Prajwal Gyawali

Routinely tested biochemical and haematological molecules in the management of diabetes control, including glycated haemoglobin (HbA1c) evaluation, are related to estimated whole blood viscosity (eWBV), which is an indicator of diabetic rheology pathology. Examination of the molecules control could establish their value for clinical laboratory-based cardiovascular risk assessment. The study investigated changes in full blood count (FBC) parameters and lipid profiles with eWBV and HbA1c. The predictiveness of FBC parameters for eWBV and HbA1c is explored. This was a laboratory-based observational study that used mixed-methods analyses. Cross-sectional, longitudinal, descriptive, correlation, and regression approaches were applied to archived clinical pathology data from two health facilities, including a dataset of N = 21,026. Results: Lipid profile molecules significantly change with the level of HbA1c (p < 0.001). The levels of eWBV and its determinant molecules also change with HbA1c, and with seasonal variations (p < 0.001). Considering the predictiveness of FBC parameters for HbA1c and eWBV levels, red blood cells (RBC) and their indices, i.e., haemoglobin molecules, show statistical significance. For instance, RBC most strongly predicted HbA1c (r = 0.30) and was highest for eWBV (r = 0.54), while mean cell volume (MCV) showed strongest inverse correlation with HbA1c (r = −0.47). Conclusion: This study demonstrates that routine FBC parameters, RBC and its indices, offer a practical, low-cost approach to both monitoring and prediction of HbA1c with blood flow issues. This broadens the understanding of blood rheology in diabetes. Future research should move beyond de-identified laboratory datasets and involve patients’ primary data collection to include medication and clinical information that are unavailable in pathology records.

Background: Routine full blood count (FBC) testing is part of the haematological workup in diabetes management. There is limited information regarding the contributions of individual haematological parameters to regression models for glycated haemoglobin (HbA1c), estimated whole-blood viscosity (eWBV) and the resulting blood viscosity complications. Importantly, because association and prediction represent distinct concepts, this study extends previous work with a focus on comparative and exploratory relationships. The objective was to compare FBC parameters between higher and lower HbA1c and eWBV groups and identify variables contributing to the Akaike Information Criterion (AIC)-based regression model among diabetics. Methods: This laboratory-based mixed quantitative study involved cross-sectional and regression analyses. Fifteen parameters were evaluated, including the following: red blood cell count (RBC) and indices (MCV, MCH, MCHC); platelet count and derived ratios (PRR, PWR, RPR); and white blood cell count (WBC) with lymphocyte ratios (MLR, NLR, PLR). HbA1c and eWBV data were used to create dichotomous subgroups for univariate comparison, followed by exploratory AIC-based model identification of variables. Results: HbA1c, RDW, MCV, and RPR, differed significantly between HbA1c groups (p < 0.1). Regression analysis identified RDW, MCV, RPR, MCH and RBC as contributors to the HbA1c model. For eWBV, five out of seven parameters (HCT, HB, RBC, WBC, and MLR) showed a significant association. Conclusions: These findings highlight haematological parameters with potential values for future predictive model development. Overall, the study supports the usefulness of selected FBC variables as adjuncts in diabetes monitoring with potential utility in understanding glycaemia control and blood viscosity-related complications.

Introduction: Blood viscosity is elevated in diabetes and is inversely related to blood flow. The pathology evidence base associated with blood stasis, namely hematocrit and serum total protein levels, is negatively correlated with age, but affordable pathology tests for blood stasis remain underutilized in clinical medicine practice. This study is intended to evaluate changes in estimated whole blood viscosity (eWBV) with age and gender, as an index of blood stasis and its associated indices of hematocrit and serum total protein levels. Method: This was a clinical laboratory observational retrospective study involving 10 years of pathology data. Three clinical medicine parameters, including eWBV, hematocrit and proteinemia, were compared in stratified age groups. Data were those monitored for HbA1c (N = 21,021). Statistical analysis included univariate (ANOVA) and multivariate (MANOVA) as well as correlation. Results: Average levels of proteinemia, hematocrit and eWBV were different in stratified age groups, and lower in females compared to males. MANOVA analysis shows a significant difference in the three clinical medicine parameters between the younger adults and the elderly (p < 0.001). Age and eWBV are inversely correlated, but this may be negligible with diabetes (r = −0.17). Discussion: There are age-related and gender differences in the pathology evidence base that underpins blood viscosity. The implication of lower blood viscosity in women and the elderly is a higher risk of bleeding. The potentially higher risk of bleeding with increasing age is contrary to the concern for thrombosis, which means that antiplatelet prophylaxis among the elderly may be confounded.

