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Prevalence of diabetic retinopathy, cataract and visual impairment in patients with diabetes in sub-Saharan Africa
  1. Simon J Glover1,
  2. Philip I Burgess2,
  3. Danielle B Cohen1,
  4. Simon P Harding2,
  5. Helma W C Hofland1,
  6. Eduard E Zijlstra1,
  7. Theresa J Allain1
  1. 1Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
  2. 2Ophthalmology Research Unit, University of Liverpool, UK
  1. Correspondence to Philip I Burgess, Ophthalmology Research Unit, University of Liverpool, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; philipburgess{at}


Background/aims There are few published data on the prevalence of diabetic retinopathy in sub-Saharan Africa. We report the prevalence of all grades of retinopathy and associations with systemic parameters in patients attending a secondary care diabetes clinic in Blantyre, Malawi.

Methods Cross-sectional study of all patients attending for diabetes care in a hospital setting. Clinical examination and biochemical testing was performed to assess visual acuity (VA), grade of retinopathy (slit lamp biomicroscopy), microvascular complications, glycaemic control, hypertension and HIV status. Sight-threatening diabetic retinopathy (STDR) was defined as moderate preproliferative retinopathy or worse, circinate maculopathy or exudates within one disc diameter of the foveal centre or clinically significant macular oedema.

Results In patients with type 2 diabetes (n=249) the prevalence (95% CI) of any retinopathy, STDR and proliferative diabetic retinopathy (PDR) was 32.5% (26.7 to 38.3%), 19.7% (14.7 to 24.6%) and 4.8% (2.2 to 7.5%), respectively. The presence of STDR was associated with albuminuria (OR 2.6; p=0.02), the presence of neuropathy (OR 3.4; p=0.005) and insulin use (OR 5.3; p=0.0004), but not with HIV status. In patients with type 1 diabetes (n= 32), the prevalence of any retinopathy, STDR and PDR was 28.1% (12.5 to 43.7%), 18.8% (5.2 to 32.2%) and 12.5% (1.0 to 24.0%), respectively. 12.1% of study subjects had VA worse than 6/18 (20/60).

Conclusion This study provides baseline information on prevalence of all grades of retinopathy and STDR in consecutive cases attending an urban/semi-urban diabetes clinic in sub-Saharan Africa. Prevalence of STDR was high and in type 2 diabetes was associated with albuminuria, neuropathy and insulin use.

  • Diabetes complications
  • diabetes mellitus
  • diabetic retinopathy
  • prevalence
  • sub-Saharan Africa
  • retina
  • epidemiology

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained from the Malawi College of Medicine Research and Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.