Encuesta CAMDI NicaraguaWith the objective of acquiring a better knowledge of the current situation of diabetes mellitus in the population of 20 years and older in Managua, the Central American Diabetes Initiative (CAMDI) conducted its first survey on diabetes and hypertension in 2003. The secondary objectives of the study were to measure the prevalence of risk factors for diabetes and hypertension as well as the relationship between the prevalence of these diseases and their risk factors, while studying the population's demographic, environmental, social, cultural, and economic features.

This study, carried out by the Ministry of Health, PAHO/WHO, and the Centers for Disease Control and Prevention of the United States (CDC), revealed that 9.9% of the respondents in Managua suffered from diabetes mellitus, with both sexes affected in similar ways. The total prevalence for hypertension was 25%, with women being more affected (28.8%) than men (21.2%). One third of the respondents had a history of diabetes mellitus; and half, of hypertension.

This qualitative, cross-sectional study was aimed at a population of 2,400 people, with a sample of 1,993 people from the five urban districts of Managua, in 50 strata of the population, and from 56 neighborhoods from 100 sectors that represent 83% of the total of the target population for this study. The selection of the sample was multistage and stratified by three age groups: 20-39, 40-59, and 60 years and over, of both sexes. Participants responded to a questionnaire and consented to testing: anthropometric measurements, blood pressure, and biochemical tests (lipid profile, creatinine, fasting blood glucose, and a glucose tolerance test).

Of the total number of those interviewed (1,993), 1,704 (85%) of them went to a health center for the blood tests. Of those who were examined, 54% were women and 46% were men. A total of 294 people did not go to get their testing done. Of the 1,993 interviewees, 1,063 (53.3%) corresponded to the age group of 20-39 years; 685 (34.3%) of 40-59 years, and 245 (12.3%) 60 years and over. Some 4 people were excluded because they did not meet the established criteria for inclusion.

Biochemical testing was done: fasting blood glucose, oral blood glucose test after two hours fasting, total cholesterol, DHL-cholesterol, LDL-cholesterol, triglycerides, and creatinine. Results showed that in 20% of this population, the total cholesterol level was above of the standard value (>200 mg/dl), which could be the result of the influence of inadequate diet, a discharge of fat, and a sedentary lifestyle.

In addition to the interviews and the biochemical tests, the researchers made anthropometric measurements on the respondents and took their blood pressure. Results indicated that 25.2% of the respondents showed hypertension. Overweight (body mass index / BMI ? 25) was found in 65% of the total of the respondents (37% overweight and 28% obesity), with women being more affected women than men (71% and 59%, respectively); and 33% engaged in low levels of physical activity.

Other risk factors studied were smoking and alcohol consumption. Of all the respondents, 21% indicated that they were smokers and 72% indicated that they consumed five or more alcoholic beverages in the four weeks prior to the survey, predominantly among men (with 77.5%) as opposed to women (with 60.7%).A high prevalence of smoking and alcoholism was observed in people under 40; and with both of these risk factors, the prevalence is higher among men than among women.

Of the respondents, 25% reported adding additional salt to food already prepared; and 62% of the respondents reported using oil most often when preparing food. This factor was reported primarily by people from the age group of 20-39.

In accordance with data from the Ministry of Health, diabetes has shown a rising trend, which has accelerated since 2003 and now ranks third among the reported cause of death. This means that, on the basis of these data and the results of the present study, the following recommendations can be made:

  • Continue the second phase of the Central American Diabetes Initiative (CAMDI), which consists of an intervention to improve the quality of diabetes care.
  • Revisit the experience of the frame of reference for chronic noncommunicable diseases (CNCDs, with the PAHO/WHO Regional Strategy and Plan of Action) as a basis for prepare a national plan to respond to all CNCDs.
  • Strengthen the epidemiological surveillance system, complementing it with an approach that works for CNCDs.
  • Strengthen the national CARMEN commission so that it can prepare and implement a joint intervention plan to reduce risk factors that predispose a person to diabetes, through health promotion in healthy schools and community participation. This initiative will involve NGOs, health agencies, and state and local health departments.
  • Strengthen human resources in health service networks, with periodic updates in subjects that allow for more effective monitoring of risk factors that predispose people to develop chronic diseases.
  • Set up a system for periodic evaluation of quality of care in health services.