Diabetes in Sub Saharan Africa 1999-2011: Epidemiology and public health implications. a systematic review

Abstract

BackgroundDiabetes prevalence is increasing globally, and Sub-Saharan Africa is no exception. With diverse health challenges, health authorities in Sub-Saharan Africa and international donors need robust data on the epidemiology and impact of diabetes in order to plan and prioritise their health programmes. This paper aims to provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa.MethodsWe conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact.ResultsType 2 diabetes accounts for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Proportions of patients with diabetic complications ranged from 7-63% for retinopathy, 27-66% for neuropathy, and 10-83% for microalbuminuria. Diabetes is likely to increase the risk of several important infections in the region, including tuberculosis, pneumonia and sepsis. Meanwhile, antiviral treatment for HIV increases the risk of obesity and insulin resistance. Five-year mortality proportions of patients with diabetes varied from 4-57%. Screening studies identified high proportions (> 40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient.ConclusionDiabetes exerts a significant burden in the region, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high mortality and prevalence of complications observed. The significant interactions between diabetes and important infectious diseases highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.

Diabetes care and complications in primary care in the Tshwane district of South Africa

“…In sub-Saharan Africa diabetes care and costs have to compete with anti-retroviral drugs, tuberculosis treatment and malaria control programmes. (3,4) Also, as far back as 1980 a Tanzanian research project carried out by Mhando and Yudkin stated that "there is no indication that the African diabetic is less vulnerable to complications of the disease, a fact which has become apparent with better follow-up". (5) Various studies conducted in South Africa, Nigeria, Ghana, Cameroon and Tanzania and others, as well as review articles on diabetes in Africa, confirm both the increase in prevalence and the changing epidemiology of diabetes complications.…”

“…(5) Various studies conducted in South Africa, Nigeria, Ghana, Cameroon and Tanzania and others, as well as review articles on diabetes in Africa, confirm both the increase in prevalence and the changing epidemiology of diabetes complications. (3,4,(6)(7)(8) The Burden of Disease study group (9) estimated in 2000 that 5.5% of South Africans aged ≥ 30 years had diabetes, and that 4.3% of all deaths in South Africa were due to diabetes. Furthermore, 14% of ischaemic heart disease, 10% of stroke, 12% of hypertensive disease and 12% of renal disease were attributable to diabetes.…”

Reasons for diabetes patients attending Bishop Lavis Community Health Centre being non-adherent to diabetes care

“…1 Unhealthy lifestyle is an important contributor to the rising prevalence of diabetes, with type 2 diabetes accounting for well over 90% of diabetes in sub-Saharan Africa. 2 Hearnshaw and Lindenmeyer identified and categorised definitions and measurements of adherence in diabetic patients. They identified five categories, which include coincidence of behaviour with professional advice; relationship as part of the process of care; outcome and process targets; taking the medication as prescribed; and others.…”

Important co-morbidity in patients with diabetes mellitus in three clinics in Western Kenya

“…10 However, these results are similar to those in many other countries in sub-Saharan Africa, where patients receive less than optimal care for their diabetes. 11,12 Despite the generally poor diabetes control in this population, a third of our patients were on insulin therapy, and our clinics used HbA1c testing, indicating reasonable access to diabetes management tools.…”