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Anemia ntawm cov neeg laus uas muaj ntshav qab zib tuaj koom lub tsev kho mob dav dav nyob rau sab hnub tuaj Ethiopia: kev kawm hla ntu
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
Ntshav qab zib yog hais txog qhov txo qis ntawm cov qe ntshav liab (RBC) thiab / lossis txo qis hauv cov pa oxygen uas muaj peev xwm ua tau, uas tsis txaus los ua kom tau raws li qhov xav tau ntawm tib neeg lub cev.1,2 Nws cuam tshuam rau cov teb chaws tsim thiab tsim, rau tib neeg kev noj qab haus huv, kev sib raug zoo thiab kev lag luam.3 Muaj kwv yees li 1.62 billion tus neeg mob ntshav qab zib hauv ntiaj teb, suav txog 24.8% ntawm cov pej xeem hauv ntiaj teb.4
Mob ntshav qab zib mellitus (DM) yog kab mob metabolic, kwv yees faib ua hom I_juvenile lossis insulin-dependent diabetes thiab hom II_non-insulin-dependent diabetes.5 Hauv cov neeg mob ntshav qab zib mellitus, anemia feem ntau yog vim yog mob, tshuaj, noj zaub mov tsis txaus, kab mob raum, nrog rau cov kab mob autoimmune, 6,7 tus txheeb ze txo qis hauv erythropoietin ntau lawm, tsis muaj hlau tsis txaus los yog ua haujlwm, thiab cov qe ntshav liab ciaj sia luv.8,9 Yog li ntawd, anemia yog tshwm sim nyob rau hauv cov neeg mob ntshav qab zib.10,11 Nyob rau hauv cov neeg laus, qhov tshwm sim ntawm anemia yog 24% ntawm cov poj niam ntawm cov me nyuam (15-49 xyoo) thiab 15% ntawm cov txiv neej hnub nyoog 15-49.12
Hauv cov neeg mob uas muaj DM, tshwj xeeb tshaj yog cov uas muaj kab mob hauv lub raum lossis lub raum tsis txaus, qhov tshwm sim ntawm cov ntshav tsis txaus yog li 2 txog 3 npaug ntau dua li cov neeg mob uas tsis muaj DM.13,14 Ntshav Qab Zib thiab ntshav qab zib mellitus, xws li nephropathy, retinopathy, neuropathy, kho qhov txhab tsis zoo, thiab kab mob macrovascular [15,16], muaj kev cuam tshuam tsis zoo rau lub neej zoo ntawm cov neeg mob.17-19 Txawm hais tias qhov tseeb no, cov ntaub ntawv tshawb fawb qhia tias ntau li 25% ntawm cov neeg mob ntshav qab zib tseem tsis tuaj yeem paub txog ntshav qab zib.20,21
Kev lees paub ntxov thiab kev kho mob ntshav qab zib hauv cov neeg mob DM tuaj yeem pab txo qis kev mob thiab kev tuag, thiab txhim kho lawv lub neej zoo.22 Txawm li cas los xij, tag nrho, kev ntsuam xyuas ntawm cov ntshav qab zib hauv cov neeg mob ntshav qab zib hauv Ethiopia yog qhov tsawg heev, thiab txog tam sim no, tsis muaj kev tshawb fawb cuam tshuam.Qhov no muaj tseeb tshwj xeeb hauv cheeb tsam kawm.Yog li, txoj kev tshawb fawb no tsom mus rau kwv yees qhov degree ntawm anemia hauv cov neeg mob ntshav qab zib hauv Gramsoe General Tsev Kho Mob nyob rau sab hnub tuaj Ethiopia thiab txiav txim siab txog yam cuam tshuam rau nws.
Txoj kev tshawb no tau ua nyob rau ntawm Glymso General Tsev Kho Mob (GGH) nyob hauv Glymso Town, Habro District, Oromiya State, Eastern Ethiopia.Lub tsev kho mob nyob txog 390 mais sab hnub tuaj ntawm Addis Ababa, lub nroog Ethiopia.23 Raws li tsab ntawv ceeb toom los ntawm Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Habro Woreda, GGH yog lub chaw xa mus rau kwv yees li 1.4 lab tus tib neeg nyob hauv thaj chaw uas nyob ib puag ncig.Nws muab kev pabcuam kev noj qab haus huv rau ntau dua 90,000 tus neeg mob hauv nws qhov chaw sib txawv thiab chaw kho mob txhua xyoo.Lub Tsev Kho Mob Ntshav Qab Zib yog ib lub chaw tshaj lij uas muab kev pabcuam rau kwv yees li 660 tus neeg mob ntshav qab zib.Habro District nyob ntawm qhov siab ntawm 1800-2000 meters.
