo wokuzungeza okhalweni kwabesilisa ≥ 94 cm, nomkhawulo okhalweni kwabesifazane ≥ 80 cm.30,36 Phakathi nenkathi yokuqeqeshwa, iziguli ezinesifo sikashukela ezingabantu abadala eziyi-10 zaba ngaphansi kwephutha lokukala lobuchwepheshe elihlobene (%TEM) ukuze kuncishiswe amaphutha okulinganisa i-anthropometric angahleliwe.Amaphutha aqashelwayo okulinganisa okusebenza ahlobene ngaphakathi naphakathi kwezibukeli angaphansi kuka-1.5% nangaphansi kuka-2%, ngokulandelana.
Ochwepheshe baselabhorethri baqoqa cishe amamililitha amabili (2 mL) amasampula egazi kubo bonke ababambiqhaza futhi bawabeka eshubhuni yokuhlola ene-tripotassium ethylenediaminetetraacetic acid (EDTA K3) anticoagulant ukuze kutholwe i-hemoglobin.Hlanganisa kahle igazi eliphelele eliqoqiwe futhi usebenzise i-Sysmex XN-550 hematology analyzer ukuze uhlaziye.Isilinganiso se-hemoglobin salungiswa ngokunciphisa ukuphakama kwabo bonke ababambiqhaza ngokukhipha u-0.8 g/dl nesimo sokubhema ngokukhipha u-0.03 g/dl.Bese uchaza i-anemia njengezinga le-hemoglobin labesifazane elingaphansi kwe-12g/dl kanye nowesilisa u-<13g/dl.Ubukhulu be-anemia buhlukaniswe: amazinga e-hemoglobin abesilisa nabesifazane angu-11-12.9 g/dl kanye no-11-11.9 g/dl, ngokulandelana, okuyi-anemia ethambile, kuyilapho amazinga e-hemoglobin e-anemia emaphakathi futhi eqinile angu-8-10.9 g/dl, ngokulandelana dl kanye <8 mg/dl.Owesilisa nowesifazane
Qoqa amamililitha amahlanu (5 mL) wegazi le-venous eshubhuni yokuhlola ngaphandle kwe-anticoagulant ukuze unqume i-creatinine ne-urea.Igazi lonke ngaphandle kwe-anticoagulant liboshwe imizuzu engu-20-30 futhi i-centrifuged ku-3000 rpm imizuzu engu-5 ukuhlukanisa i-serum.Kwabe sekusetshenziswa isihlaziyi samakhemikhali e-Mindray BS-200E (China Mindray Biomedical Electronics Co., Ltd.) ukuze kunqunywe i-serum creatinine nokuqukethwe kwe-urea nge-acid picrine nezindlela ze-enzymatic.37 Sebenzisa izinga lokuvuzwa kwe-creatinine ukuze ulinganise izinga lokuhlunga kwe-glomerular.Sebenzisa i-Chronic Kidney Disease (CKD) Ratio (GFR), echazwe njengefomula ye-CKD-EPI Cockroft-Gault evezwa ngamamitha-skwele angu-1.73.
Izinga le-glucose egazini lokuzila ukudla (okungenani amahora angu-8) likalwa ngokucofa iminwe kusetshenziswa imitha ye-glucose yegazi elinganiswe i-blood glucose.38 Uma izinga likashukela wegazi lokuzila ukudla liku-<80 noma> 130mg/dl, khona-ke ikhodi iwukulawula okungalawuleki kweglucose yegazi.Lawula lapho inani likashukela wegazi lokuzila liphakathi kuka-80-130mg/dl 39
Ababambiqhaza bocwaningo banikezwe induku ehlanzekile yokhuni kanye nenkomishi yepulasitiki ehlanzekile, eyomile, engavuzi nenombolo ye-serial number yalowo mbuzo ukuze ihlolwe i-fecal parasite.Batshele ukuthi balethe isampula yendle entsha yamagremu amabili (cishe usayizi wesithupha).Ngemva kokuthola izikelemu (amaqanda kanye/noma izibungu) kusetshenziswa amasu okukhweza okumanzi aqondile, amasampula ahlolwe phakathi nemizuzu engama-30 yokuqoqwa kwesampula.Amasampuli asele agcinwe kushubhu yokuhlola equkethe u-10 mL we-formalin engu-10% ukuze kuthuthukiswe izinga lokutholwa kwezimuncagazi, futhi ngemva kokwelashwa ngobuchwepheshe bokugxila bemvula ye-formalin-ether, i-Olympus Microscope yasetshenziswa ukuze ihlolwe.
