High prevalence in Malawi of sight-threatening retinopathy and visual impairment caused by diabetes: identification of population-specific targets for intervention.
OBJECTIVE
To report the prevalence of all grades of diabetic retinopathy and associations with demographic, clinical and biochemical variables in people with diabetes in Southern Malawi.


METHODS
We report baseline data from a 24-month prospective cohort study. Subjects were systematically sampled from two hospital-based, primary care diabetes clinics. Visual acuity, glycaemic control, systolic blood pressure, HIV status, urine albumin-creatinine ratio, and haemoglobin and serum lipid levels were assessed. Retinopathy was graded at an accredited reading centre using modified Wisconsin grading of four-field mydriatic photographs.


RESULTS
A total of 357 subjects were studied. Of these, 13.4% subjects were HIV-positive and 15.1% had anaemia. The overall prevalence rates of any retinopathy, sight-threatening diabetic retinopathy and proliferative retinopathy were 50.1% (95% CI 44.9-55.3), 29.4% (95% CI 24.7-34.1) and 7.3% (95% CI 4.6-10.0), respectively. In multivariate logistic analysis the presence of sight-threatening retinopathy was associated with duration of diabetes (odds ratio 1.11, 95% CI 1.05-1.17), HbA1c (odds ratio 1.31, 95% CI 1.13-1.50), systolic blood pressure (odds ratio 1.03, 95% CI 1.01-1.04), haemoglobin (odds ratio 0.98, 95% CI 0.96-0.99) and LDL cholesterol (odds ratio 1.63, 95% CI 1.18-2.25). No significant association with HIV status was observed. In all, 3.6 and 1.4% of people in our study cohort had visual acuity worse than 6/18 and 6/60 in the better eye, respectively.


CONCLUSIONS
The present study found a prevalence of sight-threatening retinopathy in diabetes clinics in one Sub-Saharan African country of approximately four times that reported in recent European studies and a prevalence of proliferative retinopathy approximately 10 times higher. The association of sight-threatening retinopathy with lower haemoglobin level is a new finding. Our results highlight the urgent need for provision of services for retinopathy detection and management to avoid a large burden of vision loss.
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi; Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.
P I
PI
Burgess
T J
TJ
Allain
M
M
García-Fiñana
N A V
NA
Beare
G
G
Msukwa
S P
SP
Harding
D000328:Adult; D000419:Albuminuria / Q000453:epidemiology; D000740:Anemia / Q000097:blood / Q000453:epidemiology; D001794:Blood Pressure; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D015658:HIV Infections / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000453:epidemiology*; D016015:Logistic Models; D008295:Malawi; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D014786:Vision Disorders / Q000453:epidemiology* / Q000209:etiology; D014792:Visual Acuity; D055815:Young Adult
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D003404:Creatinine; D006442:Glycated Hemoglobin; D006454:Hemoglobins; D014280:Triglycerides; C517652:hemoglobin A1c protein, human