Ib txoj kev tshawb fawb nyob hauv tsev kho mob tau ua los ntawm Lub Rau Hli 9, 2020 txog Lub Yim Hli 10, 2020. Cov neeg koom nrog tsim nyog yog cov neeg laus (≥18 xyoo) cov neeg mob ntshav qab zib uas tau soj ntsuam ntawm GGH.Cov neeg laus mob ntshav qab zib mellitus uas tau txais kev tso ntshav hauv 3 lub hlis dhau los, cov neeg mob uas cev xeeb tub lossis nyuam qhuav yug los lossis raug mob los ntawm kev puas siab puas ntsws, cov neeg mob uas tau txais kev phais lossis los ntshav vim li cas, thiab cov neeg mob uas tau txais kev kho kab mob hauv plab tsis suav nrog. .Kawm.
Cov qauv loj tau txiav txim siab los ntawm kev siv ib tus qauv pes tsawg tus pej xeem thiab ua raws li cov kev xav hauv qab no: 95% kev ntseeg siab ib ntus, 5% kev ua yuam kev, thiab ntshav qab zib ntau ntau ntawm cov neeg mob ntshav qab zib los ntawm Dessie Referral Hospital hauv Northeast Ethiopia (p = 26.7) %).24 Tom qab ntxiv 10% rau cov neeg tsis teb, qhov kawg qauv loj yog 331.
660 tus neeg mob ntshav qab zib tau nquag ua raws li hauv tsev kho mob ntshav qab zib hauv GGH.Faib tag nrho cov neeg mob ntshav qab zib mellitus (660) los ntawm qhov kawg qauv loj (331) kom tau txais ob lub sijhawm kuaj.Los ntawm kev siv cov ntawv sau npe ntawm cov neeg mob ntshav qab zib tau txais cov kev pabcuam saib xyuas ntshav qab zib hauv tsev kho mob raws li cov qauv ntsuas, peb tau siv cov txheej txheem random sampling kom suav nrog tag nrho lwm cov neeg mob hauv txoj kev tshawb no.Muab txhua tus neeg koom nrog txoj kev tshawb fawb nrog tus lej cim tshwj xeeb kom tsis txhob muab luam tawm, yog tias tib tus neeg mob rov tshwm sim thaum txoj kev kawm rau lwm qhov kev soj ntsuam.
Sau cov ntaub ntawv ntawm kev hloov pauv hauv zej zog, kev haus cawv, haus luam yeeb, thiab cov yam ntxwv ntawm kev noj zaub mov los ntawm kev siv daim ntawv nug uas tau hloov kho los ntawm cov kauj ruam los ntawm kauj ruam ntawm WHO tus kab mob muaj feem cuam tshuam rau kev soj ntsuam phau ntawv.25 Kev haus tshuaj yej thiab kas fes, siv cov kav dej, Carter's chewing daim ntawv nug, kev siv tshuaj tiv thaiv kab mob, thiab kev coj khaub ncaws keeb kwm tau txais los ntawm kev tshuaj xyuas cov ntaub ntawv sib txawv.Daim ntawv nug 26-30 tau sau ua lus Askiv thiab txhais ua hom lus hauv zos (Afaan Oromoo), thiab tom qab ntawd txhais rov qab ua lus Askiv los ntawm cov kws paub lus sib txawv los xyuas qhov sib xws.Tau txais cov ntaub ntawv kho mob xws li lub sijhawm mob ntshav qab zib, hom ntshav qab zib, cov teeb meem ntawm ntshav qab zib, thiab cov ntshav qabzib nrawm nrawm los ntawm tus neeg mob cov ntaub ntawv kho mob.Cov ntaub ntawv tau sau los ntawm ob tus kws saib xyuas neeg mob thiab tus kws kuaj mob, thiab saib xyuas los ntawm tus tswv ntawm kev noj qab haus huv kawm tiav.
