A MIXED COHORT STUDY ON DIETARY ADHERENCE, INFECTION PREVENTION, AND GLYCEMIC CONTROL AMONG DIABETIC PATIENTS IN SOUTH KIVU, EASTERN DEMOCRATIC REPUBLIC OF THE CONGO.

Authors

  • Dr Mulakwa Morisho Lambert Department of Medical Biology and Community Health, Kanyamulande Higher Institute of Medical Techniques, Walungu, DR Congo.
  • Dr Bamavu Amisi Charles Coordination of Leprosy and Tuberculosis Control, Maniema Provincial Health Division, Kindu, DR Congo.
  • Dr Chirimwami Muganda Vaccination Service, French Red Cross Health and Prevention Center in Kourou, Kourou, French Guyana.
  • BAHOGWERHE KASHENGULA Elie Preventive and Curative Service, Biomedical Research Unit, Vaccine and Antimicrobial Resistance, Muhungu-Etat/CELPA Health Center, Bukavu, DR Congo.
  • MWALA MORISHO Benoit Information Technology and Logistics Department, Data Management, Salama Afia Corporation, Kindu, DR Congo
  • Prof. Kipindula Morisho Berti Department of Community Health, University Center of Peace, Bukavu, DR Congo.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i3.1620

Keywords:

Dietary adherence, infection prevention, glycaemic control, diabetes management, South Kivu

Abstract

Background

Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body does not use it effectively. A well-adapted diet is essential to stabilize blood glucose levels and prevent complications such as hyperglycaemia and infections. However, adherence to this diet is often compromised by socio-economic factors, limiting access to balanced nutrition and healthcare. This study aims to evaluate the impact of dietary adherence on diabetes management, focusing on infection prevention and glycaemic control.

Materials and Method

A longitudinal study (2020-2024) in South Kivu (Bukavu, Mwenga, Walungu) followed diabetic patients. After informed consent, data was collected through medical records and structured interviews using standardized forms. Statistical analyses, including chi-square tests and logistic regressions, were performed using Jamovi software.

Results

Among 1520 patients, 59.3% of those with stable blood glucose levels adhered to the diet, with an infection rate of 56.8%, compared to 81.9% for non-adherent patients. Among patients with unstable blood glucose levels, 16.5% adhered to the diet, with an infection rate of 27.2%, compared to 98.1% among non-adherent patients. Non-adherence was associated with a higher risk of infection (OR = 7.84), hyperglycaemia (OR: 4.6), hospitalisation (OR = 2.03), and comorbidities (OR = 4.8).

Conclusion

Dietary adherence plays a crucial role in diabetes management by reducing infections and improving glycaemic control.

Recommendations

However, socioeconomic constraints have a significant impact on adherence. Strengthening nutrition education and improving access to healthcare, especially in rural areas, are essential strategies to optimize diabetes management and reduce associated complications.

Author Biographies

Dr Mulakwa Morisho Lambert, Department of Medical Biology and Community Health, Kanyamulande Higher Institute of Medical Techniques, Walungu, DR Congo.

Dr Mulakwa Morisho Lambert is a renowned infectious disease specialist, specializing in the diagnosis and management of infectious diseases. Drawing on his experience in tropical medicine, he has contributed to various research projects on infectious diseases in Africa, particularly in the Democratic Republic of Congo (DRC), and is actively involved in the implementation of infection management strategies in resource-limited settings.

Dr Bamavu Amisi Charles, Coordination of Leprosy and Tuberculosis Control, Maniema Provincial Health Division, Kindu, DR Congo.

Dr Bamavu Amisi Charles is an infectiologist and researcher with expertise in emerging infections and tropical diseases. He has conducted studies on the public health impact of infections, particularly in the DRC, and has participated in several research projects aimed at improving treatment and prevention strategies in high-risk areas.

Dr Chirimwami Muganda, Vaccination Service, French Red Cross Health and Prevention Center in Kourou, Kourou, French Guyana.

Dr Chirimwami Muganda Serge is an expert in transfusion medicine, specializing in the management of risks associated with blood transfusion. His research focuses on the prevention of transfusion-transmitted infections and the optimization of transfusion practices, particularly in Africa, where health systems are often fragile.

BAHOGWERHE KASHENGULA Elie, Preventive and Curative Service, Biomedical Research Unit, Vaccine and Antimicrobial Resistance, Muhungu-Etat/CELPA Health Center, Bukavu, DR Congo.

