Prevalence and management of insulin dependent diabetes mellitus among children and adolescents attending the University Teaching Hospital

Abstract

Although Insulin Dependent Diabetes Mellitus (IDDM) is not among the ten leading causes of morbidity and mortality in children and adolescents in Zambia, it is not uncommon. In many populations, the prevalence of IDDM in children and adolescents has been increasing. The situation in Zambia is not clear largely because non-infectious diseases such as diabetes take a back seat in terms of research, access to care, drug availability and provider response. Hence, data on the prevalence of diabetes among Zambian children and adolescents is scanty. This study was conducted to provide additional information on both prevalence and management of IDDM among children and adolescents attending the country's largest referral centre the University Teaching Hospital (UTH). The study was a cross-sectional survey conducted between mid December 1997 and mid June 1998. Children with IDDM aged less than 19 years presenting to the UTH Departments of Paediatrics and Child Health and Internal Medicine were recruited. Data was collected using structured interviews and in old cases of IDDM, previous case records were examined. The study's incidence rate of 20 cases per 100,000 children and a prevalence rate of 0.08 per percent were higher than the previously described in earlier Zambian studies. However, the findings in this study are comparable to other recent African studies.The mean age of onset of disease was 11 years and the sex ratio was even (1:1). However, when analysis was done for children aged less than 10 years only, the female to male ratio was 2.1. About three quarters of IDDM patients had a positive family history of diabetes. The clinical presentations were classical with most children and adolescents presenting with polyuria, polydipsia and weight loss, while in one female child aged 15, the initial presentation of IDDM was that of blindness due to cataracts. Diabetic ketoacidosis was not reported in this study. Over half of the patients had poor glycaemic control. Among the reasons for this were poor drug supply in the hospital, infrequent reviews and inability to monitor diabetic control at home. This study has shown that there is an apparent increase in the incidence and prevalence of IDDM in children and adolescents attending Zambia's largest tertiary hospital. In addition, the management of IDDM is poor due to several factors that have been highlighted above.