Ntsuas ntshav siab (BP) siv lub ntsuas ntshav siab digital (Heuer) uas tau txheeb xyuas tsis tu ncua.Ua ntej ntsuas ntshav siab, tus neeg kawm tsis tau haus dej haus kub, xws li tshuaj yej, kas fes lossis haus luam yeeb, chewed Caterpillar, lossis ua ib ce muaj zog hauv 30 feeb kawg.Tom qab cov ntsiab lus tau so tsawg kawg yog tsib feeb thiab sau qhov nruab nrab ntawm BP kev nyeem ntawv, peb qhov kev ntsuas ywj pheej raug coj mus rau sab laug.Qhov ntsuas thib ob thiab thib peb tau muab tsib thiab kaum feeb tom qab ntsuas thawj thiab thib ob, raws li.Ntshav siab txhais tau tias yog cov neeg mob siab BP (SBP≥140 lossis DBP≥90mmHg) lossis cov neeg uas tau kuaj pom yav dhau los yog noj tshuaj tiv thaiv ntshav siab.31,32 ib
Txhawm rau txiav txim siab cov khoom noj khoom haus los ntawm lub cev qhov ntsuas qhov ntsuas (BMI), peb ntsuas qhov siab thiab qhov hnyav ntawm tus neeg mob.Thaum txhua tus neeg koom nrog sawv ntsug ntawm phab ntsa, lawv lub luj tshib kov lub phab ntsa ua ke, tsis hnav khau, tuav lawv lub taub hau ncaj, thiab ntsuas lawv qhov siab nrog tus pas ntsuas thiab kaw qhov ze tshaj 0.1 cm.Siv lub ntsuas digital cim 0-130 kg los ntsuas koj qhov hnyav.Ua ntej txhua qhov ntsuas, ntsuas qhov ntsuas mus rau qib xoom.Ntsuas qhov hnyav ntawm cov neeg koom nrog thaum hnav khaub ncaws hnav thiab tsis muaj khau, thiab kaw qhov ze tshaj 0.1 kg.33,34 Lub cev qhov ntsuas qhov ntsuas (BMI) yog xam los ntawm kev faib lub cev qhov hnyav (kg) los ntawm qhov siab (m).Tom qab ntawd cov khoom noj khoom haus tau txhais raws li: yog BMI <18.5, qis dua;Yog tias BMI = 18.5–24.9, qis dua;yog BMI = 25–29.9, rog dhau;Yog tias BMI ≥30.35,36, rog rog
Nyob ze ntawm qhov nruab nrab nruab nrab ntawm ntug hauv qab ntawm lub palpable tav thiab sab saum toj ntawm qhov kawg, siv daim kab xev uas tsis yog elastic los ntsuas lub duav ncig thiab sau rau qhov ze tshaj 0.1 cm.Kev rog rog hauv nruab nrab txhais tau tias yog lub duav ncig qhov pib rau cov txiv neej ≥ 94 cm, thiab lub duav ncig ntawm cov poj niam ≥ 80 cm.30,36 Lub sijhawm cob qhia, 10 tus neeg mob ntshav qab zib cov neeg laus tau raug cuam tshuam txog kev ntsuas kev ntsuas kev ua yuam kev (%TEM) kom txo qis qhov kev ntsuas qhov ntsuas anthropometric yuam kev.Cov txheeb ze kev ntsuas kev ntsuas qhov ua yuam kev hauv thiab nruab nrab ntawm cov neeg soj ntsuam yog tsawg dua 1.5% thiab tsawg dua 2%, feem.
Cov kws kho mob hauv chav kuaj tau sau kwv yees li ob milliliters (2 mL) cov ntshav kuaj los ntawm txhua tus neeg koom thiab muab tso rau hauv lub raj tshuaj uas muaj tripotassium ethylenediaminetetraacetic acid (EDTA K3) anticoagulant rau kev txiav txim siab ntawm hemoglobin.Muab tag nrho cov ntshav sib xyaw kom raug thiab siv Sysmex XN-550 hematology analyzer rau kev tsom xam.Kev ntsuas ntawm hemoglobin tau hloov kho los ntawm kev txo qhov siab ntawm txhua tus neeg koom los ntawm kev rho tawm 0.8 g / dl thiab haus luam yeeb los ntawm rho tawm 0.03 g / dl.Tom qab ntawd txhais cov ntshav ntshav raws li poj niam hemoglobin qib <12g/dl thiab txiv neej <13g/dl.Qhov hnyav ntawm cov ntshav qab zib tau muab faib ua: qib hemoglobin ntawm cov txiv neej thiab poj niam yog 11-12.9 g / dl thiab 11-11.9 g / dl, feem, uas yog mob me me, thaum cov hemoglobin theem nrab thiab mob hnyav yog 8-10.9. g / dl, raws li dl thiab <8 mg/dl.Txiv neej thiab poj niam
Sau tsib milliliters (5 mL) ntawm cov ntshav venous nyob rau hauv ib lub raj kuaj tsis muaj anticoagulant los txiav txim creatinine thiab urea.Tag nrho cov ntshav uas tsis muaj tshuaj tiv thaiv coagulant yog txhaws rau 20-30 feeb thiab centrifuged ntawm 3000 rpm rau 5 feeb kom cais cov ntshav.Tom qab ntawd, Mindray BS-200E (Tuam Tshoj Mindray Biomedical Electronics Co., Ltd.) soj ntsuam chemistry analyzer tau siv los txiav txim siab cov ntshav creatinine thiab urea cov ntsiab lus los ntawm acid picrine thiab enzymatic txoj kev.37 Siv creatinine clearance npaum li cas los kwv yees glomerular filtration rate.Siv Cov Kab Mob Raum Hniav (CKD) Ratio (GFR), qhia raws li CKD-EPI Cockroft-Gault mis qhia ib 1.73 square meters.