Sebenzisa i-lancet oyinyumba ukuze uqoqe amasampula egazi le-capillary eminweni ukuze uthole umalaleveva.Lungiselela ifilimu yegazi elincanyana engilazini efanayo ehlanzekile ngaphandle kwamafutha, bese umoya owomile.Amaslayidi angcoliswe ngo-10% we-Giemsa cishe imizuzu eyi-10, futhi izinhlobo zezimuncagazi zikamalaleveva zahlolwa.Lapho izizinda zamandla aphezulu eziyi-100 zihlolwa ngaphansi komgomo wokucwiliswa kukawoyela, isilayidi sabhekwa njengesinegethivu.40
Ukuqeqeshwa kwezinsuku ezimbili ngamathuluzi nezindlela zokuqoqa idatha kwanikezwa abaqoqi bedatha nabaphathi.Ngaphambi kokuba i-Chiro General Hospital iqoqe idatha yangempela yeziguli ze-30 zesifo sikashukela, uhlu lwemibuzo lwahlolwa ngaphambili futhi ukuguqulwa okudingekayo kwenziwa ngokufanele.Isilinganiso somzimba sifaniswa nephutha lobuchwepheshe elihlobene lesilinganiso (%TEM).Ngaphezu kwalokho, izinqubo ezijwayelekile zokusebenza ziyalandelwa kukho konke ukuqoqwa kwesampula yelabhorethri, ukugcinwa, ukuhlaziya kanye nezinqubo zokuqopha.
Imvume yezimiso zokuziphatha itholwe eKomidini Lokubuyekeza Izimiso Zokuziphatha Kocwaningo Lwezempilo (IHRERC) leSikole Sangaphambili Sezempilo Nezokwelapha sase-Am Valley University (IHRERC 115/2020).Ikolishi selikhiphe incwadi esemthethweni yokweseka i-GGH futhi lathola imvume kunhloko yesibhedlela.Ngaphambi kokuqoqa idatha, thola imvume enolwazi, ngokuzithandela, ebhaliwe futhi esayiniwe kumhlanganyeli ngamunye wocwaningo.Ababambiqhaza batshelwe ukuthi yonke idatha eqoqwe kubo izogcinwa iyimfihlo ngokusebenzisa amakhodi, futhi azikho izihlonzi ezizosetshenziswa, futhi zizosetshenziselwa izinjongo zocwaningo kuphela.Lolu cwaningo lwenziwe ngokuhambisana ne "Declaration of Helsinki".
Hlola ubuqotho bedatha eqoqiwe, faka ikhodi bese ufaka inguqulo ye-EpiData 3.1, bese uthekelisa ku-STATA inguqulo 16.0 ukuze uthole ukuphathwa nokuhlaziywa kwedatha.Sebenzisa amaphesenti, ukulinganiswa, okumaphakathi, nokuchezuka okujwayelekile ukuchaza idatha.Ngemva kokulungiswa kwezinga le-hemoglobin ngokwesimo sokubhema sabahlanganyeli kanye nokuphakama kwendawo, isimo se-anemia sinqunywa ngokwezinga elisha lokuhlukaniswa kwe-WHO.Faka imodeli yokuhlehla kwezinto ezimbili eziguquguqukayo ukuze uhlonze okuguquguqukayo kokuhlaziya kokugcina kokuhlehla kwezinto eziningi.Ekuhlehleni kwe-bivariate logistic, okuguquguqukayo okunenani lika-p ≤ 0.25 kuthathwa njengamakhandidethi wokuhlehla kwezinto eziningi.Sungula imodeli ye-multivariate logistic regression ukuze ubone izici ezingahlobene ne-anemia.Sebenzisa isilinganiso sezinto ezingavamile kanye nesikhawu sokuzithemba esingu-95% ukuze ulinganise amandla okuhlobana.Izinga lokubaluleka kwezibalo limenyezelwe njengenani lika-p <0.05.
