Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network

Osafo, Charlotte; Raji, Yemi Raheem; Olanrewaju, Timothy Olusegun; Mamven, Manmak; Arogundade, Fatiu A.; Ajayi, Samuel; Ulasi, Ifeoma; Salako, Babatunde Lawal; Plange‐Rhule, Jacob; Mengistu, Yewondwossen; McLigeyo, Seth O.; Moturi, George; Winkler, Cheryl A.; Moxey-Mims, Marva; Rasooly, Rebekah S.; Kimmel, Paul L.; Adu, Dwomoa; Ojo, Akinlolu; Parekh, Rulan S.

doi:10.1016/j.kint.2015.12.059

Cited by 26 publications

(16 citation statements)

References 9 publications

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“…103 When factors such as hypertension, HIV, genetic predisposition, and diabetes are combined, as is often the case, renal damage is likely to be accelerated. 104 In fact, the average age of onset of end-stage renal disease in sub-Saharan Africa is estimated to be 20 years younger than that in HICs. 104…”

Section: The Lancet Diabetes and Endocrinology Commissionmentioning

confidence: 99%

“…104 In fact, the average age of onset of end-stage renal disease in sub-Saharan Africa is estimated to be 20 years younger than that in HICs. 104…”

Section: The Lancet Diabetes and Endocrinology Commissionmentioning

confidence: 99%

“…100,164 Additionally, many parts of sub-Saharan Africa have no nephrologists at all (Kenya has one per 2 million population and South Africa has just over one per million), 101 and dialysis is unaffordable to many patients. 104 See the appendix 1 for examples of successful initiatives in sub-Saharan Africa for diabetic retinopathy and diabetic foot disease.…”

Section: The Lancet Diabetes and Endocrinology Commissionmentioning

confidence: 99%

See 2 more Smart Citations

Diabetes in sub-Saharan Africa: from clinical care to health policy

Atun

Davies

Gale

et al. 2017

The Lancet Diabetes & Endocrinology

383

432

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Key message 2: diabetes and its consequences are costly to patients and economies We estimate that, in 2015, the overall cost of diabetes in sub-Saharan Africa was US$19•45 billion or 1•2% of cumulative gross domestic product (GDP). Around $10•81 billion (55•6%) of this cost arose from direct costs, which included expenditure on diabetes treatment (eg, medication, hospital stays, and treatment of complications), with out-of-pocket expenditure likely to exceed 50% of the overall health expenditure in many countries. We estimate that the total cost will increase to between $35•33 billion (1•1% of GDP) and $59•32 billion (1•8% of GDP) by 2030. Putting in place systems to prevent, detect, and manage hyperglycaemia and its consequences is therefore warranted from a health economics perspective. Key message 3: health systems in countries in sub-Saharan Africa are unable to cope with the current burden of diabetes and its complications By use of information from WHO Service Availability Readiness Assessment surveys and World Bank Service Delivery Indicator surveys and the local knowledge of Commissioners, we found inadequacies at all levels of the health system required to provide adequate management for diabetes and its associated risk factors and sequelae. We found inadequate availability of simple equipment for diagnosis and monitoring, a lack of sufficiently knowledgable health-care providers, insufficient availability of treatments, a dearth of locally appropriate guidelines, and few disease registries. These inadequacies result in a substantial dropoff of patients along the diabetes care cascade, with many patients going undiagnosed and with those who are diagnosed not receiving the advice and drugs they need. We also noted scarce facilities to manage the microvascular and macro vascular complications of diabetes. Additionally, despite calls for adding the care of diabetes and other cardiovascular risk factors onto existing infectious disease programmes (such as those for HIV), we found little evidence that such combined programmes are successful at improving outcomes.

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Section: The Lancet Diabetes and Endocrinology Commissionmentioning

confidence: 99%

“…104 In fact, the average age of onset of end-stage renal disease in sub-Saharan Africa is estimated to be 20 years younger than that in HICs. 104…”

Section: The Lancet Diabetes and Endocrinology Commissionmentioning

confidence: 99%

Section: The Lancet Diabetes and Endocrinology Commissionmentioning

confidence: 99%

See 1 more Smart Citation

Diabetes in sub-Saharan Africa: from clinical care to health policy

Atun

Davies

Gale

et al. 2017

The Lancet Diabetes & Endocrinology

383

432

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show abstract

“…Interestingly, heightened ethnic susceptibility to develop nephropathy and its faster progression have been reported in South Asians compared with Whites. Similarly, those with African ancestry have an approximate 2‐fold higher risk for end‐stage renal disease, and onset two decades earlier, compared with Whites. The prevalence of peripheral neuropathy and peripheral vascular disease is high in developing countries.…”

Section: Burden Of Complicationsmentioning

confidence: 99%

Diabetes in developing countries

Misra

Gopalan

Jayawardena

et al. 2019

Journal of Diabetes

196

129

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Highlights• Diabetes in developing countries is increasing and often undiagnosed. In South Asians, diabetes and related metabolic abnormalities develop at a younger age and at a lower body mass index and waist circumference than in Whites. • Overall glycemic control and management of diabetes is suboptimal, driven by multiple factors (eg, unawareness, cost of drugs and insulin etc.), and the load of complications is high. • To stem this epidemic, strong actions for prevention and management are required using innovative and low-cost approaches. AbstractThere has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro-and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.

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“…28 This initiative has produced 382 trainees and 219 publications. 28 While primary results from the H3Africa projects for the study of complex disease traits have not yet been published, they are poised to make substantial contributions to increasing diversity in genomic research given the following enrollment numbers: a study of over 10,000 individuals for cardiometabolic disease risk (AWI-GEN), 29,30 a study of 6000 T2D cases and 6000 controls (H3Africa T2D Study), 31 a study of kidney disease (n = 4000 cases and 4000 controls) (H3Africa Kidney Disease Research Network), 32 a study of 3000 stroke cases and 3000 controls (SIREN), 33 a study of over 11,000 women on Human Papilloma Virus and cervical cancer risk (African Collaborative Center for Microbiome and Genomics Research), 34 and a combined resource for cardiovascular studies with over 30,000 35 CAAPA, 110 NeuroGAP-Psychosis, 36 All of Us, 23 and the GWAS Catalog 10 .…”

Section: Insights Into Human Biologymentioning

confidence: 99%

Evaluating the promise of inclusion of African ancestry populations in genomics

2020

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The lack of representation of diverse ancestral backgrounds in genomic research is well-known, and the resultant scientific and ethical limitations are becoming increasingly appreciated. The paucity of data on individuals with African ancestry is especially noteworthy as Africa is the birthplace of modern humans and harbors the greatest genetic diversity. It is expected that greater representation of those with African ancestry in genomic research will bring novel insights into human biology, and lead to improvements in clinical care and improved understanding of health disparities. Now that major efforts have been undertaken to address this failing, is there evidence of these anticipated advances? Here, we evaluate the promise of including diverse individuals in genomic research in the context of recent literature on individuals of African ancestry. In addition, we discuss progress and achievements on related technological challenges and diversity among scientists conducting genomic research.

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Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network

Cited by 26 publications

References 9 publications

Diabetes in sub-Saharan Africa: from clinical care to health policy

Diabetes in sub-Saharan Africa: from clinical care to health policy

Diabetes in developing countries

Evaluating the promise of inclusion of African ancestry populations in genomics

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