Cov ntshav qabzib yoo mov (tsawg kawg 8 teev) yog ntsuas los ntawm cov ntiv tes pricks siv lub ntsuas ntshav qabzib ntsuas rau cov ntshav qabzib.38 Yog tias cov ntshav qabzib yoo mov yog <80 lossis> 130mg / dl, ces cov cai tswj tsis tau cov ntshav qabzib.Tswj thaum lub sijhawm yoo mov cov ntshav qabzib nyob nruab nrab ntawm 80-130mg / dl 39
Cov neeg koom nrog txoj kev tshawb fawb tau muab ib daim ntawv thov ntoo huv thiab ib lub khob yas huv, qhuav, tsis muaj dej pov thawj nrog tus neeg kawm tus lej ntawm nws rau kev tshuaj xyuas fecal parasite.Qhia lawv kom nqa cov quav tshiab ntawm ob grams (txog qhov loj ntawm tus ntiv tes xoo).Tom qab kuaj pom kab (qe thiab/los yog larvae) siv cov txheej txheem ntub dej ncaj qha, cov qauv raug kuaj xyuas tsis pub dhau 30 feeb ntawm cov qauv sau.Cov qauv seem tau muab khaws cia rau hauv lub raj ntsuas uas muaj 10 mL ntawm 10% formalin txhawm rau txhim kho qhov kuaj pom tus kab mob cab, thiab tom qab kho nrog formalin-ether nag lossis daus concentration technology, Olympus Microscope tau siv los tshuaj xyuas.
Siv lub lancet uas tsis muaj menyuam los sau cov ntshav capillary los ntawm cov ntiv tes txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau nws, koj yuav tsum tshem tawm cov qia.Npaj ib daim duab nyias nyias ntawm tib lub iav uas tsis muaj roj, thiab tom qab ntawd cua qhuav.Cov slides tau stained nrog 10% Giemsa rau li 10 feeb, thiab hom kab mob malaria tau kuaj.Thaum 100 lub zog hluav taws xob siab tau tshuaj xyuas raws li lub hom phiaj ntawm cov roj immersion, cov swb raug txiav txim siab tsis zoo.40
Kev cob qhia ob hnub ntawm cov cuab yeej sau cov ntaub ntawv thiab cov txheej txheem tau muab rau cov neeg sau cov ntaub ntawv thiab cov saib xyuas.Ua ntej Chiro General Tsev Kho Mob tau sau cov ntaub ntawv tiag tiag ntawm 30 tus neeg mob ntshav qab zib, daim ntawv nug tau raug kuaj ua ntej thiab kev hloov kho tsim nyog tau ua raws li.Kev ntsuas lub cev yog tus qauv tsim los ntawm tus txheeb ze kev ua yuam kev ntawm kev ntsuas (%TEM).Tsis tas li ntawd, cov txheej txheem kev khiav hauj lwm yog ua raws li nyob rau hauv tag nrho cov kev soj ntsuam cov qauv sau, cia, tsom xam thiab sau cov txheej txheem.
Kev tso cai rau kev coj ncaj ncees tau txais los ntawm Pawg Neeg Saib Xyuas Kev Noj Qab Haus Huv Kev Tshawb Fawb Kev Ncaj Ncees (IHRERC) ntawm Lub Tsev Kawm Ntawv Kev Noj Qab Haus Huv thiab Tshuaj Kho Mob ntawm Am Valley University (IHRERC 115/2020).Lub tsev kawm ntawv qib siab tau tshaj tawm tsab ntawv txhawb nqa rau GGH thiab tau txais kev tso cai los ntawm lub taub hau ntawm lub tsev kho mob.Ua ntej sau cov ntaub ntawv, tau txais kev ceeb toom, yeem, sau ntawv thiab kos npe tso cai los ntawm txhua tus neeg koom nrog kev kawm.Cov neeg koom nrog tau hais tias tag nrho cov ntaub ntawv sau los ntawm lawv yuav raug khaws cia tsis pub lwm tus paub los ntawm kev siv cov lej, thiab tsis muaj tus lej cim tus kheej yuav raug siv, thiab tsuas yog siv rau kev tshawb fawb.Qhov kev tshawb fawb no tau ua raws li "Kev Tshaj Tawm ntawm Helsinki".
