title: Urban and rural prevalence of diabetes and pre-diabetes and risk factors associated with diabetes in Tanzania and Uganda.
abstract: BACKGROUND
  The increase in prevalence of diabetes and pre-diabetes in sub-Saharan Africa underlines the importance of understanding its magnitude and causes in different population groups. We analyzed data from the Africa/Harvard Partnership for Cohort Research and Training (PaCT) studies to determine the prevalence of diabetes and pre-diabetes and risk factors associated with diabetes.
  
  
  METHODS
  Participants were randomly selected from peri-urban (n=297) and rural (n=200) communities in Uganda, and teachers were recruited from schools (n=229) in urban Tanzania. We used a standardized questionnaire to collect socio-demographic and self-reported disease status including diabetes status. Blood glucose was also measured after participants fasted for 8 h. We used standard protocols for anthropometric and blood pressure measurement.
  
  
  RESULTS
  The overall prevalence of diabetes was 10.1% and was highest in rural Ugandan residents (16.1%) compared to teachers in Tanzania (8.3%) and peri-urban Ugandan residents (7.6%). The prevalence of pre-diabetes was 13.8%. The prevalence of self-reported diabetes was low across all sites, where 68% of participants with diabetes were not captured by self-report. In multivariable logistic regression analysis, family history (OR 2.5, 95% CI: 1.1, 5.6) and hypertension (OR 2.3, 95% CI: 1.1, 5.2) were significantly associated with diabetes.
  
  
  CONCLUSIONS
  The prevalence of diabetes and pre-diabetes in Uganda and Tanzania is high, differs markedly between population groups, and remains undiagnosed in an alarmingly high proportion of individuals. These findings highlight the need for large-scale, prospective studies to accurately quantify the burden and identify effective intervention and treatment strategies across diverse African populations.
authors.affiliation: Endocrinology and Diabetes Unit, Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania; fschiwanga@yahoo.com.
authors.forename: Faraja S
authors.initials: FS
authors.lastname: Chiwanga
authors.affiliation: Department of Physiology, Faculty of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Marina A
authors.initials: MA
authors.lastname: Njelekela
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Megan B
authors.initials: MB
authors.lastname: Diamond
authors.affiliation: Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Francis
authors.initials: F
authors.lastname: Bajunirwe
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Joan
authors.initials: J
authors.lastname: Nankya-Mutyoba
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Kalyesubula
authors.affiliation: Institute of Human Virology, Abuja, Nigeria.|School of Medicine Greenbaum Cancer Center and Institute of Human Virology, University of Maryland, Baltimore, MD, USA.
authors.forename: Clement
authors.initials: C
authors.lastname: Adebamowo
authors.affiliation: Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: IkeOluwapo
authors.initials: I
authors.lastname: Ajayi
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Todd G
authors.initials: TG
authors.lastname: Reid
authors.affiliation: The South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa.|Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Volmink
authors.affiliation: Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Carien
authors.initials: C
authors.lastname: Laurence
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.|Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
authors.forename: Hans-Olov
authors.initials: HO
authors.lastname: Adami
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Holmes
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Shona
authors.initials: S
authors.lastname: Dalal
mesh_terms: D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D011236:Prediabetic State / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D014504:Urban Health
keywords: Tanzania; Uganda; non-communicable; risk factors; sub-Saharan Africa; underdiagnoses