Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Rafael Pérez-Escamilla

Abstract

Background: In Tanzania, limited healthcare infrastructure and reliance on invasive diagnostic methods significantly hinder effective diabetes screening and management. Individuals with diabetes often go undetected and have lower immune systems that make them prone to further infectious complications. Thus, properly managing this chronic condition can prevent additional infectious diseases. Salivary glucose testing offers a non-invasive, innovative alternative with the potential to transform the early detection and management of diabetes, especially in resource-constrained settings.

Design: This cross-sectional study, conducted at Muhimbili National Hospital's Diabetes Clinic in Dar es Salaam, evaluates the feasibility of salivary glucose testing using a colorimetric glucose-oxidase-peroxidase point-of-care method. The primary goal is to assess its potential as an alternative tool for type 2 diabetes mellitus (T2DM) screening and to evaluate its capacity for equitable use based on its acceptability and user satisfaction. Over five weeks, data were collected from 201 patients to address three key objectives: 1) analyze current diabetes care through surveys, 2) evaluate the acceptability and satisfaction of salivary glucose testing among individuals with diabetes, and 3) compare the diagnostic sensitivity of salivary glucose testing with traditional blood-based methods.

Methods: Adult patients with T2DM were recruited from the Department of Endocrinology. All patients completed demographic and diabetes management surveys before performing supervised self-collection of saliva samples using a colorimetric glucose test strip. The test employed a glucose oxidase-horseradish peroxidase reaction, producing color changes corresponding to four glucose concentration categories: ‘low’, ‘normal’, ‘high’ and ‘extremely high’. Concurrent finger-prick blood glucose measurements were obtained for comparison. Post-test surveys evaluated user experience and preferences. The analysis included descriptive statistics, Fisher's exact tests, ANOVA with Tukey's post-hoc tests, Markov Chain Monte Carlo (MCMC) modelling to refine cutoffs, and geospatial mapping of healthcare accessibility.

Results: Among 201 patients (53% female, 47% male, predominantly aged 50-64), 94.5% reported positive experiences with salivary testing, and 93% preferred this method over blood-based alternatives. Salivary glucose measurements demonstrated significant differentiation between glycemic ranges, with median finger-prick values of 131.4, 166.3, 217.8, and 310.5 mg/dL across the four colorimetric categories (p<0.05). MCMC modelling established data driven refined cutoff points: <141.8 mg/dL (borderline diabetes), 141.8-288.3 mg/dL (moderately high), 288.3-480.5 mg/dL (very high), >480.5 mg/dL (extremely high). Geospatial analysis revealed a 60% preference for salivary testing among patients from high-elevation regions with limited healthcare access, identifying potential implementation opportunities in underserved areas.

Conclusion: Salivary glucose testing demonstrated high patient satisfaction and moderate clinical alignment with blood glucose readings. Its non-invasive nature, ease of self-administration, and broad acceptability suggest that it may offer a practical and equitable strategy to improve diabetes screening and care in underserved Tanzanian communities. Further validation and technical refinement are needed to optimize implementation.

Comments

This is an Open Access Thesis.

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