Txheeb xyuas qhov ncaj ncees ntawm cov ntaub ntawv sau, encode thiab nkag mus rau EpiData version 3.1, thiab tom qab ntawd xa mus rau STATA version 16.0 rau kev tswj hwm cov ntaub ntawv thiab tshuaj xyuas.Siv feem pua, proportions, nruab nrab, thiab tus qauv sib txawv los piav qhia cov ntaub ntawv.Tom qab kho cov qib hemoglobin raws li kev haus luam yeeb ntawm cov neeg koom thiab qhov siab ntawm thaj chaw, qhov xwm txheej ntawm cov ntshav qab zib tau txiav txim siab raws li WHO cov qauv kev faib tawm tshiab.Haum rau ob-txheej logistic regression qauv los txheeb xyuas qhov sib txawv rau qhov kawg multivariate logistic regression tsom xam.Nyob rau hauv bivariate logistic regression, variables nrog p-tus nqi ≤ 0.25 yog suav hais tias yog cov neeg sib tw rau multivariate logistic regression.Tsim kom muaj ib qho qauv sib txawv logistic regression los txheeb xyuas cov yam tsis cuam tshuam rau ntshav qab zib.Siv qhov sib txawv piv txwv thiab 95% kev ntseeg siab lub sijhawm los ntsuas lub zog ntawm kev koom tes.Qhov ntsuas qhov tseem ceeb tau tshaj tawm raws li p-tus nqi <0.05.
Hauv txoj kev tshawb no, tag nrho ntawm 325 tus neeg laus DM tau koom nrog lub rooj sib tham, thiab cov lus teb yog 98.2%.Feem coob ntawm cov neeg koom;Cov txiv neej nyob deb nroog yog 203 (62.5%), 247 (76%), 204 (62.8%) thiab 279 (85.5%) yog txiv neej, thiab lawv haiv neeg yog Oromo.Lub hnub nyoog nruab nrab ntawm cov neeg tuaj koom yog 40 xyoo, thiab qhov sib txawv (IQR) yog 20 xyoo.Kwv yees li ntawm 62% ntawm cov neeg koom tsis tau txais kev kawm txuj ci, thiab 52.6% ntawm cov neeg koom yog cov neeg ua liaj ua teb ua haujlwm (Table 1).
Table 1 Socio-demographic yam ntxwv ntawm cov neeg laus DM kho hauv tsev kho mob dav dav hauv sab hnub tuaj Ethiopia xyoo 2020 (N = 325)
Ntawm cov neeg koom nrog txoj kev tshawb fawb, 74 (22.8%) tau tshaj tawm tias lawv tau haus luam yeeb tsawg kawg ib zaug hauv lawv lub neej, piv nrog 13 tus neeg haus luam yeeb tam sim no (4%).Tsis tas li ntawd, 12 tus neeg (3.7%) yog cov neeg haus dej haus tam sim no, thiab 64.3% ntawm cov neeg koom nrog cov tshuaj yej dub.Ntau tshaj li ib feem peb (68.3%) ntawm cov neeg koom nrog kev tshawb fawb qhia tias lawv ib txwm haus kas fes tom qab noj mov.Ib puas peb caug-peb (96.3%) thiab 310 (95.4%) cov neeg koom noj txiv hmab txiv ntoo thiab zaub tsawg dua tsib zaug hauv ib lub lis piam.Hais txog lawv cov khoom noj khoom haus, 92 (28.3%) thiab 164 (50.5%) cov neeg koom tau rog dhau thiab rog (Table 2).
Table 2 Kev coj tus cwj pwm thiab kev noj zaub mov zoo ntawm cov neeg laus DM raug kho ntawm Eastern Ethiopia General Tsev Kho Mob xyoo 2020 (N = 325)
Ntau tshaj 170 (52.3%) cov neeg mob uas muaj hom II DM muaj qhov nruab nrab DM ntev ntawm 4.5 (SD ± 4.0) xyoo.Yuav luag 50% ntawm cov neeg mob DM tau noj cov tshuaj hypoglycemic ntawm qhov ncauj (glibenclamide thiab / lossis metformin), thiab ze li peb-plaub feem pua ntawm cov neeg koom nrog cov ntshav qabzib tswj tsis tau (Table 3).Hais txog comorbidities, 2% ntawm cov neeg koom muaj comorbidities.80 (24.6%) thiab 173 (53.2%) cov neeg mob DM uas tsis muaj ntshav siab yog ntshav ntshav thiab tsis muaj ntshav qab zib.Ntawm qhov tod tes, cov neeg mob DM tau kuaj pom tias muaj ntshav siab, 189 (5.5%) thiab 54 (16.6%) yog ntshav qab zib.