Kulolu cwaningo, isamba seziguli zeDM yabantu abadala ezingama-325 ezibambe iqhaza emhlanganweni, kanti izinga lokuphendula libe ngu-98.2%.Iningi lababambe iqhaza;abesilisa abavela ezindaweni zasemakhaya bangama-203 (62.5%), 247 (76%), 204 (62.8%) kanye nama-279 (85.5%) abesilisa abashadile, kanti uhlanga lwabo i-Oromo.Iminyaka emaphakathi yabahlanganyeli yayiyiminyaka engama-40, kanti i-interquartile range (IQR) yayiyiminyaka engama-20.Cishe u-62% wabahlanganyeli abakaze bathole imfundo ehlelekile, futhi u-52.6% wabahlanganyeli bangabalimi abaqeqeshiwe (Ithebula 1).
Ithebula 1 Izici zenhlalo yabantu zeziguli ze-DM zabantu abadala ezilashwe esibhedlela esisempumalanga empumalanga ye-Ethiopia ngo-2020 (N = 325)
Phakathi kwabahlanganyeli bocwaningo, abangama-74 (22.8%) babike ukuthi babheme okungenani kanye ekuphileni kwabo, uma kuqhathaniswa nabangu-13 ababhemayo njengamanje (4%).Ngaphezu kwalokho, abantu abangu-12 (3.7%) abaphuza utshwala manje, kanti u-64.3% wabahlanganyeli bocwaningo itiye elimnyama.Ngaphezu kwengxenye eyodwa kwezintathu (68.3%) yabahlanganyeli bocwaningo babike ukuthi bahlala bephuza ikhofi ngemva kokudla.Ikhulu namashumi amathathu nantathu (96.3%) kanye nabangu-310 (95.4%) ababambiqhaza badle izithelo nemifino ngaphansi kwezikhathi ezinhlanu ngesonto.Ngokuphathelene nesimo sabo somsoco, i-92 (28.3%) kanye nabahlanganyeli be-164 (50.5%) babekhuluphele futhi bakhuluphele kakhulu (Ithebula 2).
Ithebula 2 Izici zokuziphatha nezondlekile zeziguli ze-DM zabantu abadala ezilashwa e-Eastern Ethiopia General Hospital ngo-2020 (N = 325)
Iziguli ezingaphezu kuka-170 (52.3%) ezinesifo sohlobo lwe-II zinesilinganiso sesikhathi se-DM seminyaka engu-4.5 (SD±4.0).Cishe u-50% weziguli ze-DM ezithatha imithi yomlomo ye-hypoglycemic (i-glibenclamide kanye/noma i-metformin), futhi cishe izingxenye ezintathu kwezine zabahlanganyeli bocwaningo banoshukela wegazi ongalawuleki (Ithebula 3).Mayelana ne-comorbidities, i-2% yabahlanganyeli babenezifo ezihambisanayo.Iziguli ezingama-80 (24.6%) kanye neziguli eziyi-173 (53.2%) ezine-DM ngaphandle komfutho wegazi ophakeme zazine-anemia kanye ne-non-anemia ngokulandelanayo.Ngakolunye uhlangothi, phakathi kweziguli ze-DM ezitholwe zine-hypertension, i-189 (5.5%) kanye ne-54 (16.6%) yayine-anemia ngokulandelanayo.
