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Paradoxical outcomes in cardiovascular profiles among elderly

people in Tanzania: a clinical based study

K. Leshabari




Clinical Research Unit, Candella Co. Ltd.,


Dept. of

Medicine- The Walter Hospital, Dar es Salaam, Tanzania


To analyse the association between blood pressure profile

and cardiometabolic parameters among elderly people attending

outpatient clinics in a typical sub-Saharan Africa environment.


A cross-sectional hospital based study was conducted in a

metropolitan city of Dar es Salaam in Tanzania. Study population

comprised of people

65 years old attending OPD settings. Data on

systolic and diastolic BP, Hb level, FBG/RBG, waist-to-hip ratio,

corrected serum Ca2+ and serum creatinine levels were analysed.

Log-linear models were fitted to analyse the association between

studied variables. SAS version 9.4 was used for data analysis.


Findings from 502 elderly people were analysed. There was a

slight female preponderance in the study sample (M:F = 1:1.4) Median

agewas 73.2 years (range = 65

94 years) Therewas a paradoxical trend

between systolic/diastolic BP and history of CVAwith age (P-value for

trend = 0.02). Serum Ca2+ levels and elevated BP levels were strongly

correlated (

= 0.813, p < 0.01). Women outnumberedmen in reported

history of CVA (P < 0.01). Low Hb levels and low serum creatinine were

associated with multiple CVA history (

= 0.507, p = 0.04).


Serum Ca2+ levels were inversely related to CVA events in

the elderly population in this study. Elderlywomenweremore likely to

have elevated serum Ca2+ than elderly men. Elderly with a history of

multiple CVA events were likely to have low Hb levels and low serum

creatinine. CVA risk was found to be less likely among elderly people

with elevat BP.


Further experimental studies are needed to

account for a probable causal relationship between serum Ca2+

levels and CVA protection in the elderly population.


elderly; CVA; Dar es Salaam; Tanzania.


Cardiometabolic risk modeling using a typical high risk adult

population of sub-Saharan settings

K. Leshabari


, B. Mphumuhila


, N. Mavura


, R. Bushiri


, R. Kalikawe




Clinical research unit, Candella Co. Ltd,


Dept. of Medicine, The Walter



Temeke Municipal Hospital,


Mwananyamala Hospital,


Amana Municipal Hospital,


Muhimbili National Hospital, Dar es

Salaam, Tanzania


To develop a simple, non-invasive cardiometabolic risk

tool for identification of adult at risk of diabetes mellitus in sub-

Saharan Africa.


A cross-sectional analytical based opportunistic screening

was conducted among pre-defined high risk group residents of Dar es

Salaam, Tanzania. Data were collected using a locally prevalidated

questionnaire provided by Tanzania Diabetes Association after fasting

blood glucose measurements. Analysis was done using SAS version 9.2

by fitting linear models. Averbal informed consent was sought to each

participant before screening.


We screened a total of 461 residents. Males predominated

the screened cohort (male: female = 2.3:1). Multiple logistic model

revealed age of the participant, family history of diabetes, systolic BP as

well as BMI to have a better explanatory power (p < .001) Spearman

correlation coefficient between being screened positive for diabetes

and family history of diabetes was strong and significant (


= 0.673,

p = 0.002) No statistical significant effect was found between gender

and positive diabetes screening (


2 = 4.66, df = 1)


Age of participants, family history of both diabetes and

hypertension, BMI as well as systolic measures of BP were predictive of

diabetes in this study population. Adoption of non-invasive screening

for diabetes may be an alternative to the current invasive glycaemic

measurements in resource limited settings.

Key Words:

Cardio-metabolic risk, diabetes, Dar es Salaam, Tanzania.


Glycaemic control according to health status in geriatric patients

with diabetes mellitus

A. Libiseller


, K.M. Neubauer


, A. de Campo


, T. Wiesinger


, N. Stolletz



G. Cuder


, B. Höll


, L. Schaupp


, P. Beck


, J. Plank


, T.R. Pieber





University of Graz,


Geriatric Health Centers of the City of Graz,


Joanneum Research ForschungsgesmbH Graz, Austria


About 25% of people older than 70 years suffer from type-

2-diabetes. Due to the heterogeneity of the geriatric population

guidelines emphasize the need to individualize glycaemic goals

and to simplify treatment strategies with the main focus of avoiding

hypoglycaemia. The aim of this study was to assess glycaemic control

in patients with type-2-diabetes in geriatric care facilities based on the

individual health status.


170 medical records of geriatric patients with type-2-

diabetes in 4 geriatric care facilities (64.7% female, age 80 ± 9 years,

HbA1c 51 ± 16 mmol/mol, BMI 27.9 ± 5.8 kg/m


) were retrospectively

assessed. Based on the individual health status, patients were allocated

to three groups (healthy n = 27, complex n = 86, poor n = 57).


The overall blood glucose (BG) value was highest in the poor

health group with 188 ± 47 mg/dL (poor) vs. 167 ± 42 mg/dL (complex)

vs. 150 ± 34 mg/dL (healthy). 1.6% (poor) vs. 2.8% (complex) vs. 1.4%

(healthy) of all BG values were below 90 mg/dL. 37.2% (poor) vs. 23.4%

(complex) vs. 18.5% (healthy) received insulin as the main diabetes

therapy, but only 14.3% (poor) vs. 30% (complex) vs. 40% (healthy)

were treated with basal insulin.


Overall BG values were higher in the poor and complex

group. There were few low BG values in all groups. Although recom-

mended by international guidelines basal insulin therapy with its low

complexity and low hypoglycaemic risk is still underused, especially in

the poor-health group. Therefore the simplification of diabetes therapy

should further be considered.

Supported by: Research Studio Austria


(FFG, project



Feed at risk

K.T. Ling, P. Das, T. Vedutla, G. Shorthouse.

Department of Stroke and

Elderly Care


Patients admitted to hospital often have swallowing

difficulty. Often alternative methods of feeding for example enteral

tube are considered. These patients unfortunately are deemed

unsuitable for PEG feeding or long term NG feeding due to severe

comorbidities. These patients are high risk of aspiration. Keeping them

nil by mouth puts them at risk of starvation and malnutrition. Our

search of National Guidelines does not give any guidance for risk

feeding for these patients. Healthcare professionals often find this to

be very challenging and a difficult issue to address. The feeding at risk

needs to be considered in light of the patients overall comorbidities,

wishes and prognosis. Decision should be ethically relevant.

Innovation To address these issues, we developed a

Feed at Risk

policy in our trust to aid oral feeding in these patients who are at risk of

aspiration. The policy helps patients, healthcare professionals and

family in arriving at the correct decision. Evaluation We decided to

do a retrospective audit of outcomes of patients who were managed

with the Feed at Risk policy. We audited 22 case notes from January

2014 to March 2016. Out of these 22 patients, 16 patients did not

have aspiration pneumonia. Of the other 6 patients who did have

aspiration pneumonia, 4 survived and 2 died.


Our results validates that feed at risk is a safe and effective

patient centred pathway for these high risk patients. Further studies

with larger cohort of patients are needed for further validation of this


Poster presentations / European Geriatric Medicine 7S1 (2016) S29