Table 3 Cov yam ntxwv kho mob ntawm cov neeg laus DM raug kho hauv tsev kho mob dav dav hauv sab hnub tuaj Ethiopia xyoo 2020 (N = 325)
Qhov ntsuas ntshav qab zib hauv cov neeg mob ntshav qab zib yog 30.2% (95% CI: 25.4-35.4%), thiab qhov nruab nrab hemoglobin yog 13.2 ± 2.3g / dl (txiv neej: 13.4 ± 2.3g / dl, poj niam: 12.9 ± 1.7g / dl).Hais txog qhov mob hnyav ntawm cov ntshav ntshav hauv DM cov neeg mob ntshav qab zib, muaj 64 tus neeg mob me me (65.3%), 26 tus neeg mob ntshav tsis txaus (26.5%), thiab 8 tus mob hnyav anemia (8.2%).Ntshav qab zib hauv cov txiv neej (36.0%) tau nce siab dua hauv cov poj niam (20.5%) (p = 0.003) (Daim duab 1).Peb pom muaj kev sib raug zoo ntawm qhov hnyav ntawm cov ntshav qab zib thiab lub sijhawm ntawm ntshav qab zib (r = 0.1556, p = 0.0049).Qhov no txhais tau hais tias raws li lub sijhawm ntawm DM nce, qhov hnyav ntawm cov ntshav ntshav nce ntxiv.
Daim duab 1 Ntshav qab zib theem los ntawm poj niam txiv neej hauv cov neeg laus DM kho hauv tsev kho mob dav dav hauv sab hnub tuaj Ethiopia xyoo 2020 (N = 325)
Ntawm cov neeg mob DM, 64% ntawm cov txiv neej thiab 79.5% ntawm cov poj niam tsis yog anemic, thaum 28.7% thiab 71.3% ntawm Khat chewers tam sim no yog anemic.67% ntawm cov neeg laus DM uas siv kas fes tom qab noj mov tsis yog anemic, thiab 32.9% ntawm lawv tau pom tias muaj ntshav liab.Hais txog lub neej ntawm comorbidities, 72.2% ntawm cov neeg mob uas muaj DM tsis muaj comorbidities yog anemia, thiab 36.3% ntawm cov neeg mob DM comorbidities yog anemia.Cov neeg mob ntshav qab zib muaj teeb meem DM muaj ntshav qab zib ntau dua (47.4%) dua li cov tsis muaj teeb meem DM (24.9%) (Table 4).
Table 4 Yam muaj feem xyuam rau cov ntshav ntshav ntawm cov neeg laus DM kho hauv tsev kho mob dav dav hauv sab hnub tuaj Ethiopia xyoo 2020 (N = 325)
Haum bivariate thiab multivariate logistic regression qauv los tshuaj xyuas kev koom tes ntawm anemia thiab piav qhia txawv txawv.Hauv kev tsom xam bivariate;Hnub nyoog, poj niam txiv neej, kev txij nkawm, Khat zom, kas fes tom qab noj mov, comorbidities, mob ntshav qab zib mellitus, DM duration thiab noj zaub mov zoo (BMI) muaj feem cuam tshuam rau ntshav qab zib nrog p tus nqi <0.25, thiab yog Multivariate tus neeg sib tw logistic regression.
Hauv kev txheeb xyuas qhov sib txawv ntawm cov logistic regression, cov txiv neej uas muaj DM ≥ 5 xyoo ntawm lub sijhawm, qhov muaj comorbidities thiab cov teeb meem ntawm DM tau cuam tshuam nrog ntshav ntshav.Cov txiv neej laus DM cov neeg mob muaj 2.1 npaug ntau dua yuav raug mob ntshav qab zib ntau dua li poj niam (AOR = 2.1, 95% CI: 1.2, 3.8).Piv nrog rau cov neeg mob DM uas tsis muaj comorbidities, DM cov neeg mob uas muaj comorbidities yog 1.9 npaug ntau dua yuav muaj ntshav ntshav (AOR = 1.9, 95% CI: 1.0, 3.7).Piv nrog rau cov neeg mob DM ntev ntawm 1-5 xyoos, DM cov neeg mob uas muaj DM ntev ≥ 5 xyoos yog 1.8 npaug ntau dua yuav ua rau mob ntshav qab zib (AOR = 1.8, 95% CI: 1.1, 3.3).Qhov kev pheej hmoo ntawm ntshav ntshav hauv cov neeg mob uas muaj teeb meem DM yog 2.3 npaug ntawm cov npoj yaig (AOR = 2.3, 95% CI: 1.3, 4.2) (Table 4).