Ithebula 3 Izici zomtholampilo zeziguli ze-DM zabantu abadala ezelashwa esibhedlela esisempumalanga empumalanga ye-Ethiopia ngo-2020 (N = 325)
Izinga le-anemia ezigulini ezinesifo sikashukela lingu-30.2% (95% CI: 25.4-35.4%), kanti izinga le-hemoglobin elijwayelekile lingu-13.2±2.3g/dl (abesilisa: 13.4±2.3g/dl, abesifazane: 12.9±1.7g/ dl).Ngokuphathelene nobukhulu be-anemia ezigulini ze-DM ezine-anemia, kwakukhona amacala angu-64 e-anemia encane (65.3%), amacala angu-26 e-anemia emaphakathi (26.5%), kanye namacala angu-8 e-anemia enzima (8.2%).I-anemia emadodeni (36.0%) yayiphezulu kakhulu kunabesifazane (20.5%) (p = 0.003) (Umfanekiso 1).Sithole ukuhlobana okubalulekile okuhle phakathi kobunzima be-anemia kanye nobude besikhathi sesifo sikashukela (r = 0.1556, p = 0.0049).Lokhu kusho ukuthi njengoba ubude be-DM bukhula, ubunzima be-anemia buvame ukwanda.
Umfanekiso 1 Izinga le-anemia ngobulili ezigulini ze-DM zabantu abadala elashwa esibhedlela esisempumalanga empumalanga ye-Ethiopia ngo-2020 (N = 325)
Ezigulini ze-DM, u-64% wabesilisa kanye no-79.5% wabesifazane abanawo igazi, kanti u-28.7% no-71.3% wabahlafuna i-Khat njengamanje bane-anemia.U-67% weziguli ze-DM ezindala ezisebenzise ikhofi ngemva kokudla zazingenayo i-anemia, futhi u-32.9% wazo watholakala une-anemia.Mayelana nokuba khona kwezifo ezihambisanayo, u-72.2% weziguli ezine-DM ngaphandle kokugula zazine-anemia, kanti u-36.3% weziguli ezine-DM comorbidities zine-anemia.Iziguli ezinesifo sikashukela ezinezinkinga ze-DM zine-anemia ephakeme (47.4%) kunalezo ezingenazo izinkinga ze-DM (24.9%) (Ithebula 4).
Ithebula 4 Izinto ezihlobene ne-anemia phakathi kweziguli ze-DM ezindala ezalashwa esibhedlela esisempumalanga ye-Ethiopia ngo-2020 (N = 325)
Faka amamodeli e-bivariate kanye ne-multivariate logistic regression ukuze uhlole ukuhlobana phakathi kwe-anemia nokuguquguquka okuchazayo.Ekuhlaziyweni kwe-bivariate;iminyaka, ubulili, isimo somshado, ukuhlafuna i-Khat, ikhofi ngemva kokudla, ukugula okuhambisanayo, izinkinga zesifo sikashukela, ubude be-DM kanye nesimo sokudla okunempilo (BMI) kuhlobene kakhulu ne-anemia enenani elingu-p <0.25, futhi i-Multivariate candidate logistic regression.
Ekuhlaziyweni kwe-multivariate logistic regression, amadoda ane-DM ≥ iminyaka engu-5 ubude, ukuba khona kwe-comorbidities kanye nezinkinga ze-DM kwakuhlotshaniswa kakhulu ne-anemia.Iziguli zesilisa ezikhulile ze-DM zinamathuba aphindwe ka-2.1 okuphathwa yi-anemia kunabesifazane (AOR = 2.1, 95% CI: 1.2, 3.8).Uma kuqhathaniswa neziguli ze-DM ngaphandle kwe-commorbidities, iziguli ze-DM ezine-commorbidities zinethuba eliphindwe ka-1.9 lokuba ne-anemia (AOR = 1.9, 95% CI: 1.0, 3.7).Uma kuqhathaniswa neziguli ezine-DM ubude beminyaka engu-1-5, iziguli ze-DM ezinesikhathi sobude besikhathi ≥ iminyaka emi-5 zinamathuba aphindwe ka-1.8 okuba ne-anemia (AOR = 1.8, 95% CI: 1.1, 3.3).Ingozi ye-anemia ezigulini ezinezinkinga ze-DM izikhathi ezingu-2.3 zalabo osebenza nabo (AOR = 2.3, 95% CI: 1.3, 4.2) (Ithebula 4).