Bahogwerhe Kashengula Elie is a nurse with expertise in clinical nutrition and the management of malnutrition-related diseases. He has worked on nutrition programs for vulnerable populations, particularly in humanitarian crisis contexts, and is involved in research aimed at improving access to balanced diets in resource-limited settings.

MWALA MORISHO Benoit, Information Technology and Logistics Department, Data Management, Salama Afia Corporation, Kindu, DR Congo

Mwala Morisho Benoit has expertise in data analysis, specializing in statistical methods applied to public health research. He has contributed to several epidemiological studies using advanced data analysis techniques, contributing to the reform of public health policy in the DRC.

Prof. Kipindula Morisho Berti, Department of Community Health, University Center of Peace, Bukavu, DR Congo.

Prof. Kipindula Morisho Bertin is a professor of health sociology with a focus on social determinants of health and health inequalities. He has conducted numerous studies on the impact of socio-economic and cultural factors on health behavior in Africa, particularly in the context of the DRC. His research informs public health policy and community engagement strategies for health programs.

References

Eckold C, Kumar V, Weiner J, Alisjahbana B, Riza AL, Ronacher K, et al. Impact of Intermediate Hyperglycemia and Diabetes on Immune Dysfunction in Tuberculosis. Clin Infect Dis. 23 janv 2021;72(1):69‑78.

Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 Diabetes and its Impact on the Immune System. Curr Diabetes Rev. 12 mai 2020;16(5):442‑9.

Muscogiuri G, Pugliese G, Laudisio D, Castellucci B, Barrea L, Savastano S, et al. The impact of obesity on immune response to infection: Plausible mechanisms and outcomes. Obes Rev. juin 2021;22(6):e13216.

Fédération Internationale du Diabète [Internet]. [cité 1 mars 2025]. République démocratique du Congo. Disponible sur: https://idf.org/fr/our-network/regions-and-members/africa/members/democratic-republic-of-congo/

Diabète et nutrition saine Fédération Internationale du Diabète [Internet]. [cité 1 mars 2025]. Disponible sur: https://idf.org/fr/about-diabetes/diabetes-management/healthy-nutrition/?utm_source=chatgpt.com

Diabète et alimentation au quotidien : les fondamentaux [Internet]. [cité 1 mars 2025]. Disponible sur: https://www.ameli.fr/assure/sante/themes/diabete-adulte/diabete-vivre-quotidien/equilibre-alimentaire/diabete-alimentation-fondamentaux

CARE [Internet]. [cité 1 mars 2025]. Health sector in DRC crumbles amidst conflict negatively impacting survivors of sexual assault. Disponible sur: https://www.care.org/media-and-press/health-sector-in-drc-crumbles-amidst-conflict-negatively-impacting-survivors-of-sexual-assault/

UNDP [Internet]. [cité 1 mars 2025]. PDL 145-T : Pour un meilleur accès à des soins de santé de qualité dans le milieu rural. Disponible sur: https://www.undp.org/fr/drcongo/actualites/pdl-145-t-pour-un-meilleur-acces-des-soins-de-sante-de-qualite-dans-le-milieu-rural

Yu XL, Zhou LY, Huang X, Li XY, Wang MK, Yang JS. Role of nutrition in diabetes mellitus and infections. World J Clin Cases [Internet]. 26 janv 2025 [cité 1 mars 2025];13(3). Disponible sur: https://www.wjgnet.com/2307-8960/full/v13/i3/94389.htm

L’alimentation de la personne vivant avec le diabète | Diabète Québec [Internet]. [cité 1 mars 2025]. Disponible sur: https://www.diabete.qc.ca/le-diabete/la-gestion-du-diabete/alimentation/lalimentation-de-la-personne-diabetique/?utm_source=chatgpt.com

Chaubey GK, Modanwal R, Dilawari R, Talukdar S, Dhiman A, Chaudhary S, et al. Chronic hyperglycemia impairs anti-microbial function of macrophages in response to Mycobacterium tuberculosis infection. Immunol Res. août 2024;72(4):644‑53.

Turina M, Fry DE, Polk HC. Acute hyperglycemia and the innate immune system: Clinical, cellular, and molecular aspects: Crit Care Med. juill 2005;33(7):1624‑33.