Txoj kev tshawb no tau soj ntsuam qhov hnyav ntawm cov ntshav liab thiab lwm yam cuam tshuam hauv cov neeg mob DM uas tau soj ntsuam ntshav qab zib hauv Gelemso General Tsev Kho Mob.Qhov degree ntawm anemia hauv txoj kev tshawb fawb tam sim no yog 30.2%.Raws li WHO kev faib tawm ntawm pej xeem kev noj qab haus huv tseem ceeb, nyob rau hauv kev tshawb fawb ib puag ncig, anemia yog ib qho teeb meem kev noj qab haus huv nruab nrab ntawm cov neeg laus nrog DM.Poj niam los txiv neej, lub sij hawm ntawm DM, muaj cov teeb meem DM, thiab cov txiv neej uas muaj DM comorbidities raug txheeb xyuas raws li yam muaj feem xyuam rau cov ntshav liab.
Lub degree ntawm anemia nyob rau hauv txoj kev tshawb no yog piv rau lub Ethiopian Dessie Referral Hospital [24], tab sis siab dua li ntawm lub Ethiopian Fenote Selam Tsev Kho Mob [41] nyob rau hauv ib cheeb tsam kawm nyob rau hauv Tuam Tshoj, 42 Australia, 43 thiab India [44] ]., uas yog qis dua cov kev tshawb fawb hauv Thaib teb [45], Saudi Arabia [46] thiab Cameroon [47].Qhov sib txawv no yuav yog vim muaj hnub nyoog sib txawv ntawm cov neeg kawm.Piv txwv li, tsis zoo li txoj kev tshawb fawb tam sim no uas tsis suav nrog cov neeg laus dua 18 xyoo, kev tshawb fawb hauv Thaib teb suav nrog cov neeg laus dua 60 xyoo, thaum txoj kev tshawb fawb hauv Cameroon suav nrog cov neeg laus dua 50 xyoo.Qhov sib txawv kuj tseem yog vim lub raum tsis ua haujlwm, o, pob txha pob txha tawg, thiab kev noj zaub mov tsis txaus (nce ntxiv rau hnub nyoog) 17.
Peb xav tsis thoob tias hauv peb txoj kev tshawb fawb, txiv neej anemia muaj ntau dua li poj niam.Qhov kev tshawb pom no yog qhov tsis sib xws rau lwm cov ntaub ntawv tshawb fawb [42,48], uas cov poj niam muaj feem yuav mob ntshav qab zib ntau dua li cov txiv neej uas muaj ntshav qab zib.Qhov laj thawj ntawm qhov sib txawv no yuav yog tias cov txiv neej hauv peb txoj kev tshawb fawb muaj ntau dua Khat zom cov cwj pwm, uas yuav ua rau tsis qab los noj mov 49, thiab Khat muaj tannins-ib yam khoom uas txo cov bioavailability ntawm non-heme hlau hauv cov zaub mov.50 Lwm qhov laj thawj yog vim qhov ntau dua ntawm kas fes thiab tshuaj yej hauv cov txiv neej hauv txoj kev tshawb no inhibited kev nqus hlau los ntawm txoj hnyuv.51-54 : kuv
Peb pom tias cov neeg mob uas muaj DM ≥ 5 xyoo muaj feem yuav mob ntshav qab zib ntau dua li cov neeg mob DM nrog kev kawm ntawm 1-5 xyoos.Qhov no zoo ib yam nrog cov kev tshawb fawb ua nyob rau hauv Tsev Kho Mob Fenote Selam hauv Ethiopia, 41 Iraq 55 thiab United Kingdom.17 Qhov no tej zaum yuav yog vim muaj kev cuam tshuam ntev rau hyperglycemia, ua rau muaj kev nce hauv cov kab mob cytokines nrog cov tshuaj tiv thaiv erythropoietin, uas ua rau txo qis.Kev txo qis ntawm cov qe ntshav liab ua rau txo qis hauv hemoglobin.35
Raws li kev tshawb fawb ua nyob rau hauv Suav teb, 13 anemia nyob rau hauv txoj kev tshawb no muaj ntau dua nyob rau hauv cov neeg mob DM uas muaj teeb meem.Raws li kev lom neeg, cov teeb meem mob ntshav qab zib tuaj yeem ua rau lub cev thiab cov hlab ntsha ntawm lub raum ua rau lub raum tsis zoo, cov kab mob hauv lub raum, thiab induction ntawm erythropoietin tso tawm inhibitors tuaj yeem ua rau mob ntshav qab zib.56 Hypoxia tuaj yeem cuam tshuam cov noob qhia, cov metabolism, capillary permeability thiab cell ciaj sia 57. Cov ntshav liab txo qis thiab nws cov khoom antioxidant cuam tshuam nrog ntshav qab zib kuj tseem yuav ua rau muaj teeb meem ntxiv rau cov neeg mob ntshav qab zib58.