Lolu cwaningo luhlole ubulukhuni be-anemia nezici ezihlobene ezigulini ze-DM ezalandelelwa isifo sikashukela e-Gelemso General Hospital.Izinga le-anemia ocwaningweni lwamanje lingama-30.2%.Ngokwesigaba se-WHO sokubaluleka kwezempilo yomphakathi, endaweni yocwaningo, i-anemia iyinkinga yezempilo yomphakathi emaphakathi phakathi kweziguli ezikhulile ezine-DM.Ubulili, ubude besikhathi sika-DM, ukuba khona kwezinkinga ze-DM, namadoda ane-DM comorbidities kuye kwaphawulwa njengezici ezihlobene ne-anemia.
Izinga le-anemia kulolu cwaningo liqhathaniswa nele-Ethiopian Dessie Referral Hospital [24], kodwa ephakeme kunaleyo ye-Ethiopian Fenote Selam Hospital [41] ocwaningweni lwendawo olwenziwa e-China, 42 Australia, 43 nase-India [44] ]., Okungaphansi kunezifundo ezenziwa eThailand [45], Saudi Arabia [46] naseCameroon [47].Lo mehluko ungahle udalwe umehluko weminyaka yabantu bocwaningo.Isibonelo, ngokungafani nocwaningo lwamanje olwalungabandakanyi abantu abadala abangaphezu kweminyaka engu-18 ubudala, ucwaningo e-Thailand lwaluhlanganisa abantu abadala abangaphezu kweminyaka engama-60 ubudala, kuyilapho ucwaningo lwase-Cameroon lwaluhlanganisa abantu abadala abangaphezu kweminyaka engama-50 ubudala.Umehluko ungase futhi ubangelwe ukuncipha kokusebenza kwezinso, ukuvuvukala, ukucindezelwa komnkantsha wamathambo, nokungondleki kahle (ukukhula ngeminyaka)17.
Kuyasimangalisa ukuthi ocwaningweni lwethu, i-anemia yabesilisa ivame kakhulu kunowesifazane.Lokhu okutholakele kuphambene neminye imibiko yocwaningo [42,48], lapho abesifazane besengozini enkulu yokuba ne-anemia kunamadoda anesifo sikashukela.Isizathu esingenzeka salo mehluko kungenzeka ukuthi amadoda ocwaningo lwethu ayenemikhuba ephakeme yokuhlafuna i-Khat, engase ibangele ukulahlekelwa ukudla49, futhi i-Khat iqukethe ama-tannins-into enciphisa i-bioavailability ye-non-heme iron ekudleni.50 Esinye isizathu okungenzeka ukuthi siwukuthi ukudla okuphezulu kwekhofi netiye emadodeni kulolu cwaningo kwavimbela ukumuncwa kwensimbi emathunjini.51-54
Sithole ukuthi iziguli ezine-DM ≥ iminyaka emi-5 zinamathuba amaningi okuba ne-anemia kuneziguli ezine-DM ezineminyaka engu-1-5.Lokhu kuhambisana nezifundo ezenziwa esibhedlela i-Fenote Selam e-Ethiopia, 41 Iraq 55 nase-United Kingdom.17 Lokhu kungase kube ngenxa yokuchayeka isikhathi eside ku-hyperglycemia, okuholela ekwandeni kwama-cytokines avuthayo anemiphumela elwa ne-erythropoietin, okuholela ekwehleni kwenani.Ukuncipha kokujikeleza kwamangqamuzana abomvu egazi kuholela ekuncipheni kokujikeleza kwe-hemoglobin.35
Ngokuvumelana nezifundo ezenziwa e-China, i-anemia engu-13 kulolu cwaningo yayivame kakhulu ezigulini ze-DM ezinezinkinga.Ngokwebhayoloji, izinkinga zesifo sikashukela zingalimaza kakhulu ingqamuzana nokwakheka kwemithambo yegazi yezinso, ukuvuvukala kwesistimu, kanye nokungeniswa kwe-erythropoietin release inhibitors kungase kuholele ekulahlekelweni yigazi kwesifo sikashukela.56 I-Hypoxia ingase ithinte ukubonakaliswa kwezakhi zofuzo, i-metabolism, i-capillary permeability kanye nokusinda kwamangqamuzana 57. Ukunciphisa amangqamuzana egazi abomvu kanye nezindawo zawo zokulwa ne-antioxidant ezihambisana ne-anemia kungase kubangele ezinye izinkinga ezigulini ezinesifo sikashukela58.