Background/Objective: The risk of bleeding is part of blood flow pathophysiology in diabetes mellitus (DM), and there may be potential for the relationship between blood cell indices and estimated whole blood viscosity (eWBV) in DM. However, red blood cell (RBC) indices, platelet ratios, and lymphocyte ratios have been part of routine haematology tests in clinical medicine including diabetes management. This study investigated two research questions. Firstly, how does eWBV correlate with RBC indices, platelet ratios, and lymphocyte ratios? Secondly, which parameters of RBC in routine full blood count (FBC) correlate more with glycated haemoglobin (HbA1c) changes? Methods: This was a laboratory-based clinical observational cohort study using secondary data from ongoing research. Data collected included FBC and biochemistry (HbA1c and serum protein level). Dependent variables were platelet and lymphocyte ratios as well as eWBV. Results: Averages for all parameters in the cross-sectional data were within normal range, except high HbA1c (7.67%) and marginally high monocyte-to-lymphocyte ratio. In the periodic cohort analysis, only RBC distribution width showed a significant difference (p < 0.04) between cohort groups, but least correlated with HbA1c changes. Further analysis for correlations among change scores showed that RBC had the strongest positive linearity for HbA1c (r = 0.30) and among the top three for eWBV (r = 0.54), while mean cell volume (MCV) has the strongest inverse for HbA1c (r = −0.47). Conclusions: The ongoing clinical use of RBC variables is superior to profiles of platelet and/or lymphocyte ratios in assessing the potential risk of bleeding (i.e., hypo-viscosity) in diabetes.

Background: Non-communicable diseases (NCDs) disproportionately affect low- and middle-income countries, including Ethiopia. However, community health workers’ (CHWs’) capacity in NCD health promotion is sometimes limited. Aim: This study aimed to co-design a contextually appropriate intervention with and for CHWs to support their NCD health promotion services. Setting: This co-design study was conducted in Gondar City, northwest Ethiopia. The workshops were held in the meeting hall at the University of Gondar. Methods: A qualitative participatory action research design, guided by the PRODUCES (Problem, Objective, Design, User, Co-creators, Evaluation, and Scalability) framework, was employed. Sixteen participants, including CHWs (n = 6), community-dwelling adults with (n = 3) and without NCD diagnoses (n = 3), and health system managers (n = 4) were recruited using convenience and purposive sampling. Participants attended three workshops. In workshop 1, participants discussed the roles of CHWs in health promotion and areas for improvement. Workshop 2 focused on intervention components and delivery approaches. A draft of the intervention was reviewed during workshop 3. Discussion notes and artefacts were thematically analysed in NVivo. Results: A 6-week, multicomponent intervention, ‘Empower Community Health’, was co-designed. Key themes included: (1) knowledge capacity building, (2) personal behaviour change, and (3) community-outreach initiatives. Proposed intervention topics included: (1) learning about NCDs; (2) skill motivational interviewing; and (3) behaviour change for diet and physical activity. Conclusion: The involvement of intervention users and stakeholders allowed for the sharing of experiences and fostered ownership in the ‘Empower Community Health’ programme. Contribution: The meaningful engagement of stakeholders ensures that the intervention is tailored to their needs, fosters ownership and enhances intervention buy-in. This study provides practical guidance for future co-designed health promotion programmes.

Elevation in the level of whole blood viscosity (WBV) is a known contributor to cardiovascular risk. Moreover, cardiovascular diseases are associated with seasonal variation and the potential impact of seasonal changes on blood viscosity, and associated biomolecules pose substantial cardiovascular risk and are therefore a subject of interest. To evaluate the effect of seasonal changes on whole blood viscosity, glycated haemoglobin and associated biomolecules, namely haematocrit and serum total protein, and their implications on management of diabetic cardiovascular risk are explored. This was a clinical laboratory retrospective observational study involving 10-year pathology data (1999–2008) which estimated whole blood viscosity (eWBV) and the associated biomolecules, namely haematocrit and serum total protein. Comparisons were made between seasonal changes and glycated haemoglobin, whole blood viscosity, haematocrit, and serum total protein levels. Whole blood viscosity, haematocrit, and serum total protein levels increased with colder seasons (p < 0.001), peaking in the winter. However, the seasonal variation in the level of glycated haemoglobin did not achieve statistical significance. Blood viscosity fluctuates between seasons, with peaks occurring in the winter season. This fluctuation will assist in adjusting monitoring and treatment strategies of diabetic risks seasonally. In addition, recognition of seasonal variations will help in precise risk assessment of timely interventions to mitigate the risk of cardiovascular events in diabetes management.

Background: The relationship between glycaemia and the variables of haematocrit, serum total protein and lipids possibly plays a role in pathological processes and hence is a subject of interest. Estimated blood viscosity causes impaired blood flow and is a factor in other vascular diseases. Blood viscosity is correlated with glycated haemoglobin, but the mechanism of this association has not been extensively investigated. Objective: To assess if changes in glycated haemoglobin translate into changes in blood viscosity through impact on haematocrit, serum protein or dyslipidaemia. Method: This was a clinical laboratory-based retrospective data analysis of patients attending a diabetic clinic. Analysis involved seven variables comprising serum total protein level, high-density lipoprotein cholesterol, total cholesterol, triglyceride, age and glycated haemoglobin. The statistical evaluations were descriptive, comparative and correlational. Results: A total of 12,986 sets of data represented the participants in this study. After excluding three with incomplete data of interest, the groups that were created for comparison comprised the following: good glycaemic control (2694), moderate glycaemic control (4075) and poorly controlled (6194). Serum levels of high-density lipoprotein cholesterol, total cholesterol, haematocrit and proteinaemia gradually decreased with worsening glycaemic control, while serum triglyceride and age increased. In the correlation analysis, serum triglyceride level was positively correlated with glycated haemoglobin r = 0.177, while haematocrit and proteinaemia were negatively related, at −0.045 and −0.103, respectively. Conclusions: Increase in glycated haemoglobin was inversely related to haematocrit and proteinaemia; therefore, this did not always increase with the determinants of estimated whole blood viscosity. The implication of this is that further studies are required to substantiate the observation of higher whole blood viscosity levels in patients with poorly controlled diabetes.