Tsis tas li ntawd, DM cov neeg mob uas muaj cov kab mob comorbidities feem ntau ua rau mob ntshav qab zib ntau dua li cov neeg mob DM uas tsis muaj comorbidities.Qhov no yog piv rau yav dhau los cov kev tshawb fawb zoo sib xws [35,59], uas tej zaum yuav yog vim muaj kev cuam tshuam ntawm comorbidities (xws li kub siab) ua rau mob plawv, yog li ua rau muaj kev pheej hmoo ntawm ntshav qab zib.60
Raws li ib qho ntawm cov kev tshawb fawb soj ntsuam tsawg heev tau ua hauv Ethiopia, cov kab mob ntev xws li DM tau dhau los ua ntau dua, uas yog lub zog ntawm qhov kev tshawb fawb no.Ntawm qhov tod tes, txoj kev tshawb no yog ib txoj kev tshawb fawb raws li lub tsev kho mob thiab yuav tsis sawv cev rau txhua tus neeg mob DM lossis cov neeg mob uas tau soj ntsuam hauv lwm lub tsev kho mob.Qhov sib txawv ntawm qhov kev tshawb fawb tsim peb siv tsis tso cai rau kev tsim kev sib raug zoo ntawm lub cev ntawm cov ntshav ntshav thiab cov yam ntxwv.Cov kev tshawb fawb yav tom ntej yuav xav tau siv cov ntaub ntawv tswj hwm, kev tshawb fawb hauv pawg lossis lwm yam kev tshawb fawb tsim los txiav txim siab txog cov cim thiab cov tsos mob ntawm cov ntshav ntshav, RBC morphology, serum iron, vitamin B12, thiab folic acid.
Hauv kev tshawb fawb ib puag ncig, anemia yog ib qho teeb meem kev noj qab haus huv rau pej xeem nruab nrab ntawm cov neeg laus DM.Poj niam los txiv neej, lub sij hawm ntawm DM, muaj cov teeb meem ntawm DM, thiab comorbidities yog txiv neej thiab raug txheeb xyuas raws li yam muaj feem xyuam rau anemia.Yog li ntawd, niaj hnub kev tshuaj ntsuam xyuas ntshav qab zib thiab kev tswj kom tsim nyog rau cov neeg mob DM nrog lub sijhawm ntev DM, comorbidities thiab teeb meem yuav tsum tau tsim los txhim kho lub neej zoo ntawm cov neeg mob.Kev kuaj mob ntxov thiab kev saib xyuas ntawm DM tsis tu ncua kuj tseem tuaj yeem pab txo qis cov teeb meem.
Cov ntaub ntawv txhawb nqa cov txiaj ntsig tau tshaj tawm hauv cov ntawv sau tuaj yeem tau txais los ntawm tus neeg sau ntawv raws li qhov xav tau tsim nyog.
Peb xav ua tsaug rau lub taub hau ntawm Gelemso General Tsev Kho Mob, cov neeg ua haujlwm ntawm Lub Tsev Kho Mob Ntshav Qab Zib, cov neeg koom nrog kev kawm, cov neeg sau cov ntaub ntawv thiab cov kws pab tshawb fawb.
Txhua tus kws sau ntawv tau muaj txiaj ntsig zoo rau kev ua haujlwm ntawm daim ntawv tshaj tawm, txawm tias hais txog lub tswv yim, kev tsim kev tshawb fawb, kev ua tiav, kev nrhiav tau cov ntaub ntawv, kev tshuaj xyuas thiab kev txhais lus, lossis txhua yam no;koom nrog hauv kev sau ntawv, kho dua lossis kev tshuaj xyuas nruj ntawm cov lus no;Thaum kawg Pom zoo lub version yuav tsum luam tawm;mus txog qhov kev pom zoo ntawm phau ntawv journal uas tsab xov xwm raug xa mus;thiab tau pom zoo ua lub luag haujlwm rau txhua yam ntawm txoj haujlwm.
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