Use of Medical Services and Medicines Attributable to Diabetes in Sub-Saharan Africa

Abstract

BackgroundAlthough the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be done.MethodsTo ascertain recent use of medical services and medicines and other information about the impact of ill-health, we in 2008–2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs) and 1,770 matched comparison subjects (MCs) without diabetes in Cameroon, Mali, Tanzania and South Africa. We sampled DMs from diabetes registries and, in Cameroon and South Africa, from attendees at outpatient diabetes clinics. To recruit MCs, we asked subjects with diabetes to identify five persons living nearest to them who were of the same sex and approximate age. We estimated diabetes impact on medical services use by calculating ratios and differences between DMs and MCs, testing for statistical significance using two-stage multivariable hurdle models.FindingsDMs consumed 12.95 times more days of inpatient treatment, 7.54 times more outpatient visits, and 5.61 times more medications than MCs (all p<0.001). DMs used an estimated 3.44 inpatient days per person per year, made 10.72 outpatient visits per person per year (excluding traditional healers), and were taking an average of 2.49 prescribed medicines when interviewed.ConclusionsIn Sub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed diabetes is much greater than in industrialized countries and in China. Published calculations of the health-system impact of diabetes in Africa are dramatic underestimates. Although non-communicable diseases like diabetes are commonly thought to be minor problems for health systems and patients in Africa, our data demonstrate the opposite.

Direct and indirect costs of diabetes mellitus in Mali: A case-control study

“…The study was completed in Mali and was part of a larger study performed in four Sub-Saharan African countries–Cameroon, Mali, Tanzania, and South Africa–and described in detail elsewhere [9]. …”

Global and regional estimates and projections of diabetes-related health expenditure: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

“…The availability of economic data on diabetes is heavily skewed towards high-income countries. Among low-income countries relatively recent (within the last 10 years), data exist on diabetes-related health expenditures for Bangladesh [20], Mali [21,22], Pakistan [23], Sri Lanka [24], Sudan [25] and Sub-Saharan Africa [26]. In Iran (classified by the World Bank as an upper-middle income country), in a prospective, case control population-based study diabetes-related health expenditures totalled USD 10,627 million (in 2004) -about 5.5% of total Iranian healthcare expenditure with a value of R of 2.92 [27].…”

“…Further information (and its practical use) are particularly needed where diabetes prevalence is increasing, and national and individual incomes are low [28]. Such information as does exist suggests that incremental use of medical care associated with diabetes is much greater in Sub-Saharan Africa (and, presumably, also in other low-income countries) than in industrialized countries [26]. In Mali, the expense associated with type 2 diabetes mellitus treatment is ''beyond reach for many patients, particularly when there are complications" [22].…”

Use of medical services and medicines attributable to type 2 diabetes care in Yaoundé, Cameroon: a cross-sectional study

“…Also, in a multi-centric study in Africa including Cameroon and 3 other countries (Mali, Tanzania and South Africa), the overall proportions were also as high as in Cameroon; the proportions from people with T2D were 90.5% for outpatient visits, 4.9% for inpatient visits, 94.8% for ongoing medication; compared to 15.4, 1.1 and 26.6% respectively for people without diabetes [12]. …”