title: Prevalence and incidence of clinically recognized cases of Type 1 diabetes in children and adolescents in Rwanda, Africa.
abstract: OBJECTIVE
  To determine prevalence and incidence estimates for clinically recognized cases of Type 1 diabetes from the Life For a Child Program (LFAC) with onset < 26 years in six representative districts, and the capital, of Rwanda.
  
  
  METHODS
  Cases were identified from the LFAC registry and visits to district hospitals. Denominators were calculated from district-level population surveys. Period prevalence data were collected from 1 August 2011 to 31 July 2012 and annual incidence rates were calculated, retrospectively, for 2004-2011. Ninety-five per cent confidence intervals (95% CI) were calculated using a Poisson distribution.
  
  
  RESULTS
  The prevalence of known Type 1 diabetes in seven districts in Rwanda for ages < 26 years was 16.4 [95% CI 14.6-18.4]/100 000 and for < 15 years was 4.8 [3.5-6.4]/100 000. Prevalence was higher in females (18.5 [15.8-21.4]/100 000) than males (14.1 [11.8-16.7]/100 000; P = 0.01) and rates increased with age. The annual incidence rate for those < 26 years was stable between 2007 and 2011 with a mean incidence over that time of 2.7 [2.0-3.7]/100 000 ( < 15 years = 1.2 [0.5-2.0]/100 000). Incidence rates were higher in females than males and peaked in males at ages 17 and 22 years and in females at age 18 years.
  
  
  CONCLUSIONS
  Our report of known Type 1 diabetes cases shows lower incidence and prevalence rates in Rwanda than previously reported in the USA and most African countries. Incidence of recognized cases has increased over time, but has recently stabilized. However, the likelihood of missed cases due to death before diagnosis and misdiagnosis is high and therefore more definitive studies are needed.
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Marshall
authors.affiliation: Northwestern University, Feinberg School of Medicine, Pediatrics, Chicago.
authors.forename: D
authors.initials: D
authors.lastname: Edidin
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, USA.
authors.forename: V C
authors.initials: VC
authors.lastname: Arena
authors.affiliation: University of Pittsburgh School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Becker
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Bunker
authors.affiliation: Association Rwandaise des Diabetiques, Kigali, Rwanda.
authors.forename: C
authors.initials: C
authors.lastname: Gishoma
authors.affiliation: Association Rwandaise des Diabetiques, Kigali, Rwanda.
authors.forename: F
authors.initials: F
authors.lastname: Gishoma
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: LaPorte
authors.affiliation: Association Rwandaise des Diabetiques, Kigali, Rwanda.
authors.forename: V
authors.initials: V
authors.lastname: Kaberuka
authors.affiliation: International Diabetes Federation Life for a Child Program and Australian Diabetes Council, Sydney, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Ogle
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Sibomana
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Orchard
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D015995:Prevalence; D012423:Rural Health / Q000706:statistics & numerical data; D012432:Rwanda / Q000453:epidemiology; D017678:Sex Distribution; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult