Retention in care for type 2 diabetes management in Sub‐Saharan Africa: A systematic review

Abstract

Objective: Diabetes prevalence has risen rapidly in Sub-Saharan Africa, but rates of retention in diabetes care are poorly understood. We conducted a systematic review and meta-analysis to determine rates of retention in care of persons with type 2 diabetes. Methods: We searched MEDLINE, Global Health and CINAHL online databases for cohort studies and randomised control trials (RCTs) published up to 12 October 2021, that reported retention in or attrition from care for patients with type 2 diabetes in Sub-Saharan Africa. Retention was defined as persons diagnosed with diabetes who were alive and in care or with a known outcome, while attrition was defined as loss from care. Results: From 6559 articles identified, after title and abstract screening, 209 articles underwent full text review. Forty six papers met the inclusion criteria, comprising 22,610 participants. Twenty one articles were of RCTs of which 8 trials had 1 year or more of follow-up and 25 articles were of non-randomised studies of which 19 had 12 months or more of follow-up. A total of 11 studies (5 RCTs and 6 non-randomised) were assessed to be of good quality. Sixteen RCTs were done in secondary or tertiary care settings. Their pooled retention rate (95% CI) was 80% (77%, 84%) in the control arm. Four RCTs had been done in primary care settings and their pooled retention rate (95% CI) was 53% (45%, 62%) in the control arm. The setting of one trial was unclear. For non-randomised studies, retention rates (95% CI) were 68% (62%, 75%) among 19 studies done in secondary and tertiary care settings, and 40% (33%, 49%) among the 6 studies done in primary care settings. Conclusion: Rates of retention in care of people living with diabetes are poor in primary care research settings.

Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey

“…This finding does not comport with low health system spending and quality of care challenges in sub-Saharan Africa. 2 , 49 , 50 Higher confidence in sub-Saharan Africa could be due to highly visible recent investments in health systems (eg, large increases in the number of health facilities) that were made from a lower starting point than in high-income countries. 51 Rapid health investments have been linked to population trust in Nepal and China.…”

Implementation of Kidney Biopsy in One of the Poorest Countries in the World: Experience from Zinder Hospital (Niger)

“…The average age of patients was 35 years, with extremes of 5 and 68 years. The most represented age group was [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], making up 48.33% of the cohort. This average age was lower than that reported in studies conducted by Ben Salem et al in Tunisia in 2020 (45 years old) [11] or in a study carried out in a military hospital in Morocco (44 years old) [12], with a standard deviation of 16 and 15 years, respectively.…”

“…However, there were big disparities across Africa, i.e., the pooled prevalence of both overweight and obesity across the five geographical areas in Africa ranged from 56.9% in East Africa to 88.5% in Southern Africa [33]. In addition, a recent systematic review has demonstrated that the rates of retention in care of people living with diabetes are poor in sub-Saharan countries [34].…”

Transfers between health facilities of people living with diabetes attending primary health care services in the Western Cape Province of South Africa: A retrospective cohort study

“…However, healthcare systems in LMIC have developed to address acute health problems, and provision of care for people with NCDs including for people living with diabetes (PLD) is suboptimal [7][8][9]. In many LMIC including South Africa, levels of retention in care among PLD are low and, among those in care, few are controlled on treatment [10][11][12][13]. Poor outcomes are largely due to the episodic and unstructured care currently provided in LMIC and strategies to improve the provision of long-term, continuous care in these settings is required.…”