Diabetes self-care intervention strategies and their effectiveness in Sub-Saharan Africa: A systematic review

Abstract

Background Diabetes poses a significant public health challenge, predominantly affecting low-and middle-income countries (LMICs), including in Sub-Saharan Africa (SSA). The evolving landscape characterized by resource constraints, gaps in availability and functionality of healthcare system, and socio-demographic impediments has compounded these challenges. As an example, self-care interventions have played a crucial role in diabetes care. However, the effectiveness of these interventions in the SSA remains insufficiently explored. Therefore, this systematic review evaluated the effectiveness and implementation approach of diabetes self-care interventions in SSA. Method A comprehensive search was conducted across electronic databases including PubMed, Scopus, and Google Scholar, to identify studies focusing on diabetes self-care interventions in SSA from 2013 to 2023. The included studies reported interventions targeting dietary adherence, physical activity, medication adherence, blood glucose monitoring, foot care, and educational or support programs. The quality of the studies was assessed using the JBI checklist. Effectiveness was assessed through outcomes including glycemic control, adherence rate, complication reduction, and improvement in patient outcomes. Result Overall, 38.5% of interventions result showed positive changes in either primary or secondary outcomes. Studies that employed diabetes self-management education showed positive changes in approximately 28.6% of cases. However, SMS text messaging interventions did not demonstrate significant changes in the measured outcomes. Of the 13 studies reviewed, 12 used randomized controlled trial designs, whereas one study employed a quasi-experimental approach. The total of participants across intervention and control groups was 3172 adults with diabetes. The interventions employed various strategies including diabetes self-management education led by nurses and other professionals, SMS text messaging for treatment adherence, and other targeted approaches. The duration of these interventions varied from 2 to 12 months. Specific interventions, such as glucose machine provision with training, family support with culturally tailored educations, and periodontal treatment, exhibited notable improvement in adherences and reductions in HbA1c levels. Conclusion The review underscores the significance of diabetes self-care interventions in SSA, showing varying effectiveness levels across different strategies. It emphasizes the importance of tailored approaches and highlight interventions that have shown promising outcomes, providing insights for future research, policy, and healthcare strategies in the region.