Inserm [Internet]. [cité 1 mars 2025]. Le diabète responsable d’immunodépression • Inserm, La science pour la santé. Disponible sur: https://www.inserm.fr/actualite/diabete-responsable-immunodepression/

Berrou J, Fougeray S, Venot M, Chardiny V, Gautier JF, Dulphy N, et al. Natural Killer Cell Function, an Important Target for Infection and Tumor Protection, Is Impaired in Type 2 Diabetes. Ahlenstiel G, éditeur. PLoS ONE. 25 avr 2013;8(4):e62418.

Lee H, Kim MJ, Lee IK, Hong CW, Jeon JH. Impact of hyperglycemia on immune cell function: a comprehensive review. Diabetol Int. oct 2024;15(4):745‑60.

Manuels MSD pour le grand public [Internet]. [cité 1 mars 2025]. Complications du diabète sucré - Troubles hormonaux et métaboliques. Disponible sur: https://www.msdmanuals.com/fr/accueil/troubles-hormonaux-et-métaboliques/diabète-sucré-ds-et-troubles-du-métabolisme-de-la-glycémie/complications-du-diabète-sucré

Esposito K, Nappo F, Marfella R, Giugliano G, Giugliano F, Ciotola M, et al. Inflammatory Cytokine Concentrations Are Acutely Increased by Hyperglycemia in Humans: Role of Oxidative Stress. Circulation. 15 oct 2002;106(16):2067‑72.

Charlot A, Boumiza R, Roux M, Zoll J. Obésité, inflammation et COVID-19 : intérêt préventif de l’alimentation cétogène ? Biol Aujourd’hui. 2021;215(1‑2):63‑72.

Kacem A, Ben Ahmed I, Berriche O, Jamoussi H, Ben Ammar I, Mnif S, et al. P194 Prévalence et facteurs prédictifs de la néphropathie diabétique chez le diabétique type 2. Diabetes Metab. mars 2008;34:H94.

Belkacem S. Les particularités de l’hypertension artérielle chez le patient diabétique. 2023;2.

Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 1 nov 2022;45(11):2753‑86.

Nutrition and Food Safety [Internet]. [cité 1 mars 2025]. Disponible sur: https://www.who.int/teams/nutrition-and-food-safety/overview

Pauvreté alimentaire de l’enfant | UNICEF [Internet]. [cité 1 mars 2025]. Disponible sur: https://www.unicef.org/fr/rapports/pauvrete-alimentaire-de-l-enfant?utm_source=chatgpt.com

Réduction des inégalités au service de la sécurité alimentaire et de la nutrition.

3.2 L’urbanisation a une incidence sur les systèmes agroalimentaires, et engendre des défis et des possibilités au regard de l’objectif qui consiste à assurer l’accès à une alimentation saine et abordable [Internet]. [cité 2 mars 2025]. Disponible sur: https://www.fao.org/3/cc3017fr/online/state-food-security-and-nutrition-2023/urbanization-affects-agrifood-systems.html

apollo247 [Internet]. [cité 2 mars 2025]. Barriers to Diabetes Care In Low-Income Communities. Disponible sur: https://www.apollo247.com/blog/article/barriers-to-diabetes-care-in-low-Income-communities

Khatun MM, Rahman M, Islam MJ, Haque SE, Adam IF, Chau Duc NH, et al. Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference? Public Health. mai 2023;218:1‑11.

Tang PL, Yuan WL, Tseng HF. Clinical Follow-Up Study on Diabetes Patients Participating in a Health Management Plan. J Nurs Res. déc 2005;13(4):253.

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Published

2025-03-31

How to Cite

MORISHO, L., Charles, B. A. ., Serge, C. M. ., Elie, B. K. ., morisho, mwala ., & Bertin, K. M. . (2025). A MIXED COHORT STUDY ON DIETARY ADHERENCE, INFECTION PREVENTION, AND GLYCEMIC CONTROL AMONG DIABETIC PATIENTS IN SOUTH KIVU, EASTERN DEMOCRATIC REPUBLIC OF THE CONGO . Student’s Journal of Health Research Africa, 6(3), 10. https://doi.org/10.51168/sjhrafrica.v6i3.1620

Issue

Vol. 6 No. 3 (2025): March 2025 Issue

Section

Section of Community and Public Health Research

License

Copyright (c) 2025 Dr Mulakwa Morisho Lambert, Dr Bamavu Amisi Charles, Dr Chirimwami Muganda, BAHOGWERHE KASHENGULA Elie, MWALA MORISHO Benoit, Prof. Kipindula Morisho Berti

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