Ngaphezu kwalokho, iziguli ze-DM ezine-commorbidities zivame ukuba ne-anemia kuneziguli ze-DM ngaphandle kokugula.Lokhu kuqhathaniswa nezifundo ezifanayo zangaphambilini [35,59], okungenzeka kube ngenxa yomthelela we-comorbidities (njenge-hypertension) okuholela ezinkingeni zenhliziyo, ngaleyo ndlela kwandise ingozi ye-anemia.60
Njengolunye lwezifundo ezimbalwa kakhulu ezisekelwe elabhorethri ezenziwa e-Ethiopia, izifo ezingapheli ezifana ne-DM sezivame ukwanda, okwenza amandla alolu cwaningo.Ngakolunye uhlangothi, lolu cwaningo luwucwaningo olulodwa olusekelwe esibhedlela futhi lungase lungamele zonke iziguli ezine-DM noma iziguli ezilandelwa kwezinye izikhungo zezokwelapha.Imvelo ehlukene yomklamo wocwaningo esiwusebenzisile ayikuvumeli ukusungulwa kobudlelwano besikhashana phakathi kwe-anemia nezinto.Ucwaningo lwesikhathi esizayo lungase ludinge ukusebenzisa izilawuli zecala, izifundo zeqoqo noma eminye imiklamo yocwaningo ukuze kucatshangelwe izimpawu nezimpawu ze-anemia, i-RBC morphology, i-serum iron, uvithamini B12, namazinga e-folic acid.
Endaweni yocwaningo, i-anemia iyinkinga yezempilo yomphakathi emaphakathi phakathi kweziguli ze-DM yabantu abadala.Ubulili, ubude besikhathi sika-DM, ukuba khona kwezinkinga ze-DM, kanye nezifo ezibangelwa amagciwane kwabesilisa futhi kwaphawulwa njengezici ezihlobene ne-anemia.Ngakho-ke, ukuhlolwa kwe-anemia okujwayelekile kanye nokuphathwa okufanele kweziguli ze-DM ezinesikhathi eside se-DM, izifo ezihlangene kanye nezinkinga kufanele kuklanyelwe ukuthuthukisa izinga lempilo yeziguli.Ukuxilongwa kusenesikhathi nokuqapha njalo kwe-DM nakho kungasiza ekunciphiseni izinkinga.
Idatha esekela imiphumela ebikwe kulo mbhalo wesandla ingatholwa kumbhali ohambelanayo ngokwezidingo ezifanele.
Sithanda ukubonga inhloko ye-Gelemso General Hospital, abasebenzi base-Diabetes Clinic, ababambiqhaza ocwaningweni, abaqoqi bedatha nabasizi bocwaningo.
Bonke ababhali benze igalelo elibalulekile emsebenzini wombiko, kungakhathaliseki ukuthi ngokomqondo, umklamo wocwaningo, ukubulawa, ukutholwa kwedatha, ukuhlaziya nokuchazwa, noma kuzo zonke lezi zici;iqhaza ekubhalweni, ekubuyekezweni noma ekubuyekezweni okuqinile kwalesi sigaba somthetho;ekugcineni Igunyazwe inguqulo ezoshicilelwa;ufinyelele isivumelwano ngejenali okwathunyelwa kuyo indatshana;futhi wavuma ukuba nesibopho kuzo zonke izici zomsebenzi.
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