Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review

Abstract

Background Effective health systems are needed to care for the coming surge of diabetics in sub-Saharan Africa (SSA). Objective We conducted a systematic review of literature to determine the capacity of SSA health systems to manage diabetes. Methodology We used three different databases (Embase, Scopus, and PubMed) to search for studies, published from 2004 to 2017, on diabetes care in SSA. Results Fifty-five articles met the inclusion criteria, covering the different aspects related to diabetes care such as availability of drugs and diagnostic tools, the capacity of healthcare workers, and the integration of diabetes care into HIV and TB platforms. Conclusion Although chronic care health systems in SSA have developed significantly in the last decade, the capacity for managing diabetes remains in its infancy. We identified pilot projects to enhance these capacities. The scale-up of these pilot interventions and the integration of diabetes care into existing robust chronic disease platforms may be a feasible approach to begin to tackle the upcoming pandemic in diabetes. Nonetheless, much more work needs to be done to address the health system-wide deficiencies in diabetes care. More research is also needed to determine how to integrate diabetes care into the healthcare system in SSA.

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

“…We did not perform a systematic review since there have been an appreciable number of recent publications, including systematic reviews, discussing ongoing research in this area and its implications including current prevalence rates, health system concerns, as well as possible policies and ways to improve future care (Brouwer et al, 2015;Agyemang et al, 2016;Hill et al, 2017;Jaam et al, 2017;Pastakia et al, 2017;Issaka et al, 2018;Nuche-Berenguer and Kupfer, 2018;Owolabi et al, 2018;Stephani et al, 2018;Wagnew et al, 2018;Asmelash and Asmelash, 2019;Farmer et al, 2019;Manne-Goehler et al, 2019;Mapa-Tassou et al, 2019). In addition, a number of the references, especially regarding ongoing national activities, are typically only available on the Internet as some of these have only just been launched.…”

“…to demonstrate the need for strategies to improve guideline adherence and to assess their impact in practice (Igbojiaku et al, 2013;Mukanu et al, 2017;Pastakia et al, 2017;SEMDSA, 2017). There have also been strategies to improve access and availability of medicines (Sandoz -A Novartis Division, 2015;Meyer et al, 2017;Nuche-Berenguer and Kupfer, 2018;Shannon et al, 2019;Rockers et al, 2019), as well as strategies to improve the monitoring and follow-up of patients including advice on the doses of medicines prescribed (Pastakia et al, 2015;Morris-Paxton et al, 2018;Chang et al, 2019). However, such activities are not universal across Africa.…”

“…This includes appraising key issues associated with co-morbidities with infectious diseases such as HIV and the resultant implications. There have been a number of systematic reviews looking at key issues surrounding the management of patients with diabetes in Africa including initiatives to strengthen healthcare systems (Brouwer et al, 2015;Atun et al, 2017;Hill et al, 2017;Issaka et al, 2018;Jaam et al, 2017;Nuche-Berenguer and Kupfer, 2018;Ong et al, 2018;Owolabi et al, 2018;Stephani et al, 2018;Wagnew et al, 2018;Asmelash and Asmelash, 2019;Manne-Goehler et al, 2019). We are also aware of the recent NCD research conference for Africa to share evidence and identifying research priorities (Juma et al, 2019).…”

Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

“…(28) The scarcity and inadequacy of decision aids is a common phenomenon to most sub-Saharan Africa countries (4,32). It is obvious from these findings that there is a need for collective initiatives from different stakeholders to make appropriate decision aids available to facilitate empowerment of patients and ultimately their participation in their care.…”

Effectiveness of task-shifting for the detection of diabetic retinopathy in low- and middle-income countries: a rapid review protocol.

“…15 There is some evidence of the successful use of task-shifting in SSA in other health fields including diabetes. 16,17 However, it is not clear whether task-shifting interventions for the detection of DR in LMICs results in an increase in the uptake of screening and higher DR detection rate.…”