Introduction: Physical inactivity is a major global public health concern, increasing the risk factor of non-communicable diseases (NCDs) and mortality. The WHO has initiated the Global Action Plan on Physical Activity to reduce global physical inactivity by 15% by 2030. Rapid urbanisation and insufficient physical activity in the Global South have significant implications for public health, leading to increased NCDs. Understanding physical inactivity and related risk factors among adults is essential in addressing the growing NCD epidemic. This study aims to estimate the pooled prevalence of physical inactivity and its associated risk factors among adults in Eastern African countries. Methods and analysis: This review protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (2020) Guideline. A comprehensive search will be conducted using the CoCoPop (condition, context, population) frameworks to include all observational studies published from 1 January 2010 to 31 October 2024. Databases such as PubMed, Scopus, Embase, CINAHAL, Web of Science, Science Direct and Google Scholar will be searched. Studies with citations without an abstract or full text and qualitative studies will be excluded. The Joanna Briggs Institute critical appraisal tool will be used to assess the quality of each study. The heterogeneity of studies will be quantified using the I ² statistic, and a fixed-effects or random-effects model will be used for the pooled analysis. Publication bias will be assessed using visual (funnel plot) and statistical methods. The study countries will be the basis for subgroup analysis, and sensitivity analysis will be used to see how one study’s results may affect the estimate as a whole. Ethics and dissemination: Ethical approval is not required for this systematic review. The results will be disseminated through peer-reviewed publications and conference presentations. Furthermore, this systematic review and meta-analysis will be used to generate comprehensive and robust evidence for public health interventions. PROSPERO registration number: CRD42024567592

Existing effective treatments for ischemic stroke restore blood supply to the ischemic region using thrombolysis or mechanical removal of clot. However, it is increasingly recognized that successful removal of occlusive thrombus from the large artery—recanalization, may not always be accompanied by successful restoration of blood flow to the downstream tissues—reperfusion. Ultimately, brain tissue survival depends on cerebral perfusion, and a functioning microcirculation. Because capillary diameter is often equal to or smaller than an erythrocyte, microcirculation is largely dependent on erythrocyte rheological (hemorheological) factors such as whole blood viscosity (WBV). Several studies in the past have demonstrated elevated WBV in stroke compared with healthy controls. Also, elevated WBV has shown to be an independent risk factor for stroke. Elevated WBV leads to endothelial dysfunction, decreases nitric oxide-dependent flow-mediated vasodilation, and promotes hemostatic alterations/thrombosis, all leading to microcirculation sludging. Compromised microcirculation further leads to decreased cerebral perfusion. Hence, modulating WBV through pharmacological agents might be beneficial to improve cerebral perfusion in stroke. This review discusses the effect of elevated WBV on endothelial function, hemostatic alterations, and thrombosis leading to reduced cerebral perfusion in stroke.

Community health workers, also known as health extension workers (HEWs), play an important role in health promotion. This study evaluates HEWs’ knowledge, attitude, and self-efficacy for non-communicable diseases (NCD) health promotion. HEWs (n = 203) completed a structured questionnaire on knowledge, attitude, behaviour, self-efficacy and NCD risk perception. Regression analysis was used to determine the association between self-efficacy and NCD risk perception with knowledge (high, medium, low), attitude (favourable/unfavourable) and physical activity (sufficient/insufficient). HEWs with higher self-efficacy were more likely to have high NCD knowledge (AOR: 2.21; 95% CI: 1.21. 4.07), favourable attitude towards NCD health promotion (AOR: 6.27; 95% CI: 3.11. 12.61) and were more physically active (AOR: 2.27; 95% CI: 1.08. 4.74) than those with lower self-efficacy. HEWs with higher NCD susceptibility (AOR: 1.89; 95% CI: 1.04. 3.47) and perceived severity (AOR: 2.69; 95% CI: 1.46, 4.93) had higher odds of NCD knowledge than their counterparts. Moreover, sufficient physical activity was influenced by HEWs’ perceived NCD susceptibility and perceived benefits of lifestyle change. Therefore, HEWs need to adopt healthy lifestyle choices to become effective role models for the community. Our findings highlight the need to include a healthy lifestyle when training HEWs, which might increase self-efficacy for NCD health promotion.