Morbidity and Complications of Diabetes Mellitus in Children and Adolescents in Ghana: Protocol for a Longitudinal Study.

BACKGROUND: Diabetes is associated with premature morbidity and mortality from its many complications. There are limited data on the chronic complications of diabetes in children and adolescents in sub-Saharan Africa. OBJECTIVE: The study aims to determine the (1) burden and related factors of chronic systemic complications of diabetes, including diabetic and nondiabetic ocular conditions in children and adolescents, and (2) quality of life (QoL) of participants compared to healthy controls. This manuscript describes the study methodology. METHODS: Demographic information, medical history, anthropometric measurements, and laboratory characteristics were collected, and the participants were screened for microvascular and macrovascular complications as well as nondiabetic ocular disease. QoL questionnaires were administered to participants, their caregivers, and controls. Participants were followed up annually up to 3 years to determine the natural history of and trends in these conditions. SPSS Version 25.0 will be used for data analysis. Continuous and categorical data will be presented as mean (SD) and as percentages (%), respectively. t tests and analysis of variance will be used to compare means, and chi-square tests will be used to compare categorical data. Correlation, regression, and logistic regression analyses will be employed to establish linear associations and causal associations as appropriate. Relative risk and odds ratios will be used to estimate risk. QoL outcomes in Ghanaian children and adolescents with diabetes mellitus compared with caregivers and healthy controls will be assessed using the Pediatric Quality of Life inventory. Significance will be set at α=.05. RESULTS: Institutional approval from the Ethical and Protocol Review Committee of the University of Ghana Medical School was received on August 22, 2014 (Protocol Identification Number: MS-Et/M.12-P4.5/2013-2014). Funding for the project was received from the University of Ghana Research Fund (#UGRF/9/LMG-013/2015-2016) in March 2016. Patient recruitment, clinical examination, and data collection commenced in August 2016 and was completed in September 2019. A total of 58 children and adolescents with diabetes mellitus have been recruited. Blood samples were stored at -80 °C for analysis, which was completed at the end of July 2020. Data analysis is ongoing and will be completed by the end of December 2020. Investigators plan to submit the results for publication by the end of February 2021. CONCLUSIONS: The prevalence, natural history, trends in diabetic complications and nondiabetic ocular disease, and QoL will be provided. Our data may inform policies and interventions to improve care given to children and adolescents with diabetes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21440.

How Accurate is Our Misinformation?: A Randomized Trial to Assess the Cost-Effectiveness of Administering Alternative Survey Modes to Youth at Risk: Dominican Republic Case Study

The study reports on a randomized trial of 1,200 young adults enrolled in an employment training program, to determine the most cost-effective and appropriate interview mode for measuring youth risk behaviors. Four different survey administration modes -two interviewer-assisted (FTFI and CATI) and two self-administered modes (SAI and ACASI)-were randomly assigned. The authors have centered the study on the question of cost-effectiveness -actual implementation costs and estimates of measurement bias- and the randomization of interviewer gender in order to assess the interaction between gender and data quality. The research shows that the target population is likely to underreport sensitive questions in self-administered surveys, and thus the degree to which a mode improves self-reporting of a particular risk behavior or set of behaviors is likely to be context specific.

Chronic Diseases, Primary Care and Health Systems Performance: Diagnostics, Tools and Interventions

Growing exposure to risk factors in combination with low levels of access to preventive care are increasing unmet health needs. LAC has been experiencing a "nutrition transition" towards less healthy diets. Thirty to sixty percent of the region's population does not achieve the minimum recommended levels of physical activity and obesity is rising rapidly. Inadequate access to high quality health services, including clinical prevention and diagnostic services and difficult access to essential medicines are significant contributing factors to the growing burden of chronic disease.

A Toolkit for the Measurement of Youth Risk Behavior

A toolkit for the measurement of youth risk behavior This publication is the third in a series of monographs prepared by the Inter-American Development Bank's Social Protection and Health Division to support the measurement of youth at risk. In this context, this document has been created to support and strengthen the monitoring and evaluation processes of programs aimed at youth. With an emphasis on effective results measurement, it is structured as a user-friendly operational guide for teams of specialists who work with this population group.

It Can Be Done: An Integrated Approach for Controlling and Eliminating Neglected Tropical Diseases

This book analyzes the efforts made by the Neglected Tropical Disease Initiative in Latin America and the Caribbean (LAC NTD Initiative) to control or eliminate these dreadful diseases through integrated NTD programs that address multiple diseases by combining interventions from health, water and sanitation, education, and other sectors in a unified, coordinated way. It shares the LAC NTD Initiatives experiences advocating for the financing, design, and implementation of integrated programs to combat the diseases, and it highlights several important lessons learned and challenges confronted throughout the process. Unlike previous works, this book employs a single conceptual framework to compare and contrast the integration of projects implemented in different contexts. The experiences, case studies, and analyses presented here offer ideas and best practices for building partnerships for promoting NTD control, and for integrating the management structures, financing arrangements, implementation, and monitoring and evaluation activities of NTD projects and programs.

Health Benefit Plans in Latin America: A Regional Comparison

Guaranteeing the right to health care under equal conditions for all is a goal that every society desires to achieve, particularly in a region as unequal as Latin America and the Caribbean. Universal coverage is an important objective for most countries; however, the context for attaining universal coverage is difficult, as the pressure on health spending mounts with each passing day. So, what to leave in or out of a health benefit plan?

Intervention and Policy Options for Combating Malnutrition in Guatemala

Guatemala is facing a health paradox. On the one hand, chronic child malnutrition rates are worse than those in Africa, and are quadruple the average rates for Latin America. On the other hand, obesity and overweight affect half of the country's women, and anemia has also increased at an alarming rate. The study addresses the topic of malnutrition in an innovative and pragmatic way and provides key recommendations for implementing much-needed nutrition interventions in Guatemala. Dietary deficiencies and low breastfeeding rates are limiting children's developmental potential in Guatemala and negatively affecting quality of life and opportunities for the country's population.

Indicadores e Dados Básicos - Brasil 2004

Apresenta indicadores disponíveis que evidenciam disparidades regionais importantes no acesso aos recursos, o que reflete desigualdades sociais, econômicas e de atenção à saúde

Caribbean regional health study

Second working draft